I move:
That Dáil Éireann request the Minister for Health to make a regulation under subsection (3) of section 45 of the Health Act, 1970 specifying that the following classes of persons shall be deemed to be within the categories mentioned in subsection (1) of section 45 of that Act:
(1) Persons over 65 years of age
(2) Widows
(3) Persons suffering from any long term illness
(4) Families where the weekly income of husband and wife after deducting rent, rates, ground rent, mortgage repayments and expenses necessarily incurred in travelling to and from work and an amount of £4.00 per week in respect of each child with no income under 18 years of age, does not exceed £40.00 per week
(5) Single persons, living with relatives, whose income does not exceed £20.00 per week and
(6) Single persons living alone whose income after deducting rent, rates, ground rent, mortgage repayments and expenses necessarily incurred in travelling to and from work does not exceed £20 per week;
and request the Minister for Finance to assent to the making of such a regulation.
The purpose of this motion is to expand to a much greater number of people than at present the benefits of the general medical service by making them automatically entitled to entry in the general medical services register and to receive a medical card. Fianna Fáil are putting forward this motion because we believe that one specific way in which the welfare of ordinary men and women can be positively improved is by making better health services more widely available.
Illness, by itself, brings suffering and distress to the individual and into the home, but when there is added to that natural and inevitable suffering the additional misery of worry about the cost and expense, the strain becomes intolerable. We cannot abolish illness from human life, but it should be our resolve to move steadily towards a position where nobody in our community will be deprived of any medical attention he needs because of his financial circumstances, so that that fear one so often hears expressed of not being able to afford to be ill will be removed from our midst.
The general medical service is the cornerstone of our health services. It is through its expansion and improvement that the most positive and widespread progress can be made. Health services here, as in most other countries, are absorbing community resources at an increasingly alarming rate, and it is doubtful if even the richest nations can provide adequate resources for all the things they would wish to do in regard to health. The control of the development of our health services in a modern community is, therefore, something that calls for great wisdom, judgment and balance. There must be constant forward movement, but great care must be taken to ensure that in that process of forward movement the resources and capacities are not overstretched to the detriment of the services provided.
It is these considerations that have led us in Fianna Fáil inevitably to decide that an extension of the general medical service to a wider section of the community is the major improvement that should be undertaken at this time in our health services. This is something we see as urgent and inescapable in our circumstances today. There is no other single improvement in our community services which is so clearly called for for a widening section of our community. The mounting pressure of the general cost of living and the alarming rise in the cost of medicine are making it impossible for them any longer to provide for their medical needs out of their own resources.
This proposal to extend the general medical service to embrace a wider section of the population is a basic component of our general health policy. That policy is based on the principle of advancing steadily on a broad front. It will seek to achieve a tolerable balance between overall requirements, on the one hand, and the availability of resources, on the other, to improve services comprehensively without diluting the quality of those services. It is part of that policy to afford priority to improving existing facilities, and that is precisely what we are seeking to do in this motion, by extending the general medical service while, at the same time, as resources permit, improving and adding to the general level of that service.
Our policy is to push forward within the existing framework, the progress rate to be determined by community needs, scientific advances, social and economic factors, and not by any doctrinaire considerations. We believe that in this way it will be possible to evolve a comprehensive health service in an orderly manner, services being augmented steadily and not reduced in quality from time to time by ill-considered, unprepared decisions.
That strategy of advancing on a broad front will, nevertheless, mean that there will have to be preferential direction of resources to certain problem areas. That guiding principle acknowledges the fact that certain groups will always require special attention and protection, and we are making a start with some such groups in this motion. The family doctor is, of course, the key to the general medical service and, indeed, to the health services in general. Our policy for health involves a greater emphasis on increased recruitment into the general medical service with—and we must admit this—a corresponding curtailment of recruitment for hospital medical staff. Accordingly, conditions of service in the general medical service will have to be made more attractive to secure this change of emphasis. If doctors are to be attracted into this service, there is undoubtedly a need for a contract to be negotiated on a new, far-reaching basis with the profession.
We believe also that the local health centre, as the focal point of the general medical service, is the key to the most efficient use of our limited resources. The development and improvement of the services provided in these health centres will reduce greatly the necessity for hospital admissions and will facilitate something which we aim at also—the ultimate integration of our medical services with our social and community services.
This motion seeks to increase in two ways the number of people eligible for medical cards. First, it seeks a general increase in the number of people eligible for medical cards by raising fairly substantially, but not irresponsibly, the upper income limits for eligibility in the case of families and individuals. Secondly, it seeks to make obligatory the issue of medical cards to specific categories of persons. Those categories to which we seek to have the issue of medical cards automatic and obligatory are, first, persons over 65 years of age, secondly, widows and, thirdly, any person suffering from a long-term illness. It is our view that the general circumstances of these people and their status in the community are such that there should be no question as to their eligibility for medical cards and that the common-sense approach to this is to make automatic the issue of a card to anyone in any of the three categories.
The case for doing this in respect of a person over 65 years is self-evident and is entirely in keeping with modern thinking in this area. There may be people in this category who, because of their private circumstances, would not be regarded as being badly in need of eligibility for free general medical services but I submit that such persons are few in number and that, consequently, we need not concern ourselves unduly with them. They would not be likely to avail of the service in any event. It is entirely in keeping with the whole trend in community thinking that senior citizens should have automatic entitlement to free general medical services.
The case in respect of widows is equally self-evident. Widows are in a very special category. They are a section of our community who require and deserve special consideration and concern. Any reasonable approach to the question of an extension of eligibility for the general medical services would include widows automatically.
The case for including persons suffering from long-term illnesses is unanswerable. There are special provisions in existence for such persons in so far as a limited number of illnesses are concerned and I know that recently the Minister extended the list of diseases but, again, the simple straightforward way of dealing with the matter is to make automatic and obligatory the issuing of medical cards to all persons suffering from any long-term illnesses. Regardless of how the Minister may extend the categories there will always be the case which, if excluded, will result in hardship. It must be pointed out, too, that in respect of the diseases listed by the Minister, the sufferers are entitled only to special financial assistance relating to certain costs and expenses. I am proposing that they be entitled to the full services which a medical card would make available to them.
When we specified these various categories we should not be regarded as excluding any other either now or in the future. No doubt most Deputies, from their own experience in their constituencies, will see a need to add to the list of three which I have included in the motion. Indeed, no sooner had I drafted the motion and tabled it than I realised there was one important category which I should have included and which I would include if I were to amend the motion. I refer to unmarried mothers. The issue of medical cards to persons in this category should be automatic also. I trust that if the Minister is adopting our proposal he will include them. I should hope also that the categories I am enumerating would be regarded as a tentative beginning and that the list would be added to periodically as the need arises and as resources become available.
In addition to the desirability of improving generally our health services by making the general medical service available to a wider section of the community, there exists an immediate, urgent need to revise the present income limits upwards so as to cope with the effects of inflation. The existing guidelines are being rendered irrelevant by these inflationary pressures. Income increases which have been granted, either to people in employment or to those in receipt of social welfare were granted to compensate for increases in the cost of living. However, these increases are resulting in medical cards being withdrawn unjustifiably from people to whom they had been issued already and are operating in a way that prevents the issue of new cards in cases where the necessity for them is clear. This is because these necessary increases are resulting in persons earning more than is the guideline in the limits for eligibility.
I went through my constituency correspondence and at random—I am sure most Deputies could do the same—I was able to extract seven cases where medical cards are denied to individuals and families where any of us would agree that, if at all possible, the card should have been issued.
I shall take the case of Mrs. D who lives in Artane. She applied for a medical card in 1973 in respect of her baby daughter who was a rubella baby and was also born deaf. With the complaint this child has, she is open to colds and infection and needs permanent heating in her bedroom. The family installed central heating which they could barely afford. The child requires regular attention and they are finding it very difficult to meet the bill. The husband is not covered by any insurance scheme and any visits to specialists or anything of that nature has to be paid for out of their own resources and they are not able to afford the cost involved.
When I got in touch with the Eastern Health Board I was told that because of the family income they would not be eligible for a card but my attention was directed to a scheme where the cost of medicines in excess of £4 in a calendar month can be refunded to them. That is a help but it is not sufficient. They still have to pay £4 a month for drugs. That scheme is not very efficiently administered. In addition there are countless other medical expenses which they have to meet out of their own meagre resources. That is a typical case extracted at random.
There is another case, that of Mrs. C of Santry, who has a three-year-old boy who suffers from hypogammaglobulinemia. It is a long-term illness which requires very special treatment. She also applied for and was refused a medical card. I appealed to the Minister for Health in that case and I had a very courteous and helpful letter from the Minister but the gist of it is that in the circumstances and within the context of the guidelines laid down for the Eastern Health Board, a medical card cannot be issued. He directed my attention to the scheme for refunding the cost of drugs and medicines in excess of £4 a month. That is of very little help to this woman who is a widow.
Another widow, Mrs. C of Coolock, has a full contributory widow's pension which comes to £18.95 per week. She works part-time in a local factory. She has three children and after all the calculations are made and all allowances granted to her within the guidelines, she is about £4 over the limit and is denied a medical card. Again, this is a particular case in which I think in the circumstances of today a medical card should be issued.
I have put down in the motion particular figures because I thought it advisable and desirable that I should put some positive proposals to the Minister. As regards (4), I set out that medical cards should be issued in the case of families where the weekly income of the husband and wife after deducting rent, rates, ground rent, mortgage repayments and expenses necessarily incurred in travelling to and from work and an amount of £4 per week in respect of each child with no income under 18 years of age, does not exceed £40 per week. There is nothing sacrosanct about the £40 per week or the £4 per child and if the Minister were to accept lesser figures I do not think anybody would quarrel with him. I do not want to suggest that my figures are figures over which we would challenge a division. They are just a kind of starting point and I put them into the motion for the sake of having some positive figures to work on.
Perhaps I should explain why we have adopted the particular method set out in the motion to achieve the extension of the general medical service which we believe to be necessary at this time. We have done so because it seems to be the only means by which such an extension could be immediately and uniformly accomplished throughout the whole country. In 1970, the Minister for Health asked the CEOs of the eight health boards to accept responsibility for deciding who is, or is not entitled to a medical card and he urged that uniform standards be adopted in all areas. That was agreed to and the present position is that medical cards are issued throughout the country on the basis of guidelines laid down by the eight CEOs of the health boards in pursuance of that agreement. To bring about the substantial change we regard as vitally necessary would, I assume, involve getting those eight regional health boards through their CEOs to adopt new criteria and guidelines. That would seem to involve long and tedious negotiations and the process might well turn out to be fruitless at the end of the day.
The procedure we are proposing in the motion is that the Minister make an order with the consent of the Minister for Finance which would enable this proposal, if the House deems it to be worthy and worth while, to be brought into operation immediately throughout all regions on a uniform basis. We do not regard it as appropriate for us, as a responsible and constructive Opposition, simply to demand the provision of services without any regard to their cost or the budgetary implications involved. We, also, must establish our priorities and we must relate any proposal we put forward to the overall financial situation. Fully conscious of that responsibility we have however, no hesitation in putting forward this proposal and pressing its adoption on the Government and the Minister. I think the House will appreciate that on these Opposition benches we have found great difficulty in endeavouring to calculate the exact cost of this proposal but we are satisfied on the best evidence available to us that cost need not be prohibitive. In the context of an Estimate of £177 million for the Department of Health this year, the cost of our proposal would be of an order that could legitimately be dealt with within the normal processes of dealing with excess expenditure of a Vote of the size of the Department of Health. Certainly there is no other proposal over the entire spectrum of the health services that would bring such widespread and universal relief throughout the economy for such a relatively modest cost.
This is a serious considered proposal. I hope it will be considered by the House on its merits and that it will receive mature examination. I am quite certain that Deputies, with their experience of the administration of health services, will be able to point perhaps to flaws in this proposal, to suggest improvements and, if necessary, limitations on what we propose. I hope it will be dealt with by the House in that attitude and that we will not have, as unfortunately we sometimes have from the Government back benches, a certain standardised, sterile type of comment. This extension in eligibility for medical cards is urgently needed to alleviate widespread worry and hardship among a large section of the community. I strongly commend this proposal to the House and to the Minister. While having regard to limitations that may exist, I hope it will receive favourable and sympathetic consideration.
