I am thankful for the opportunity to speak on the Bill. While it is welcome, it is not what the Government committed itself to in the last general election, nor is it what it promised in the programme for Government. The programme for Government in 2011 stated: "Universal primary care will remove fees for GP care and will be introduced within the Government's term of office." That programme for Government was revised less than 12 months ago and the commitment was reiterated as follows: "We remain committed to the introduction of a universal GP service for the entire population as part of universal health insurance, in line with the programme for Government." However, we now find that this is not going to be the case and, in fact, that policy, if it is ever introduced, will apparently take a further three years to happen, and we are not even sure of that. What we do know is that it has been delayed for three years and, at the earliest, will be introduced by 2019.
In addition, the Bill is not in compliance with what thousands upon thousands of the over-70s demonstrated for during the term of the last Government outside these buildings. They were addressed by the current Taoiseach and the then leader of the Labour Party, Deputy Gilmore, who promised the over-70s that their medical cards, which were being withdrawn by the Fianna Fáil-Green Government, would be restored. They were told they would revert to a situation where they had full medical card cover for GP services, hospital services, primary care and medication services. What happened is that this Government not alone did not do that, but it significantly reduced the income limits for over-70s from €1,400 per week when it came into office to €900 per week now, which is a huge reduction. What is now clear is that the current Taoiseach, the former leader of the Labour Party and their members were simply playing politics with elderly people at that stage.
Part of the difficulty with introducing this type of legislation for particular groups is that other groups are left out and find themselves placed in a very difficult situation. One of the groups that comes to mind is the 65-69 year old age group. Such people come to my office on a daily basis, as I am sure they come to the offices of every Oireachtas Member. The vast majority of these people have retired and are in receipt of State pensions but they are not covered by this legislation. Many of them will have only a very small occupational pension as they may have worked for the local authority, the health board or the council, or for a company which had an occupational pension scheme. Some who have pensions of as little as €10 or €20 per week find themselves over the income guidelines for medical cards and are in a situation where they are not covered because the medical card limits are completely out of date, given the last review of these limits was in 2006. To give an indication of the figures, the income limit is €298 per week for a couple aged 66 years and over. If a couple of that age group has a small occupational pension of, say, €10 per week, they will be over the limit and will not be covered for the card. That is the kind of thing that happens when selective groupings are introduced in regard to primary care and GP services.
It is important also to revisit the whole area of medical card applications and the granting of medical cards. There is no doubt that even after all of the difficulties that arose in regard to medical cards being withdrawn, or reduced from full cards to GP cards, many people with serious and chronic illnesses are not able to get cards.
While the situation may have improved slightly, there has been no significant improvement. From the point of view of medical card applicants, centralisation has been a dismal failure. We should consider organising the application system and processing of cards on a local basis. It is currently taking ten days for applicants to be registered on the central system. If one sends in an application today and calls the centre within ten days, one will be told one's application has not been received and is not on the system.
Another issue is that there is absolutely no filtering of applications on a medical basis at the initial stages. People have very serious illnesses that are flagged on the application form or by an individual or public representative, but there is no filtering. I am dealing on an ongoing basis with someone who has a very serious illness. The person sent in an application and found it was not on the system for ten days. In the particular case, the person had a cancer diagnosis. There is no way of fast tracking such applications which is simply unacceptable. If those applications were processed on a local basis, the situation could be dealt with very quickly. The worry for applicants like that is significant. They are already worried about their medical condition and now they are also worried about whether they will receive a medical card, if it has been lost in the post or whatever. There needs to be some filtering of applicants by way of medical illness at the earliest stage of the applications process.
It is vitally important that there is a contact person for public representatives, in particular, in the PCRS to whom we could speak. In the current system, applications can be sent on an Oireachtas line, but there is no individual to whom a public representative or advocate can speak, explain a situation or speed up the process, thereby ensuring that the medical card office does not need to send letters to applicants who do not apply, something which happens on a regular basis. I ask that the entire applications process be examined. It is not working well and it would be much better if it operated on a local basis.
From time to time, I and many other Deputies have raised the matter of GPs charging for bloods. It is happening on a daily basis. Following many representations, a system was put in place whereby medical card holders who are charged for the taking of bloods can receive a refund by applying through the PCRS. While that is all very fine, as the Minister, who is a medical practitioner, knows, there is a doctor-patient relationship and the majority of patients are not happy to use that system because it interferes with the relationship. I hope that any arrangements or agreements made with GPs under this Bill would ensure that medical card holders will not have to pay upfront for the taking of bloods and will be entitled to the service. The Minister and his predecessor have said people are fully entitled to have their bloods taken free of charge. They have told GPs that, but it needs to be clear in any contract in the future that it will not be legal to charge for the taking of bloods. While the refund system is in place, many patients feel uncomfortable about using it and do not claim refunds.
The fair deal scheme has been very difficult over the past 12 months, with long delays of 16 weeks before and 11 weeks after Christmas. It is to be hoped that with the new injection of funds this will change and it will take four or five weeks to process and award fair deal scheme funding. There is widespread unease among the elderly population and their families about a recent report on "Prime Time", where it was indicated that one option for the future would be further cost increases for those availing of the scheme. The report referred to increasing the threshold for savings and the number of years of payback on family homes and assets. It also suggested that there may be a change in the scheme whereby an elderly person who receives 20% of his or her social welfare income would have his or her income reduced. There was a suggestion that there might be a charge for other community-based services for the elderly. All of that gives rise to considerable difficulty, worry and concern for elderly people and their families.
We need to urgently address rural GP practices across the country. It is now clear that it is becoming more difficult for them to continue when a GP retires. It was an issue recently in my constituency, Tipperary South. Some initiatives will need to be put in place to ensure that it is attractive for GPs to locate in rural areas, something which is not currently the case. Difficulties in filling vacancies in rural practices are becoming more common.
I refer to the urgent necessity for community intervention teams to be put in place. As the Minister knows, such teams mean that services can be provided for people in their own homes, thereby avoiding the necessity of costly admission to hospital services.
Their purpose is to provide services to people in their own homes, thus obviating the need for costly hospital services. The teams are in place in some areas and they represent an effective and cost-effective method of ensuring people can remain in their homes for as long as possible and ensuring they do not have to take up very costly beds in general hospitals.
While the legislation is welcome, it is certainly not what we were promised or what was committed to in the programme for Government. It is certainly not what the elderly were promised by the current Government, including the Taoiseach.