As a Deputy I am entitled to stand up and speak and the Minister will not dictate to me on this matter. I will tell him that from the beginning. That is how we start. It is disgraceful of the Minister to try to object to our speaking on this. What does he want? Does he want us all to go home and let him do what he likes? It is a terrible state of affairs that a Minister is becoming very annoyed because we are making contributions to this. We have reason to criticise this because there is in the Health Act, 1970 section 45 which says:
(1) A person in either of the following categories shall have full eligibility for the services under this Part—
(a) adult persons unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants,
(b) dependants of the persons referred to in paragraph (a).
(2) In deciding whether or not a person comes within the category mentioned in subsection (1) (a), regard shall be had to the means of the spouse (if any) of that person in addition to the person's own means.
It is spelled out in the Health Act, 1970 that where application was made for a medical card consideration would only be given to the income of the person and the person's spouse. Here we have back tracking by this Government as they have back tracked on so many things. They are determined to push the Forcible Entry Bill through but they would not give time to proper consideration of this.
I know, as a public representative, that people come to find out if you will get them the medical card. There is no question of entitlement. What is being asked is whether the TD will get them the medical card. It is interesting to see who gets the medical cards. I received a reply to a question two weeks ago and it is interesting to see the variations through the country. We see that in the Eastern Health Board area 14.7 per cent of the population are in receipt of medical cards. This represents in Wicklow 34.2 per cent, Dublin 12.3 per cent, Kildare 26.2 per cent. Laois is 34 per cent, Longford 35 per cent, Offaly 40 per cent and Westmeath 29.9 per cent. Clare is 31.8 per cent, Limerick 25.9 per cent, Tipperary north 22.9 per cent. Cavan is 29.6 per cent. The Minister's county, Monaghan, is 41.9 per cent. I wonder where he gets the medical cards from for all these people. Louth is 28.4 per cent and Meath is 35.3 per cent. Meath is 35.3 and Dublin is 12.3 per cent. That seems to be a tremendous disparity between these two. Donegal is 41.2 per cent, Leitrim 40.5, Sligo 39.6, Carlow 44.7, Kilkenny 43.7, Tipperary south 35.7, Waterford 32.1 and Wexford is 48.2 per cent. Cork is 26.5, Kerry 44.1, Galway 50.7, Mayo 47.1 and Roscommon is 51 per cent.
It should be obvious to the Minister that there is a tremendous disparity throughout the country in the number of people and the type of people who are eligible for medical cards. It depends on the TD. What is better than representation is better representation. It is how good a case a TD can make for a person which decides whether a person will receive a medical card or not. Entitlement is not a factor. I always feel ashamed when people say: "You got me the medical card". I think it is a terrible thing that people have to come grovelling to TDs to get them a medical card. I am finding more and more people who have not realised that they are entitled to medical cards and have been crippled with medical expenses and it is only when representations have been made that it has been conceded that they were entitled to medical cards. I expected the Minister to come up with a formula for deciding who is entitled to medical cards. Instead he comes along and says:
I had hoped also to include in these regulations a provision fixing income standards for full eligibility, that is for that category who are entitled to medical cards. After very detailed and careful studies of the matter, I have come to the conclusion that, as circumstances other than the purely financial vary so much as between country and town and between one family and another, I should not at this stage make regulations on such standards but rather leave it to the chief executive officer of the eight health boards to try to achieve the greatest practicable uniformity in their decisions on eligibility.
I am wondering who in a health board office decides who will get the medical card, I remember writing over and over again for a patient of mine who was a severe asthmatic and crippled with the financial burden of the cost of drugs and other treatment. I tried in vain as a doctor to get her a medical card. On the day that I was elected to this House I could make representations on her behalf and she had the card that afternoon. That is a terrible indictment on us as public representatives. A doctor would be more aware of the problems, much more concerned and more able to put forward her case than a TD or other public representative. Because of this I am very concerned and annoyed that the Minister has decided on the status quo and is not making any proper regulations to determine who are entitled to the medical card.
It is humiliating to have to disclose all one's means and all the treatment one is undergoing, the exact nature of one's medical condition and to have to send in the prescriptions. It takes months. A certificate of income must be obtained from the employer. The person humilitates himself in saying to the employer: "I am destitute. I need a certificate of income because I am applying for a medical card as I cannot afford a doctor and to pay for drugs." That is exactly what is implied in a certificate of income. When the certificate is presented to the employer for completion it is obvious to him that the person is not able to cope with medical and other expenses. It poses the problem as to whether the employee should be retained because where medical expenses occur so often the employer may be inclined to the view that the person is not a good employee or that he may have trouble with him later. This is a very serious matter. It should not have been decided to leave things as they were, especially after the promises made by the Minister.
It is shameful to take into account the income of a son or daughter in a household. The son may already be paying income tax and contributing to other things. He may be planning to get married. He may be paying his mother merely enough for his keep. Many a father or mother has been faced with the problem of literally asking the children to leave the house because of the fact that as long as they remained in the house the father or mother could not get a medical card. I have been told this by many parents. I have told them that their sons or daughters were depriving them of the medical card and were of no advantage to them in the household and, perhaps, the only way to get the card was to ask them to leave. This is a serious state of affairs and not something to be fobbed off by the Minister with a statement to the effect that there will be consultations and some form of uniformity throughout the country in the number of persons receiving the medical card. That does not alter the present humiliating situation where people have to disclose intimate details of their personal life and their medical history. How often have medical reports to be sent in with full details of prescriptions? This is a very small country. It can be known exactly what is happening in a household through details being submitted to health authorities. I have often received letters saying that a person is not eligible, with the addition: "If they need assistance towards the cost of drugs ..." Does the Minister know exactly what is implied in that? Take Dublin, with which I am very familiar —I do not have the situation existing in the Minister's county where 41.9 per cent of the people have medical cards. If you walked around that county I do not think you would see anyone without one. In my constituency, and in Dublin generally, for this assistance towards the cost of drugs, a person must travel to the headquarters of the Eastern Health Board and must pay in a sum each week, usually 10s to £1. Then he has to come back again with the receipt and present it at the local dispensary to receive the drugs. I have seen cases where drugs have been supplied, the basic cost of which to the Eastern Health Board has been £1 and the persons were charged £1 by the Eastern Health Board. To me that does not represent assistance towards the cost of drugs because the Eastern Health Board and other health boards all receive drugs at 50 per cent of the retail price. There is subterfuge. The retail cost of the drugs may be £2 and the medical card holders will pay £1, whereas the cost to the board is only £1. It is a disgraceful situation that people should be put to such inconvenience and trouble in having to travel so far to get the receipt and bring it to the dispensary. This is supposed to be done to relieve hardship cases. I say it is a pathetic effort and one that must be condemned.
With 12 per cent of the population of Dublin receiving the medical card, there is something radically wrong. I am not content to listen to the Minister saying he is doing the best he can and will ensure uniformity. I say we have to change the whole system. In the first place we have to decide on a figure of income of the husband and wife to be taken into account, a figure of £20 or £22 a week, then we should have flexibility where there is prolonged therapy or chronic illness. You must decide on a basic figure so that people will know exactly where they stand.
In one case a person who was in receipt of a medical card in one county moved to Dublin, where she was informed that she was not eligible for the medical card. This seems wrong. If there is a switch around of population, things will become chaotic, with people not knowing when they are entitled and to what they are entitled.
Where the parent in a household is in need of treatment, the income of the children should not be taken into consideration. There is no law in this land that can compel a son or daughter to pay a certain amount to the household. Therefore, the income of the son or daughter should not be taken into account. It is ludicrous to take it into account and it is terribly unfair in the context of improving the health services. This rule should be discarded. The incomes of sons and daughters should be ignored.
I do not think we can accept this as being a proper way of determining who are and who are not entitled to medical cards. At present the advice of a medical officer is not taken into consideration. The medical officer will know the nature of the illness, the treatment required. It is left in the hands of officials, who have no knowledge of medicine, to decide under the jurisdiction of the chief executive officer. This is very wrong. At least there should be some appeal to a medical officer or someone in charge in a health board. If we are not going to specify the income limit for medical card holders, we must be more specific than to leave things as they are. We are leaving it open to political influence, to representation by a Deputy. This should stop and the sooner the better. We should not depend for our seats on the number of medical cards we get for people. This is the situation prevailing at the moment; the more medical cards you get, the more votes. This is very wrong. We shall not improve Parliament by this arrangement. This system should be abolished, and the sooner it is the sooner the image of Parliament and of public representatives will be enhanced in the eyes of the public. I object very much to this system and shall continue to do so. People should get cards on their entitlement and not on efforts or representations of public representatives. I have seen cases where my intervention on behalf of applicants was successful when it was rejected for others or rejected where it was successful in the case of representations by other Deputies. This is very wrong. I want to know what the Minister will do about it. Is he going to leave things as they are?
I am very suspicious about this. Reading between the lines, I can see that an effort will be made to reduce the number of people becoming eligible for medical cards. The Minister has realised that his deal with the doctors will cost a good deal of money. It should be possible to determine the number of people with £22 a week and from that decide the number who would qualify for medical cards. It should not be beyond the ability of the Department to work out these figures. If this were done, the Minister would find, perhaps, that more than 30 per cent of the population would become eligible for medical cards. This is why it is not being done. Instead, an attempt will be made to reduce the number becoming eligible. More and more applications for medical cards are being rejected. I think there has been a directive from the Department to the health boards to reduce the numbers eligible for medical cards. This is happening at a time of rising prices, increased costs of medicines and drugs. Reducing the number eligible for medical cards is the only way that the Minister would be able to arrange things. Because of the deal he has made with the doctors he is saying: "We can only afford to pay for it by reducing the number entitled to medical cards." I have no doubt this is what he has in mind. I think it is wrong and that the system is wrong.
By discussing it with the CEOs of the health borads I do not think he will arrive at a uniform system of applying standards of eligibility. This should have been decided on income with certain factors also to be taken into account. This could have been easily done. Unless the Minister decides to ignore cases of families with sons and daughters in the household I think he will cause a great deal of trouble because more and more people realise the costs are so great that they will have to ask their families to leave. The Minister must do something about this. This matter is creating great concern. It is causing discord in households when it is realised that a father who is a chronic asthmatic or bronchitic cannot have treatment because his son or daughter is contributing fairly to his or her maintenance.