That is not so. I read the report of Deputy O'Hanlon's speech last evening and I considered his contribution to have been measured and responsible unlike the contributions we had from Deputy O'Rourke and a few others whose object was to score political points. What I am saying is that in-patient, out-patient and free consultancy services are available without charge to every student irrespective of his parents' income. We are talking about what are the most expensive services within the health services. Therefore, the question of hardship in respect of a student having to undergo an operation does not arise. Equally, I have made the point repeatedly to the USI whose president, regrettably, is more interested in having his name in the papers or in appearing on television, that where any hardship arises in relation to the delivery of medical health services, there is a clear provision that a medical card can be issued.
It is not possible nor is it desirable to set out all the criteria for hardship in terms of the way in which income guidelines are expressed. For example, if a student must attend a doctor on a regular basis and at considerable cost to his family and if he must spend a great deal of money on drugs and medicines on a regular basis by virtue of the severity of his medical condition, there is provision in the regulations I have signed for the chief executive officer of a health board to issue a medical card. The CEOs will take account of the circumstances of each student by assessing applications for medical cards. The general question of means will be considered. As I have explained in the House and to the USI I have made specific provision in the regulations that where hardship is likely to arise the CEO of the appropriate health board will have power to make these services available without charge. Unfortunately students are not being told the full facts.
To sum up, not all students will lose medical cards. On our estimate, 35,000 students will retain this entitlement. This figure will include those at greatest risk of having difficulty in paying for GP services — those from lower-income families, the working class that Deputy De Rossa talks about while at the same time advocating the issuing of medical cards to everyone, irrespective of income. That is an approach that cannot be sustained by the Government in the future. It is the approach of selective socialism. It is hypocrisy. In the light of the current serious economic climate it is essential to have regard to the cost of our health services. In the current year I do not have the money available to allow me to provide services without charge to everyone, irrespective of income. There were many options open to me in that regard. For instance, I could have imposed charges on those who used medical cards but I decided not to do that. I could have provided for a charge in respect of prescriptions but I did not do so because those in the lower income group, 38 to 40 per cent of the community, have medical cards. Four out of ten people have medical cards but I decided I would not impose further financial hardship on that sector.
For example, I could have decided not to increase the income guidelines for medical cards. I would have saved money by so doing but I decided deliberately to increase the income guidelines by 10.3 per cent from 1 January. This is well within the increase in the rate of inflation. I decided to use about £500,000, out of the £2,500,000 I saved on the decision in relation to universal application, to help people over 66 years. For the first time we have given extra help to them. They need health services and are the most vulnerable section.
Instead, I withdrew limited services from a group of persons — between the ages of 16 and 25 years — who were low users of the services and who received them without regard to ability to pay. I believe that less hardship will be caused because of the decision I have taken. I published the arrangements in the newspapers. In the remaining few minutes I shall deal with points raised by Deputy O'Hanlon.
Deputy O'Hanlon pointed out the possibility that problems may arise in deciding on dependency in applications for medical cards. I agree that problems can arise, but they can be met and I made this perfectly clear to student deputations and to party political deputations I received. Dependency is a matter to be determined in the circumstances of each individual case. For example, Deputy O'Hanlon spoke of a student who may be in part-time employment and financing his or her way through third level education. On the basis of that information I would be very surprised if the health board considered that the person in question was a dependant and I have no doubt that most likely the regulations would not apply. However, it is a matter for the CEO to determine. I have framed the regulations in as flexible a way as possible. Two students may marry and I would not regard them as being dependent on their parents. They are a family unit in their own right and the two would apply for a medical card based on their income as a family unit. Under the regulations I have signed most likely they would receive a medical card.
I received a responsible representation from the Irish Student Health Association and I will quote one paragraph:
This submission does not request that all third level students should automatically get medical cards irrespective of their income.
That is the issue at stake. The USI said they must get the cards but I say I cannot give them. The submission from which I quoted was signed by H.G. Nelson, Secretary of the Irish Student Health Association from the TCD Health Centre dated 27 January, and they support me in this. With regard to hardship cases, they ask that particular and speedy consideration be given to individual submissions under this heading and of course that will be done. There has been a tremendous amount of propaganda about this matter and, unfortunately, many students are being misled.
In the submission they state that the income of many students and their parents can deteriorate dramatically at some stage after the student has begun his or her course. In particular, unforeseen unemployment is now affecting all socio-economic groups and they ask that health boards make arrangements to deal with students so affected. Of course, the health boards will make speedy decisions in those cases.
In the submission it is recommended that problems in the home, such as desertion and alcoholism, be taken into account when assessing the eligibility of third level students. Of course that is done. Deputy O'Hanlon and Deputy McCarthy are members of health boards and Deputy Ormonde has for long been associated with health board employment. Where there is sudden unemployment in a family the situation with regard to medical cards will be reviewed immediately. I have included in the regulations a provision that the CEO concerned should take care of the situation.
Deputy O'Hanlon referred to a situation in Cork. I checked on that case where a student has been involved in expenditure of £300 in respect of medical attention. I do not doubt the Deputy's information but I must point out the situation could not have arisen as a result of my decision to withdraw automatic entitlement because no medical card has yet been withdrawn in the Southern Health Board area which covers Cork and Kerry. In a hypothetical situation if a student is going to have heavy expenditure, having to visit his doctor on a regular basis and having to spend a considerable amount on drugs, and if his family has not the money to provide the funds, the CEO is empowered to provide that student with a medical card or free access to drugs. A student will have total access to hospital consultants even if his father is earning £100,000 per year.
I do not want to impose undue hardship. I am trying to be as helpful as possible. In my constituency the children of very wealthy families are dropped off at a health clinic, they go in with the medical card and get free drugs and free GP services. There is no country in Europe providing that kind of service without charge. There is always a qualification in each case and there is a definite controlling element in that regard.
Deputy O'Hanlon expressed concern about third level students living away from home in flats or digs and who may have difficulty in meeting the cost of a visit to a GP when this is required urgently. If the circumstances of a student who does not have a medical card are such that he is in any danger of not being able to get the services, the hardship provision will come into operation. I share the concern of the Deputy that some urgent cases may fall outside the safety net. I have indicated to the CEOs — and I will take up the matter again at the request of the Deputy — to make sure that additional safeguards are built into the system to ensure that these cases are catered for adequately.
I have dealt with the points raised. I received a submission from the Irish Student Health Association on this matter. That submission will be very carefully considered. I only wish that the representations made to me by the USI had been delivered in a rational form, instead of with stridency and hysterics. Every time the television camera appeared, the representatives fell to the floor in total hysteria. That does not rate serious consideration, but the submission I have received now will have my serious consideration and I shall respond to it.
We must provide the best possible health services for our people, within the extreme limitation of our resources. These services are being provided on an in-patient and out-patient and free consultancy basis.
