I welcome the Minister of State, Deputy Alex White.
Health (Alteration of Criteria for Eligibility) Bill 2013: Second Stage
Question proposed: "That the Bill be now read a Second Time."
The maintenance of health services is a priority in 2013 for the Government, despite the need for significant and difficult financial savings in the health area. In the context of the very difficult financial circumstances in which the State has found itself in recent years, it is the Government’s intention that front-line health services will be protected to the greatest extent possible.
As part of budget 2013, over €13.6 billion in current funding has been made available to the Health Service Executive for the provision of services. This amount represented an increase of €150 million over and above the original expenditure targets for 2013. However, despite the extra funding provided, just over €750 million in savings have to be made during 2013. This represents a major challenge for the health service. The budget strategy has been to achieve savings through efficiencies and re-organisation under the public service agreement, curtailing the growing cost of pharmaceuticals and increasing income generation. The aim of this budgetary strategy is, as far as possible, to cut the cost of services, not the services themselves.
For example, we have focused on reducing the cost of the State’s drugs bill. Key actions being taken to achieve this include the following: the Health (Pricing and Supply of Medical Goods) Bill 2012 which is before the Dáil will introduce a system of reference pricing and generic substitution for prescribed drugs and medicines; the HSE has established a clinician–led, multidisciplinary medicines management programme, which will bring forward a series of measures to promote more cost-effective prescribing practices by GPs and consultants; and pricing deals have been agreed with the Irish Pharmaceutical Healthcare Association, IPHA, and the Association of Pharmaceutical Manufacturers in Ireland, APMI, which are estimated to generate combined gross savings in excess of €120 million in 2013.
For the health sector as a whole, budget 2013 set out a wide range of savings that were required, which are made up of the following: a €323 million reduction in the cost of primary care schemes; €308 million in pay-related savings; €65 million in increased generation of income by public hospitals; €60 million in net savings on the Department’s Vote; €20 million savings on procurement; and €5 million in other savings. Nonetheless, the achievement of €781 million in savings in 2013 remains difficult. The majority of savings have been designed not to impact on front line activity. However, we have previously acknowledged that it has been necessary to take a number of difficult measures in order to ensure that the most vulnerable are protected.
The General Medical Service, GMS, scheme is comprised of the GP service and prescription drugs, as well as some other services, where such services are provided for holders of medical cards or GP-visit cards. In recent years there has been a significant expansion in the GMS scheme. At the end of 2007, there were 1.28 million medical cards. By the end of 2012, there were 1.85 million medical cards in circulation. This represents an increase of almost 600,000 cards, or about 45%, over a five-year period.
The total cost of the GMS scheme is about €2 billion per year. At the end of 2012, there were approximately 1,986,000 qualifying people under the GMS. Medical cards make up the majority of this number, amounting to about 93% of the total. Medical cards for persons aged 70 years and over account for about 360,000 individuals or about 20% of all medical cards. The total cost of services provided for over-70s medical cardholders is approximately €750 million per year, which represents about 38% of the total cost of the GMS scheme.
Under the Health Act 2008, special eligibility rules applying to persons aged over 70 years were put in place, which are more generous than those applying to the standard means-tested medical cards. Under the 2008 framework, a single person over 70 with a gross income of up to €700 per week, equivalent to about €36,000 per year, qualifies for a medical card. A couple over 70 with a gross income of up to €1,400 per week, equivalent to about €72,000 per annum, also qualify for a medical card.
It is estimated that there are approximately 370,000 people aged over 70 in the State. Given that there are about 360,000 medical cards issued to people aged over 70, medical card coverage of the over-70s population is about 97%. By comparison, the medical card coverage of the under-70s population is about 35%. Last December, as part of budget 2013, two inter-related changes to the over-70s eligibility arrangements were announced to deliver €12 million in savings during 2013 from the €750 million expenditure on over-70s medical cards. First, the income limit for an over-70s medical card is to be reduced.
Second, people who no longer qualify for a medical card will continue to receive a free GP service. In addition, they will qualify under the drugs payment scheme, DPS, to have some of the cost of their prescription drugs met by the HSE.
More specifically, the income limit for an over-70s medical card is to be reduced to €600 per week, equivalent to approximately €31,000 per year, for a single person. For a couple, the income limit for the over-70s medical card is to be reduced to €1,200 per week, equivalent to gross income of approximately €62,000 per year.
As I stated, those who no longer qualify for an over-70s medical card will qualify for an over-70s GP visit card. A single person over 70 with a gross income of up to €700 per week, equivalent to approximately €36,000 per year, continues to qualify for unlimited GP care. A couple over 70 years old with a gross income of up to €1,400 per week, equivalent to approximately €72,000 per year, also continue to qualify for unlimited free GP care. In addition, under the DPS, the HSE will meet the prescription drug costs of the people concerned in excess of the DPS threshold of €144 per month.
It is estimated that approximately 20,000 people will have their medical card replaced with a GP visit card under the new income rules. Therefore, it is important to note that approximately 95% of the over-70s population will not be affected by the new rules. A total of 92% of the over-70s population that have already qualified for a medical card will continue to have a medical card. The 3% of over-70s who did not qualify heretofore for a medical card will continue not to have either a medical card or a GP visit card. The 5% of over-70s who did qualify for a medical card will now qualify for a GP visit card instead.
The new legislation is very focused and narrow in that it is only meant to affect a small proportion of people aged over 70, namely, single individuals earning more than €31,000 per year and couples earning more than €62,000 per year. Again, it is important to reiterate, to avoid any confusion, that approximately 95% of the over-70s population will not be affected by the new rules. I do not seek to minimise the effect of the changes on the small minority of persons affected by the new income rules. However, they will continue to receive free GP care and their expenditure on prescription drugs will be capped under the DPS. As a result, these new arrangements will limit the expenditure on prescription drugs of an individual earning €600 per week or a couple earning €1,200 per week to less than €34 per week.
The Civil Partnership and Certain Rights and Obligations of Cohabitants Act was passed in 2010 to introduce certain rights and obligations for civil partners and cohabitants. It is important that these rights and obligations are also reflected in the legislation relating to over-70s medical cards and the new over-70s GP visit cards. The necessary amendments to achieve this are also included in the Bill to ensure spouses, civil partners and cohabitants are treated in a similar manner.
A primary objective of public service reform is to integrate services with a view to providing better services for citizens and greater efficiency for the State. Inter-agency co-operation among public bodies at national and local level is one of the key pillars to the achievement of the objective. The legislation will facilitate the exchange of personal data between the HSE and the Revenue Commissioners and the Department of Social Protection with a view to ensuring public services are delivered as efficiently as possible to those who have an entitlement to such services.
One of our intentions under the new over-70s arrangements was to avoid having to unnecessarily contact as many over-70s individuals as possible or to limit the number of over-70s we were required to contact. Contacting all over-70s would be a very wasteful and time-consuming task, as well as disturbing for the individuals themselves, especially given that 95% of the over-70s population are unaffected by the new rules. One of the benefits of greater co-operation between the HSE and the Revenue Commissioners is that the HSE will be able to prioritise contacts with higher income over-70s medical card holders. However, the exchange of personal information is more general than just the changes to the over-70s arrangements. The prevention of fraud and abuse of the health service is an important element of the work of the HSE, even more so in a time of severely limited resources. One of the most effective and efficient ways of targeting cases for review is to electronically match data from other relevant Departments and public bodies against the HSE’s computer systems. The purpose of that is to identify people who may be holding a medical card to which they are not entitled.
It is very important to be clear that in carrying out such data exchange exercises under these provisions, the HSE is obliged to comply with its responsibilities to protect the rights and privacy of individuals in accordance with the Data Protection Acts 1988 and 2003. The rights and privacy of individuals continue to have the protection of the Data Protection Acts, even in the event of the Bill being enacted. The Office of the Data Protection Commissioner has made clear that a public organisation such as the HSE that collects, stores, or processes any personal data must obtain and process the information fairly; keep it only for one or more specified, explicit and lawful purposes; use and disclose it only in ways compatible with these purposes; keep it safe and secure; keep it accurate, complete and up to date; ensure it is adequate, relevant, and not excessive; retain it for no longer than is necessary for the purpose or purposes; and give a copy of his or her personal data to an individual, on request. Therefore, the proposed data exchange provisions and the data exchange agreements they allow build on the existing data protection framework. They are entirely in line with the existing data protection framework. In addition, the proposals were developed by the Department in full consultation with the Office of the Data Protection Commissioner.
It is a Government priority during 2013 that health services are to be maintained despite the need for significant and difficult financial savings in the health area. The majority of savings have been designed not to impact on front-line activity. However, it has been necessary to take a number of difficult but targeted measures, such as this proposal, to ensure the most vulnerable continue to be protected. I commend the Bill to the Seanad and look forward to hearing the views of the Senators.
As always, I welcome the Minister of State, Deputy Alex White, back to the House. It is good to see him. I know he is working very hard in the Department. The Bill is hardly one the Minister of State would regard as a great achievement. It is, clearly, one we cannot support.
In 2009, when the universality of the over-70s medical card went under the microscope, the Government of the day was rightly condemned in terms of the elderly people who were affected. Fine Gael Members will be aware of the words of their colleague, now Minister, Deputy Reilly, who at the time was rightly apoplectic with anger. It was probably mentioned in the other House as well that the people who were going to lose as a result of the legislation – at the time more generous criteria were being introduced – were those who made this country what it is today. He said they raised us, nursed us when we were sick, protected us from violence, grew our food and ran a proud Civil Service. In defending the current Government, people criticise me for having amnesia at times. I have no difficulty responding to them. The legislation shows there is an epidemic of amnesia in the Cabinet room.
The Minister of State highlighted the figures in terms of who will be affected. The spin doctors within the Labour Party headquarters or the Fine Gael headquarters should do a political benefit analysis and compare it with the income that will be generated. I accept that is a cynical approach but political parties at times do make such considerations. Let us say, for example, that €12 million will be saved. One could ask what we could have done, for example, if the proposal of the Labour Party, Fianna Fáil and other parties for a 3% increase in the universal social charge-----
Is that in the manifesto? I do not recall seeing it.
The Minister of State must not know the manifesto as well as I do. If he wants to talk about manifestos, there was a lot in the Labour Party’s manifesto and the Fine Gael manifesto.
We are dealing with the Bill.
It is a Second Stage speech. If the Acting Chairman were in the House for as long as I am, he would be aware that one can go off the subject to a certain extent.
There is a general thrust to the debate and speakers are allowed to refer generally to the subject, which is what I am doing.
The 3% universal social charge increase would have taken in hundreds of millions of euro and I am sure the Minister of State would agree that if it was his call, or that of his party, such measures could take in a significant amount of money and look after the relative security and well being of the most vulnerable, the over-70s who, regardless of income, are distressed. They are being told that although they have a medical card that does not expire until 2016, after the passage of this legislation, if they are a couple of euro above the income threshold they will get a GP only card despite the fact that they must pay for medication every month. For €12 million it is unnecessary.
The Minister of State mentioned manifestoes. The Labour Party manifesto and the programme for Government both promise universal health care. We still have not seen a White Paper on that and this Bill will do nothing for universal health care. When in opposition, the Minister for Health said the 50 cent increase on prescription charges would stop people from going to the GP for a prescription but he has since trebled the charge to €1.50 and the threshold for medical cards is being reduced. Although only a small percentage will lose out entirely, following the Minister's own logic, we are focusing on people who are not in a position to deal with this sort of hit and who do not deserve it. These are the people who raised us, nursed us, fed us and grew crops for us.
There was a cut in child benefit and the mobility grant is being abolished. There were legal issues with that but to cut the grant unilaterally without having a replacement for a period created unnecessary uncertainty. Now there is this but there is no sign of the free GP care or universal health care. There seems to be calamity after disaster after catastrophe for the Minister for Health generally with the haphazard management of the health service.
As Senator Henry knows, in Sligo a consultant dermatologist had moved from England to take up the position in the hospital. Due to creative accountancy within the HSE or the Department, €10 million has been taken from the hospital; therefore, there is not enough money to keep the lights on never mind to appoint a dermatologist. Consultants in neurology, epilepsy and other areas were promised under the clinical programmes but there is no money to appoint them. The Minister was in Sligo last week to open a road but there was no announcement on the funding for these positions. In the final analysis, the people will pay the price. The existing consultant broke ranks last week to say he cannot take GP referrals because prioritising would be a lottery and waiting lists in Sligo generally were three years, while in Letterkenny, for which he is also responsible, the waiting list is five years. That is far from the window dressing we see with special delivery units.
One wonders what this will achieve for the sake of €12 million. I would much prefer to see an increase in something like the universal social charge where we would be talking about hundreds of millions of euro. Those who were on higher incomes expected the hit in the last budget and they would not mind making an additional contribution to secure the health of the most vulnerable and the elderly.
We know it is Government policy to abolish the Seanad. If that succeeds, no Minister will have to come in here to defend himself or herself or answer difficult questions on legislation, but from this legislation, it appears it will not even been necessary to go the Dáil to change the criteria for income. The Minister made the point in the other House that it was linked to the consumer price index.
That is what it says.
I appreciate that but it does not have to be done by way of legislation. The Minister can change the criteria for eligibility without coming before the Oireachtas. It is a bad precedent because, increasingly, as a result of the Whip system and the fact that the Oireachtas is a mere tool of the Cabinet of the day, we are now passing legislation to remove the troublesome necessity of having to bring legislation before the Houses. We can do the deal on Merrion Street and we will not even to consult the parliamentary party meetings, which can be difficult from time to time; we can just plough ahead and make things up as we go along without any public scrutiny.
We will be tabling some amendments tomorrow, if they remembered to put them in for us yesterday, and we will engage on some of the sections. The Minister of State is always welcome here as a colleague and friend but we cannot go along with him on this one because for €12 million, it is a step too far and it is unnecessary. There were other options which the Labour Party is well aware of, having tried to get the 3% universal social charge over the line. That was not to be, as reflected in the general theme of a particular election leaflet in Meath East yesterday.
I welcome the Minister of State to the House. I also welcome the announcement by the Minister for Health that the proposal to destroy the Guthrie heel prick test cards is being scrapped.
It is important we realise where we are coming from when looking at the current criteria. A single person is entitled to a medical card while earning up to a maximum of €700 per week or €36,400 per annum, and a couple is entitled to earn €72,800 per annum, or €1,400 per week. The current State pension is €230 per person per week, a total of €11,960 per annum. People earning three times as much as those on the State pension are entitled to medical cards as things stand. We are talking about a slight reduction in real terms, reducing the income for a single person down to €31,200 per annum and the income for a married couple down to €62,400 per annum. Those with an income up to that figure will be entitled to a medical card while those with an income greater than that will be entitled to a GP visit card. All services are not being withdrawn. If people spend more than €144 per month, they are entitled to apply to the drug refund scheme. The incomes limits will still be 2.5 times more than the State pension. The alterations are minor.
People talk constantly about the promises made during the election.
Although we never promised to provide an additional 251,000 medical cards and general practitioner visit cards, that is exactly what we have done since entering government.
That is because people lost their jobs.
If the Senator gives me a little space, I will deal with that issue.
I look forward to that.
Last year alone, we gave an additional 165,000 medical cards and GP visit cards.
Medical cards are not gifts from the Government. The Senator should provide some context.
The Senator is correct that the increase in the number of medical cards is a reflection of the decline in people's incomes. In the past two years, the Government has acted in a caring manner by ensuring people have an entitlement to access the services they require. Some tweaking and tidying up is needed in health care and the Bill proposes only a small change. The figures for 2012 show that we were issuing approximately 14,000 medical cards per month, a significant number that reflects the Government's commitment to ensure people on low incomes have access to health care.
Senator MacSharry referred to delays in the health service. The Hanly report of 2003 recommended increasing the number of consultants to 3,600 by 2012. The current figure of 2,500 consultants is 1,100 short of the target. However, in light of the change in the country's financial position, it will be difficult to implement the recommendations set out in the report.
I welcome the decision to bring the rules pertaining to cohabitants into line with the provisions of the Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010. Income is not calculated on the basis of gross income, for instance, in calculating net rental income allowances are made for certain expenses. I presume the property tax is regarded as an expense. Perhaps the Minister will clarify this matter as the Bill is a little unclear in this regard. Having said that the Bill has been carefully drafted to ensure income received from redress payments or compensation payments made as a result of an accident is not taken into consideration when calculating a person's net income.
The health service presents many challenges and many issues need to be tackled. I refer specifically to the cost of drugs, an issue in which I have taken an interest in recent months. The efforts being made by the Department in this regard are not insufficient. The Sunday Business Post and other media outlets have reported on the costs of medication, which were also the subject of a recent report by the Consumer Association of Ireland. Susan Mitchell in The Sunday Business Post noted price differentials for medicines between Ireland and other European Union member states, with some items costing 25 times more here than in the United Kingdom. Domestic price comparisons show major variations in the price of drugs in different pharmacies in the same town or city. We must carefully examine this issue.
In 2000, the State spent €574 million on drugs. By 2010, this figure had increased to €1.894 billion, an increase of 230%, and I understand it is set to exceed €2 billion this year. The Department should set a target for reducing expenditure on drugs as it is a major element of the health budget. It would not be unreasonable to set a target of reducing the drugs bill by 25% or €500 million. This would necessitate addressing the problem of over-prescribing. I spoke recently to a person who had worked and lived in England for some years and expressed astonishment at the much higher rate of prescribing here than in the UK. While medication is very important, its overuse can have negative long-term effects, such as increasing immunity to the treatments being prescribed. We must work on this issue in the next 12 to 24 months.
While I am open to correction, I understand 90% of all income tax revenue is allocated towards meeting the cost of health care. A further 14 Departments must be funded from income tax revenues. We need to reduce costs in the health service without reducing the level of service. The Minister, Department and Health Service Executive have an important task in ensuring we obtain value for money for health care expenditure in the next ten years.
I, too, extend a warm welcome to the Minister of State. It is important to reflect on how one gets into a problem. The Brennan commission, of which I was a member, examined this issue. When we embarked on the process of issuing medical cards to everyone aged 70 years and over, it was estimated that 39,000 people would be eligible for the new card at a projected cost of €19 million. It subsequently transpired, however, that 77,000 people were eligible for the cards. Clearly, the Department needs a health economist.
The medical cards for the elderly scheme was doomed from the beginning. It was not only that it amounted to a political promise to secure the votes of the elderly but that the Department did not know how many people of a certain age were living in the State. I found this failure impossible to believe at the time because the Central Statistics Office can provide information on the number of people in the various age categories. Professor Niamh Brennan's report was critical of the Department's mistake, which demonstrates the need for the Department to engage in proper appraisals and analysis.
I agree with Senator Colm Burke on the need to secure a much better deal on drugs. Susan Mitchell of The Sunday Business Post, the journalist to whom the Senator referred, has been flying this flag. She cites Mr. Paul Bell of SIPTU who noted not only that we pay too much for medicines but that pharmacists receive secret discounts of up to 90%. The key benchmark used by the "Today with Pat Kenny" programme and in other forums is usually how much cheaper drugs are in Spain than Ireland. When the drugs industry argues that prices here are reasonable because Ireland is in a particular zone, I must ask what zone Spain is in and where does free trade in the European Union enter the equation? Why can the drug companies supply medicines at much lower prices in other countries?
The Sunday Business Post and an International Monetary Fund report have found that our hospital bed night costs are twice the OECD average and twice those of Germany and Canada, two countries that enjoy the triple A credit rating that the Government is working hard to get back. In addition, the Milliman report on health insurance notes that treatments that would take 3.7 days on the basis of worldwide best practice take on average 11.6 days in Ireland. Closing this gap could give rise to savings of a couple of thousand euro per bed night.
We have to ensure that the people from whom medical cards are being taken, those who remain in the medical card system, the taxpayer and the Department get good value for the money being spent.
The Minister of State only mentioned it in passing but we must take cognisance of the fact that we passed legislation here to open up the GMS market to new graduates and perhaps we will be given an update on how that is progressing. I am concerned about a section in this Bill that appears to be sliding back from that. It was an IMF requirement under the bailout agreement because that organisation has expressed concern about the high cost of the Irish health service compared with the cost in some of the countries which are bailing us out. What savings could be made from opening up the GMS market? I came across some figures published in the Irish Examiner on 29 September 2011. The article refers to GPs earning over €750,000 from the medical card scheme. I will not mention any names here but there was one doctor in Dublin who earned €767,000, another in Donegal who earned €754,000 and another in south Dublin who earned €718,000. A GP in Cork earned €679,000 while one in Kerry earned €569,000 and the list goes on. The summary was that 58 GP clinics earned over €500,000; 156 earned between €400,000 and €500,000; 379 earned between €300,000 and €400,000; and 615 earned between €200,000 and €300,000. Lots of new medical graduates had to emigrate last year but I am sure it was at least a possibility that some of those jobs could have been done for less than €300,000. I hope that the Department is shopping around for new graduates and not allowing local monopolists to push up the costs to the Department and to patients.
I broadly support this specific measure, albeit with the caveats I have just mentioned. The Minister of State has said that the income limit will be €700 per week for a couple. That compares with the €298 income limit for those aged between 65 and 69 and €266.50 for a couple under 65. In that sense, it has been tilted towards older people but we have a problem with universalism itself. This project was always bedevilled by the fact that we undertook it on the basis of incorrect data. To say that millionaires of a certain age are entitled to a benefit that is not available to many working people and to which those who are surviving solely on a State pension are barely entitled, was a mistake. It was a mistaken form of universalism in the first instance.
I have tabled two amendments to the Bill which we will be discussing tomorrow but, broadly speaking, as the Minister of State has said, this change has to be made. However, it does not address many of the huge problems regarding the way resources are allocated within the Irish health services, such as the drugs and hospitals bills and the lack of competition in health insurance. It does not address the question of whether local monopolists earning €600,000 or €700,000 per year from the GMS are inhibiting new doctors from providing such services instead of emigrating. Such doctors could provide a better service for patients and reduce the bill to the Exchequer.
Broadly speaking, I welcome the Bill. I know the Minister of State is new in the Department of Health and I wish him success in his role. However, there are a lot of legacy issues to be addressed in the context of this particular legislation and in the wider health service, in terms of its relatively high cost. The health service costs between 11% and 12% of gross national income. In the Scandinavian countries, which we admire so much, health service costs are between 9% and 10% of gross national income. There is an excess cost here, as documented in an article by Oliver O'Connor in the Sunday Business Post last Sunday, based on IMF data. The challenge is to get the best value for the patient and the taxpayer and to tackle many of the restrictive practices in the system. I agree with other Senators that drugs prices would be a very good place to start in that regard.
I welcome the Minister of State to the Chamber. I cannot welcome this Bill but no matter how much I dislike it, I recognise the necessity of implementing the measures contained in it. The Minister of State referred to the requirement to take €750 million from the health budget, which totals €13.6 billion. This certainly presents a challenge, especially on top of the reductions in the budget we have already seen in recent years. There is no question but that the cuts or reductions in service we are implementing will cause real difficulties for people. Unfortunately, however, there is no possibility of closing the fiscal deficit without finding cost-savings in the large-spending departmental programmes. It is as simple as that. That is the horrible reality facing the Government. In other circumstances and in normal times, we would not be doing this at all because there would be no requirement to do it. Unfortunately, here we are and this is the situation we are faced with. If members of the Opposition or anybody else have suggestions as to how we can close the deficit without taxing ourselves into oblivion, the Minister for State would be very happy to hear them, as would I and members of the Cabinet. We must be realistic in what we are attempting to do.
The Minister of State has pointed out that 97% of those over 70 will not be affected by this Bill and that the 3% who are affected will still be entitled to a doctor-visit card and will be eligible for the drug prescription scheme and many other schemes. This is a proportionate response to the issue at hand. It also recognises what could be called the enhanced health requirements that people accrue as they get older. The targeting of resources to this area is probably the most important element here.
Senator Colm Burke referred to the fact that there are 165,000 extra medical cards in the system since the Government came to office. That in itself is a recognition of the need that is out there. It is also something that is never referred to by anybody except members of the Government. Nobody in opposition will draw attention to the fact that there has been an increase in the number of medical cards issued. Members of the Opposition prefer to hark upon the decreases. Having said that, once something is given as an entitlement, it is particularly difficult to take it away, no matter how few people are actually affected.
The populist political decision to give everybody over the age of 70, irrespective of income, a free medical card was nothing short of reckless, especially as it was based on gross miscalculations. Senator Barrett referred to mistakes made at the Department of Health in this regard but the Department of Health has a political master. It is important to remind people that the Minister who made that decision in 2008 was Deputy Micheál Martin, the current leader of Fianna Fáil in the other House. Deputy Martin has form in terms of deflecting responsibility away from himself. We saw that when he blamed his officials for the fact that he had not read his brief when he was challenged about the illegal nursing home charges by members of an Oireachtas committee. He blamed one of his officials, who was moved sideways while the Minister was moved upwards. It is just remarkable that political accountability does not go both ways.
At a time of limited resources, it is very important that we target spending and direct resources to where they are needed most. Senator MacSharry has said that a saving of €12 million this year and €24 million in a full year is a small amount of money. While that is true, it also demonstrates just how well targeted this initiative is, when the sums involved are acknowledged by the Opposition to be very small. Nonetheless, the changes in this legislation will have an impact on some people. The threshold we are dealing with here is an income of €31,000 per year.
Senator MacSharry said that we are again targeting a vulnerable group of people. To accrue an income of €31,000 a year would require an investment in a pension fund of approximately €650,000, which is not a small amount of money and such an investment would not be typical of the most vulnerable people in our society. Senator Colm Burke pointed out that the annual income threshold for medical card holders below the age of 70 who are in receipt of State pensions is in the region of €11,500. Proportionately, we are not doing too badly here. We certainly cannot be charged with targeting a vulnerable cohort of our society. In the interests of fairness, such a measure is warranted under the circumstances.
Senator MacSharry has also mentioned that the Opposition is blind. Of course, the Opposition is always blind, as it is right now, because in 2008 in a vote in the other House, the Fianna Fáil-led Government voted by 81 to 74 in favour of doing exactly what we are doing here. It was in favour of it then and against it now. We were against it then and are in favour of it now. Does it not indicate how the Opposition of the country operates? It might be a debate for another day.
Senator MacSharry also mentioned amnesia. I love the splendid retrospective detachment he has from every decision made by the previous Government. He seems to have opposed every measure the previous three Governments implemented and continues to oppose. We need to congratulate him on his consistency of approach to politics. I trust his colleague, Senator Wilson, will pass that message on to him.
Certainly.
His language portrays the political opportunism at the heart of the poor decision to grant universal entitlement to a medical card to the over-70s in the first place. Of course, there was a lack of accountability after such a disastrous miscalculation was made. It is a pity Senator MacSharry did not stay to hear my witty contribution at his expense.
We suffer on his behalf.
Unfortunately, he suffers from the St. Augustine approach to cutbacks. He is not alone; all Fianna Fáil people do this.
The Senator would be well aware of what we thought.
While Fianna Fáil Members are all in favour of reducing the deficit, every time they are just one cutback away from actually supporting it. The cutback we are discussing is always the one. They claim they will support the next one, until it comes and then it will be the next again. St Augustine would be proud. Of course, we would prefer not to have to make these changes.
It is St. Jude the Government needs.
Judas.
Senator Gilroy to continue, without interruption.
The religious analogies are flying around like mad. I thank the Acting Chairman for protecting me from them. We will be supporting the measure and it is important we do so. It is a minor change to the structure and does not target the more vulnerable in our society. In a matter of fairness, it is a requirement under the circumstances and we will have more to say about it tomorrow.
Cuirim fáilte roimh an Aire Stáit. I speak from the perspective of having worked in the health service. The issue of drugs is deadly simple. The Government should pass a law to make it mandatory to use generic drugs unless there is a specific doctor-ordered exception to the rule, which will arise in virtually no cases. There is a bit of an argument brewing at the moment, which I understand, in the case of some very specialised drugs where the level of the drug in the blood is important. We have heard this argument being advanced appropriately and eloquently by those who are expert in the field of seizure disorders. In general, we should be using generics. I have been using Lipitor for almost a decade for high cholesterol and it has worked extraordinarily well. I have recently started insisting on getting generic atorvastatin calcium and while I may be leaving myself open to a charge of being unpatriotic, the next time I am outside the jurisdiction of the State, I intend on stocking up with a six month supply of it because it is so unbelievably expensive here compared with other countries.
There are many ways we can save money on the drugs bill and there are some ways we cannot. We get some new, highly innovative drugs for conditions such as cystic fibrosis and cancer where we do not have alternatives. At international level I believe there are other strategies and it is a shame we are not pursuing them during our EU Presidency because we need concerted international action on drug pricing. We are beginning to see what I believe is predatory drug pricing in the rarefied, non-competitive atmosphere when companies have ten, 15 or 20 years of patency on products for conditions surrounding which there is significant emotional cost. Cancer and cystic fibrosis are such examples. I have been involved in the development of some drugs which were expensive but where it cost a lot to develop those drugs. I have recently seen drugs with prices of €80,000 to €100,000 a year, where I know they were not that expensive to develop because the trials used to license them involved not the 15,000 patients who were involved in one set of trials in which I was involved, but 40 or 50 patients, which costs much less. This is something beyond the abilities of a small country's government to do alone, but it is certainly a debate we need to start internationally.
I believe the pharmaceutical industry was playing silly buggers with the Taoiseach and the Minister, suggesting there was some linkage between the location of its manufacturing facilities here and our decision to use generic drugs. This country appropriately has an extraordinary dependency on this wonderful sector leading to significant employment in a €40 billion industry, nearly all of the output of which is exported. The decisions about where those factories are located are not influenced by our decision to use generic drugs. Those companies will locate their plants here because of the low corporation tax and the ability of workers. It has nothing to do with what one of the smallest drug markets in the world is doing. Its local affiliates are trying to play a little game here and are trying to use a bit of emotional blackmail. I have used similar arguments with them over the years, trying to extort money for research undertakings. It is a game. The reality is that the person making the decision on locating a factory will look at the profit and loss balance sheet for what that factory will produce if it is in Ireland as opposed to Asia or eastern Europe.
What about the inefficiencies in the system? We have now had expert reports from the IMF, which is not exactly a health economist but a loan shark. The IMF wants a system that gets the IMF's money back. The IMF is like big Vinnie. When big Vinnie comes around knocking on someone's door at collection time, he just wants his money back and does not care how he gets it. The reality is we have extraordinary inefficiencies in our health system because we designed it to be that way. I do a slow burn when I hear people alleged to be health care experts and international health care consultants, who had no background in health economics or health care consulting before they became officials of the previous Government, lecturing us about the efficiencies implicit in our health system and using a system that they themselves designed.
Our hospital has one CAT scanner. An equivalently sized American hospital would probably have ten. What does that mean? It means somebody sitting in the bed waiting for a CAT scan not for that afternoon but for Wednesday week because it is cheaper to have that person sitting in a hospital for a week not having a CAT scan than it is to get him or her out very efficiently after one day and get different people on each subsequent day. That is how to deal with waiting lists and increase efficiency. It costs a little more but makes much more sense. However, the people at the top of the bureaucracy who run the health system will never see it that way and will always see it in terms of having a budget and needing to make it last. Hospitals are told that if they are great and more efficient at bringing in more patients, they will not get more money. People will inevitably be decanted onto waiting lists because they are free. That is why need to reform our system. That is why we have the worst waiting list in the world. That is why the British have the second worst waiting list in the world. It is because we follow this absurd budget-based model.
I am sorry if I sound like the same old broken record every time. The Minister of State, Deputy White, is a new victim to my wrath. It is not wrath and I wish him well. I know he will bring the zeal of a reformer to a Department that at its zenith actually has some reformers right now - reformers who are swimming in a sea of treacle to get to the side of the pool where the reform will be achieved. They just have to keep working on it.
Until we fix the fundamental structure of how we finance the health system and run the health service, until we deal with the extraordinary bureaucracy which we have allowed to build up within it and until we introduce the German model of universal health care which is available to everybody based on a freely negotiable insurance instrument where everybody goes to one tier of care, we will not reform it.
I also welcome the Minister of State, Deputy Alex White, to the House for this important debate. The Bill seeks to amend the eligibility for the medical card for people over 70 years of age. Like other speakers, I would be much happier if we did not have to address this issue but we live in very difficult times, resources are scarce and we must target them at the most needy.
A total of 40% of the population have access to GP services under the GMS scheme. It is amazing and alarming that, as of February 2013, almost 1,860,000 people or 40% of the population have medical cards. Another 130,000 or 3% of the population have a GP visit card. Due to the desire of a previous Government some years ago to guarantee re-election, medical cards were issued to all 370,000 people aged more than 70 years, irrespective of their means or income. That was not just or equitable at a time when the Government should have been targeting scarce resources at the most needy and vulnerable. Today, 360,000 or 97% of the over 70s have a medical card, whereas between 35% and 40% of the population under 70 years of age have medical cards. This legislation will still leave 92% of the over 70s with a medical card and a further 20,000 people, or 5%, will continue to receive free GP care instead of the full medical card.
This change will have no impact whatsoever on the vast majority of ordinary citizens over 70 years of age. We should not be worrying and alarming people about this. What is happening is scaremongering. People are frightened and are phoning their public representatives to inquire about their situation. In the vast majority of cases they will not be impacted.
I welcome the fact that in the past two years the Department has been corresponding with people to determine if they still require the card and if they are eligible for it. There were huge abuses of the scheme due to the failure to cross check between social welfare, the Revenue Commissioners and the Department of Health. Politicians must take some of the blame too. They were complicit in securing medical cards for people who were not eligible for them. The full facts were not being declared and medical cards were being given out like sweets. Some people appeared to be able to manipulate the system and get a medical card, while somebody with comparable means living next door was unable to get a medical card. Obviously, the full story was not disclosed by many applicants over the years.
The reality we must address today is the gap of approximately €1.2 billion per month between income and expenditure. There is no painless way of bridging that gap. However, when cuts are made we must ensure that the most vulnerable are protected and that those who are in a position to shoulder more of the burden are asked to do so. It is fair that a person with an income of over €600 per week and a couple with an income of over €1,200 per week should be treated somewhat differently from somebody on a very low income and possibly depending solely on the State old age pension. It is clear that only people who are quite well off will be impacted by these changes. However, we must be conscious of the middle income families who are really stretched to pay mortgages and educate their families. They are hit by every new tax and charge and in many cases will probably not qualify for a medical card because the gross income figure is used to assess eligibility.
I ask the Minister to keep an eye on the administration of the medical card system. Many of us have great difficulty getting answers and also in getting through the appeals system, which appears to be slow and cumbersome. I encountered a case recently in which somebody's file was supposed to have been sent from Dublin to Donegal for review, but it appeared to take almost three months before the file eventually reached its destination. The appeals system is taking too long. That must be examined.
I wish the Minister well in his efforts to achieve savings and to tackle the inefficiencies in the Department. Senator Crown gave him some very valuable advice. The Minister should examine the situation with the cost of drugs and deal with the many inefficiencies that remain within the HSE system. At a time when resources are scarce we must do everything possible to target those resources at the most needy in our society. This Bill will not impact too severely on any member of our community. I believe the modest adjustments being made will be accepted by most right thinking people who want to see the country back on its feet again, people back at work and resources being spent where they are most needed.
I welcome the Minister of State to the House. Unfortunately, my welcomes will end there. I do not support this Bill and will outline my reasons to the Minister of State. Modest adjustments are not what we were promised, incidentally. We were promised profound change. I glanced quickly through the programme for Government before this debate to remind myself of what the Government and both parties promised after the election-----
There are thousands of extra medical cards. Is that in the programme for Government?
This must be the fourth or fifth time I have got to my feet after sitting and listening to other Members without interrupting them-----
The Senator interrupted me.
----but they seem to think that is what should be done when I get to my feet. That is okay, but I will ask the Chair's indulgence to be given a few minutes to make my contribution.
Senator Gilroy mentioned the decision by the Fianna Fáil-Progressive Democrats Government to extend medical card eligibility to people over 70 years of age without a means test and described it as outrageous.
It was an outrageous miscalculation of the numbers, if the Senator is to quote me properly.
Senator Cullinane to continue, without interruption.
If he keeps it honest.
He used the word "outrageous". I am quoting the word he used.
As what confuses me goes to the heart of this Bill, perhaps the Minister will be able to help me. The Government promised universal health care, although through the private health insurance model. The programme for Government promises universal primary care, which will remove fees for GP care, and that it will be introduced within the Government's first term of office. On the one hand it says there will be free GP care for everybody, but there is no sign of it after two years in office. We have no idea when it will be introduced. The groundwork has not been done. What we see is the introduction of measures such as this, which will reduce the eligibility for free GP care for some.
They all get GP visit cards.
I am talking about the total cover.
To clarify, nobody loses access to free GP care cover as a result of this Bill. The full medical card is removed from 20,000 people but each of the people concerned will continue to have access to free GP care.
I am talking about the universal supports or the total health cover which is being removed. The point is that the Government promised people that they would have free GP care and universal health cover. That simply has not happened.
It is disappointing that the Minister for Health is not present today because he has an interesting track record on this issue, which is worth recalling for Members. Approximately ten years ago the Minister was the head of the Irish Medical Organisation's GP section.
When he held that position, he robustly opposed the decision of the Fianna Fáil-Progressive Democrats Government to extend medical cards, without means tests, to people over the age of 70. That was fair enough because that was the approach he adopted. On the other hand, however, he then negotiated a very generous deal for GPs to treat people over 70. At the time of the next general election, the Minister was Opposition spokesperson on health and he took a completely different position. He denounced from a height the decision of Fianna Fáil and the Green Party and then adopted a completely different position again and supported it. He appears to have changed his mind again and is altering the criteria for people over the age of 70 once more.
I do not believe that this sits well with the programme for Government or the reforms this Administration promised in respect of health care. I referred earlier to the commitment relating to universal primary health care. Perhaps the Minister of State might provide some indication of when the latter may become a reality. We do not believe it will emerge within the lifetime of the current Government. However, we may be proved wrong in that regard. The programme for Government states:
Access to primary care without fees will be extended in the first year to claimants of free drugs under the Long-Term Illness Scheme at a cost of €17 million.
Access to primary care without fees will be extended in the second year to claimants of free drugs under the High-Tech Drugs scheme at a cost of €15 million.
Access to subsidised care will be extended to all in the next phase.
The Minister for Health stated the first of these three goals was to be achieved in the summer of 2012. However, it has still not been realised. All of these promises were made and the Minister indicated that he would reform the system. If there was an Olympic medal for mental acrobatics, he would, in light of his track record, win it hands down. People have seen through both the Minister and the promises that were made in the context of what has been delivered in the area of health. Perhaps that is one of the reasons the Taoiseach has decided to take a more hands-on approach to health care.
Senator Gilroy referred to the Opposition being blind. The best way to judge that will be when the results of today's by-election come to hand. People's eyes have been opened. When the votes are counted tomorrow, we will see exactly who is blind and which parties are being judged to be acting blindly.
This is all about party political opportunism and populism. The Senator should acknowledge that at least.
Perhaps we might discuss that matter next week when the people have passed judgment on all parties in government and opposition.
As there are no other speakers offering, I call on the Minister of State to reply.
That happened more quickly than I expected. I thank Senators who contributed to this important and interesting debate.
Senator Cullinane of Sinn Féin and the Fianna Fáil Senators are opposing the Bill for the reasons they explained. Those are reasons on which we all have views, one way or the other. However, no one actually made a strong case against the alterations to the eligibility limits. That fact is striking. Senators are perfectly entitled to oppose the Bill for whatever reasons they see fit. I have no objection to that because it is the system within which we work. It is worthy of note that no one, including Senator Cullinane, addressed the core issue with which the Bill deals, namely, the reduction in eligibility limits, nor has anyone, either expressly or specifically, opposed that reduction.
I repeat what I said at the outset that 90% of those who are over 70 will not be affected by the proposals contained in the Bill. When Senator Cullinane was making his contribution, I offered a point of clarification and I take this opportunity to repeat what I said. Certain colleagues are seeking to convey an impression that the Bill in some way undermines - a number went so far as to suggest that it reverses - the Government's approach to universal free GP care. It does nothing of the kind. That argument simply cannot be sustained. Nobody will lose access to free GP care as a consequence of the enactment of this legislation. Anyone who loses his or her medical card on foot of the legislation will be given a free GP card. It flies in the face of both reality and the truth to suggest that the Bill will somehow give rise to a reversal. I understand the other arguments that have been put forward and I will deal with them in a moment. However, I must stress that what is involved here is not a reversal in the context of universal access to free GP care. This legislative provision is neither a reversal nor an undermining of that Government commitment. It remains an absolute commitment on the Government's part that it will extend free GP care to everyone in the community by the end of its term in office.
A number of other issues were raised by different Senators as the debate progressed. Senator MacSharry raised an issue to which reference was made in the Lower House. I know the Senator is aware that it was raised there because he made mention of that fact. The point in question is not a good one because it is not really based on fact and it does a disservice to the debate. I admire Senator MacSharry very much and I value his contribution but it is simply not true to say that the Minister for Health is being given power under this Bill to unilaterally alter the general eligibility limits relating to medical cards without having recourse to the Oireachtas. That is simply not happening. In order to clarify the position for the benefit of the House, I wish to read the provision contained in section 7(5), which states:
The Minister shall, on 1 September of every year, review the most recent information on the consumer price index made available by the Central Statistics Office, and may, with the consent of the Minister for Public Expenditure and Reform, by regulations to take effect on 1 January next following that review, increase or decrease the gross income limits specified for the purposes of this section to reflect any increase or decrease in that index.
This is a very circumscribed power that will be bestowed upon the Minister and it will be based on upward or downward changes in the consumer price index. It is designed to maintain the real value of the eligibility limits. That is all it will do. It will not extend to the Minister a unilateral power to increase or reduce eligibility limits generally. The Oireachtas has the power in that regard, which is quite right. In the case of the Bill before the House, the Oireachtas is being asked to reduce the eligibility limits. That is a power which rests with the Houses of the Oireachtas in the context of primary legislation and it will not be disturbed by anything which is being done in the Bill.
As Senator Gilroy stated, no one - least of all me or anyone else in government - takes pleasure in introducing a measure which takes away entitlements from citizens. We are endeavouring to protect the most vulnerable and to engage in the fairest possible distribution of scarce resources. Those resources are, of course, particularly scarce. I understand and appreciate that some Senators object to the Bill and may wish to oppose it. However, it should be opposed on the basis of what it actually says rather than on the basis of what people suggest it says.
A number of Senators referred to the cost of medicines. I completely agree with the emphasis that has been placed on this issue. It is important that it should be addressed. I stated in my initial contribution that it is being addressed and that the legislation on reference pricing and generic substitution, which began life in this House, has passed Committee Stage in the Lower House. Report and Final Stages of that legislation will be taken in the Dáil in early course. The legislation is extremely important and it was long called for and long spoken about. It has now been introduced by the Government and is undergoing its passage through the Oireachtas.
It meets Senator Crown's point, namely, that the default approach should be generic substitution, but there should be exceptions, for example, where a doctor indicates that substitution is not appropriate in a particular case.
We have introduced responsible prescribing initiatives, in which respect we are working with general practitioners, GPs, and consultants to ensure a more careful and focused approach to prescribing. Professionals in the field will co-operate with these initiatives.
We saw progress in our agreements with the drugs companies last year. They have had and will continue to have an effect. However, a problem remains and must be addressed. One element has seen us commission the ESRI to conduct a comparative study of the price of drugs in Ireland and among our comparators. I hope that the results of this expert study will become available to the Government in the coming weeks. People want the problem rectified, as do I. As a minimum, I want an explanation. This is a matter of considerable public interest and concern. I compliment the journalistic work done in this regard, including that of The Sunday Business Post. Debating the information openly is in the public interest.
On the opposite side of the argument, it has been suggested to me that one is sometimes not comparing apples with oranges. Other countries have different circumstances and do not permit proper comparisons. These may be legitimate arguments, but I want to put my finger on the truth. For this reason, the study will be of benefit to us in seeking to address this issue. I agree with colleagues, in that it should be addressed. It will be.
Senator Barrett referred to the opening up of the General Medical Services, GMS, scheme. He fairly acknowledged the legislation that we passed last year, relatively early in the Government's lifetime. The legislation affords more doctors the opportunity to enter the scheme. The number of participating doctors has increased as a result.
In respect of GPs' earnings and as GPs would point out to the Senator, they have already been subjected to a number of reductions in fees under the Financial Emergency Measures in the Public Interest, FEMPI, Acts. My colleague, the Minister for Health, is undertaking a FEMPI process to assess whether it is appropriate to apply further reductions to primary care fees. Certain targets were set in the Estimates process, the outcome of which we need to await. Due process is necessary in the assessment. This issue will also be addressed in early course.
I take the Senator's point on what he described in his usual, reasonably benign fashion as legacy issues in the Department and across the health service, for example, excess costs. I am aware of Mr. O'Connor's recent analysis, to which the Senator referred. Considerable progress has been made on the financial restructuring and reform of the way in which business is done and finances are managed across the system. Given what I know about the changes to practices, I am confident that we will see many results from this process.
In Senator Colm Burke's interesting contribution he discussed the basis upon which income was to be defined or assessed for eligibility limits. He raised an interesting question on whether the property tax would come into play. The provision on income from property in section 7(7) is meant to prevent an elderly person from being penalised simply because he or she owns a family home or other property, even where no rental income accrues. Where there is rental income, the costs associated with renting out the property are to be taken into account. I will not express an opinion on whether the property tax is such a cost, but there might be a question mark over whether it can be considered a cost necessarily incurred and associated with the rental of the property.
Put it up for judicial review.
Shoehorning it into this provision might be difficult. It is unlikely, but I will not express a definitive opinion on it, as it is not for me to do so.
Senator Mullins asked about the administration of the medical card system, in particular its appeals system. That Ministers repeat the global figures on the scheme's success is sometimes a source of irritation for colleagues, but I should point out that, on 18 March, 95.38% of medical cards were being processed within 15 working days.
Incredible.
The move to centralise under the Primary Care Reimbursement Service, PCRS, has had a beneficial effect on the way the system is being administered. Some Senators are shaking their heads. As diligent public representatives, individual cases present to them. I have examined some cases, as I have also been approached. I have taken Adjournment debates and parliamentary questions. We have considered many of the issues that have been raised, but the backlog of people awaiting decisions on, for example, discretionary medical cards, the issue that concerns people the most, has reduced substantially. The target turnaround time for discretionary medical cards is 20 working days. However, if a Senator has an experience that causes him or her to disagree with my comments on the great progress being made, it should be brought to our attention so that it can be addressed.
I wish to address the commitment in the programme for Government to universal access to GP-only medical cards. It remains a commitment to ensure it is done before the end of the Government's term of office. We pointed to a particular route. The programme for Government referred to addressing the long-term illness scheme first, high-tech drug users second and, third, a form of subsidised GP visit cards. That was our aspired route to a destination, although it is not the route now being taken.
I have dealt with the issue before in this and the other House. We are examining a different route, which is to extend GP visit cover to persons with certain chronic illnesses. That does not refer to people on the long-term illness scheme but rather people with certain demonstrated chronic illnesses. This chimes with a general population health approach to primary care and it is the route we are considering.
I emphasise that we will get to our destination and it is absolutely our commitment to extend GP visit cards and free GP care to all of the community by the end of the lifetime of the Government. That is the intention and very much what I am dedicated to achieving; the biggest priority I have as Minister of State with responsibility for primary care is to make this happen. That will not come without difficulty or complication. The Health Act 1970 is based on extending medical cards to people based on income and financial or material hardship. For example, having a chronic illness would mean a GP visit card would have to be extended on the basis of a particular illness rather than income or hardship, which is a different conceptual issue and not without legal difficulty. That does not take from the strength of our commitment to reach the destination of universal GP care by the end of the lifetime of the Government.
The Minister for Health and I still hold to the universal health insurance commitment in the programme for Government. We did not say we would be able to achieve universal health insurance within the life of this Dáil but we would do so by the end of the next Dáil. We have much work to do on the precise model to be put in place, which I accept, but universal primary care is a necessary prerequisite of universal health insurance. That is the objective to which I am most closely dedicating myself while working with the Minister for Health and the Government to achieve the broader agenda of universal health insurance in the coming years.
I am almost exactly six months in this job and one discovers certain frustrations in public life, policy and administration. Nevertheless, I do not doubt the close dedication and commitment of public servants across the board, in the Department of Health and in the HSE. This is a period of major change and reform and the process takes longer than one may hope. That does not diminish our commitment or set us back in the least from what we need to achieve in the shape of true reform and a much-improved health service available to people on the basis of need rather than income.
Question put:
The Seanad divided: Tá, 26; Níl, 12.
Tá
- Bacik, Ivana.
- Barrett, Sean D.
- Brennan, Terry.
- Burke, Colm.
- Clune, Deirdre.
- Coghlan, Eamonn.
- Coghlan, Paul.
- Comiskey, Michael.
- Conway, Martin.
- Cummins, Maurice.
- D'Arcy, Jim.
- Gilroy, John.
- Harte, Jimmy.
- Healy Eames, Fidelma.
- Henry, Imelda.
- Keane, Cáit.
- Landy, Denis.
- Moloney, Marie.
- Moran, Mary.
- Mullins, Michael.
- Noone, Catherine.
- O'Donnell, Marie-Louise.
- O'Keeffe, Susan.
- O'Neill, Pat.
- Sheahan, Tom.
- Whelan, John.
Níl
- Crown, John.
- Cullinane, David.
- Daly, Mark.
- Leyden, Terry.
- MacSharry, Marc.
- Mooney, Paschal.
- Ó Clochartaigh, Trevor.
- Ó Murchú, Labhrás.
- O'Donovan, Denis.
- Power, Averil.
- Walsh, Jim.
- Wilson, Diarmuid.
Tellers: Tá, Senators Ivana Bacik and Paul Coghlan; Níl, Senators Marc MacSharry and Diarmuid Wilson.
Question declared carried.
When is it proposed to take Committee Stage?
Tomorrow.
Committee Stage ordered for Thursday, 28 March 2013.
Sitting suspended at 3.45 p.m. and resumed at 4 p.m.