Deputy Ó Caoláin was in possession and has one minute remaining.
Health Bill 2008: Second Stage (Resumed).
The following motion was moved by the Minister for Health and Children, Deputy Mary Harney, on Wednesday, 10 December 2008:
That the Bill be now read a Second Time.
Debate resumed on amendment No. 1:
To delete all words after "That" and substitute the following:
"in view of the fact that the Health Bill 2008,
removes automatic medical card eligibility for people over 70,
reneges on the commitment in the Programme for Government agreed between Fianna Fáil, the Progressive Democrats and the Green Party in 2007 to extend medical card eligibility,
represents a further step away from universal access to public health services based on need alone,
Dáil Éireann declines to give a Second Reading to the Bill."
—(Deputy Caoimhghín Ó Caoláin.)
As I indicated, in this State, where the overall ratio of general practitioners to population is much too low and far below the European Union average, as the Minister admitted in response to questions I asked in the House, we have a duty and responsibility to ensure equitable access for all citizens to their local medical practitioner. We are constantly challenged when we call for better health services and wider entitlement and the question posed is, "Who will pay for this?" The question should be, "Who has paid for this?" The answer is clearly that the pensioners of Ireland paid for a decent health service in taxes during their working lives.
If the Government seeks savings, instead of removing medical cards, let it remove tax breaks from the developers of private hospitals.
The Deputy's time has expired.
May I conclude? I could not hear myself speak in the first part of the minute available to me?
Yes.
The tax break to which I refer cost €10.6 million in 2006. This saving alone is in excess of what is sought by the Government in terms of the saving signalled in respect of medical cards. While other options were available, the Government failed to capitalise on other opportunities and instead, I regret, chose to target older citizens and people who have invested a lifetime in helping to build this economy. I urge all Deputies to reject this so-called Health Bill and ensure access for all citizens over 70 years to the medical card, as a forerunner to the roll-out of full and universal access to free health care for all citizens, paid for by fair and equitable tax contributions.
I wish to share time with Deputy Blaney.
The legislation before us introduces new arrangements for medical cards for those aged over 70, the net result of which will be that the vast majority of people aged 70 and over will continue to have medical cards under the new income threshold. There are three distinct routes for qualifying for the medical card. First, 95% of people aged 70 and over will qualify on the basis of income. Second, discretionary medical arrangements are in place in cases where a person's health circumstances cause undue hardship. Many people who have terminal illnesses, for example, are granted medical cards, although they do not qualify under the means test. Third, the standard net income means test which applies to people under 70 years takes into account personal circumstances such as high outgoings on nursing home fees. For those now aged 70 or over, or who will be by the end of the month, there will be no new means test. Those who turn 70 in the new year will have a simplified means test.
The Bill before us enables the ending of the special high capitation fees for GPs paid since 2001 in respect of over 70s who received a medical card by virtue of age rather than means, which is the "gold card". I welcome the recommendation of Mr. Eddie Sullivan for a single fee capitation level of €290 which we intend to implement from 1 January.
I also welcome the announcement by the Minister for Health and Children, Deputy Mary Harney, that the new arrangements ensure a person aged 70 or older would not lose their medical card as an immediate consequence of the death of their spouse. All possible solutions to this were explored in recent weeks within the boundaries of what is possible from a non-discrimination point of view between widowed and single persons. I welcome the Minister’s introduction of an amendment on Committee Stage to give effect to this objective.
The Minister also outlined that a person who had automatic entitlement to a medical card, and therefore full eligibility, would continue to have full eligibility until 2 March 2009. Consequently, all persons in this category can continue to use their medical card as normal until that date even if their gross income exceeds the relevant income limits set out in the Bill.
The Government wants to ensure a process of self-assessment for persons covered under these arrangements will be greatly simplified compared to the means assessment process required under the existing hardship-based scheme. The HSE has been asked to ensure that any assistance needed by a person currently over 70 on self-assessment will be made available by it on an administrative basis.
A greatly simplified means test will be put in place for persons who will attain the age of 70 on or after 1 January 2009 to enable them to apply under the new arrangements. The HSE will provide confirmation they meet the qualifying criteria for full eligibility under these arrangements. They will continue to have full eligibility as long as their gross income does not exceed the relevant limit. The Bill also provides for the dependents of those over 70.
The Bill includes a provision to amend the Health Contributions Act 1979 to provide an exemption from the health contribution for any person who is 70 or reaches the age of 70 on or after 1 January 2009. The amendment will exempt everyone over 70 from paying the contribution regardless of whether they fall into the existing categories exempted under section 11 of the 1979 Act. For those now aged over 70, or who will become so by the end of this month, there will be no new means test.
The objective of the general medical services scheme is to ensure the medical card benefit is available for those who are unable, without undue hardship, to meet the cost of health services for themselves or their dependents. Recently I met a 40 year old lady with cancer who was concerned that despite her medical condition and her husband's income being the minimum wage, she did not qualify for a medical card. She queued in a chemist behind two people, whom she described as very wealthy, who were aged over 70 and had medical cards. Speakers tonight may not be in the chemists or at the doctor beside the Tony O'Reilly's of this world, but she was incensed that wealthy people had a medical card while she had to pay for her medication despite her cancer diagnosis. We want to try and protect people like this with medical cards. People with a genuine medical need should receive a card whether they are over or under the age of 70. Those over 70 who do not qualify under the current arrangements can apply for a discretionary medical card.
As we look to future changes in demographics, it can be seen that Ireland has the youngest population in Europe, with approximately 11% of the population aged 65 or over. It is estimated this figure will rise to 20% by 2036 and 29% by 2056. In the years ahead our nation's age profile will change. The number of people in the population aged 70 is approximately 350,000 but this is projected to increase to 535,000 by 2021. We need to plan for this and provide many health services for those aged 55 and over who will form the over 70 group at that time, and use public resources in the most effective and fairest way possible.
The Minister, in her speech, outlined the new arrangements which will form part of the Bill to ensure the vast majority of people aged 70 and over will continue to hold a medical card.
I thank Deputy Wallace for sharing time. The content of this Bill has been the subject of much debate over recent weeks and I am glad to have the opportunity to speak on it. The decision taken by the Government to end the automatic entitlement to a medical card for all those aged 70 and over was not an easy one. When the commitment was made to enact the practice of automatic entitlement we faced very different times. Ireland was in darkness for many years and is experiencing significant changes in its economic environment. Things were on the way up and the Government was in an enviable position whereby it could provide such measures. However, things have changed and we are now in a global economic crisis which has resulted in a situation where expenditure has had to be cut across most Departments.
Cuts are never easy to endure, contrary to what the Opposition would have one believe. Decisions on where cuts may be implemented are difficult. I realise the Minister and Ministers of State in the Department of Health and Children faced tough decisions when balancing its books. The Minister has presided over a radical overhaul of the health service which is ongoing. The overhaul was necessary and courageous. We have all heard the negative issues which have plagued our health service over the years. The overhaul was and is necessary to ensure we can provide a world-class health service.
Unfortunately the issue of automatic entitlement to a medical card for those aged 70 and over had to be reviewed to make necessary savings to continue to provide other critical services in the health sector. It is vital to point out the criteria which will take effect with this Bill. The vast majority of those aged 70 and over will continue to have medical cards under the new income thresholds. The income threshold has been set at €700 per week for a single person and €1,400 per week for a couple. This is a sizeable income per week.
Furthermore, should an individual find themselves to be above the income thresholds outlined there is a process whereby they can apply for a medical card subject to personal circumstances causing undue hardship. There has been anxiety amongst older people which we have all experienced in our constituencies. There has been a great deal of scaremongering, which is not helpful.
Those aged 70 and over who currently hold a medical card will have their entitlement fulfilled under the new arrangements. They will not be subjected to any means test and will continue to hold their medical card. Those who will turn 70 before the end of this month are also automatically entitled to a medical card. Those who turn 70 after the end of this month will be subject to a simplified means test whereby their gross income will be examined to establish if it is below the new income threshold.
We would prefer to be in a position to offer automatic entitlement to medical cards to all those over 70 years of age, but it is not possible in the current economic climate. We have reorganised the scheme to ensure the elderly most in need are protected in terms of medical card entitlement.
It is fair that those who are financially secure and in a position to pay for their health care should be asked to do so at this time. This debate also raised the issue of capitation fees for GPs, which have been paid since 2001 for those over 70 in receipt of medical cards due to age rather than means. These fees have been financially unsustainable and I commend Mr. Eddie Sullivan's efforts in securing an agreement where a single fee capitation level will be paid to GPs in respect of medical card holders over 70 years of age.
Irish people are living longer and healthier lives. I read yesterday that Irish children were ranked first out of 41 countries for physical activity and general health in a WHO survey. We enjoy very high standards of living in this country, which is something that does not receive enough attention. However, much of that is due to the standards in our health services. We have a young population in Ireland, but this is expected to change in the future, as our population ages and people are expected to live longer than in the past. We must plan for this and it is within these terms that the medical card scheme has been adjusted. It is vital that the scheme continues to be sustainable in the years that lie ahead. Therefore, I believe that this Bill provides a fair and equitable method of medical card provision for the ageing members of our society. They deserve to be looked after, and they deserve fair access to health services. That is why the issue had to be addressed at this time. Those most in need are those we are endeavouring to cater for most in this Bill.
The health service has been a hot topic in the past number of years, but that is what is to be expected when an overhaul is in progress. The Minister, Deputy Harney, has overseen the biggest overhaul in the service in recent years, and I commend her and Professor Drumm on their efforts.
For God's sake——
The Deputy will have his chance in a minute, so I will have my say now. There has been much criticism, which has not been constructive, of her efforts, even though she has taken criticism on board when necessary. Nonetheless, she has continued to pursue the changes required in order to ensure that our nation will enjoy a first class health service in the future. There have been shortcomings in the past, but we are endeavouring to ensure that those shortcomings are eliminated step by step.
The decision to develop centres of excellence has been a contentious matter, but I fully support it. If I was unwell, I would much prefer to go to one of these centres of excellence where I would receive top class treatment, rather than attend a local facility where the appropriate expertise may not be available. Politicians come under pressure to retain all services at our local hospitals, but this is not always the best option. In time, the people of this country will realise that the road the Minister is taking is the right one.
Having said that, it is fitting to recognise the importance of the services provided by local hospitals all around the country. My local hospital in Letterkenny continues to provide an excellent service to the people of Donegal, despite the focus in recent years on services that do not exist at the hospital. I commend the general manager at the hospital, Mr. Seán Murphy, and his staff, on continuing to put the patient first in these difficult times. I was relieved to learn recently that the colposcopy services at the hospital are to be retained and upgraded, with a view to being included as one of the centres of excellence by the National Cancer Screening Service, headed by Mr. Tony O'Brien.
We are also pleased that the breast care unit at Letterkenny General Hospital will be officially opened by the Tánaiste later this month. This is very welcome progress. A new accident and emergency unit has been sanctioned by the Department and will include an additional 70 beds. A new mental health unit is also in the pipeline for the hospital, so it must be said that there is good news for the health service in these hard times. It is important that these good news stories are highlighted, because it is easy to be negative, but it is also futile at times. We all recognise that there is not as much money in the Exchequer as we would like, so the onus is on all of us to ensure that there is value for money in everything we do. Less money does not have to mean less effective services, but it puts emphasis on those who are most in need, which is what this Bill is all about. It is about putting the focus on those most in need and dealing with the resources that are available to us. I commend the Minister, the Ministers of State at the Department and the rest of the Cabinet on their constant efforts in ensuring that people are put at the centre of health services and for dealing with those most in need before dealing with anybody else.
I wish to share time with Deputy Seymour Crawford.
I welcome the opportunity to speak on this Bill. I do not understand from where this came. A brave decision was made to recognise those over 70 who contributed to the development of this State, to the development of the services we have and to the development of the standard of living to which Deputy Blaney refers, by giving them a medical card which they prized very much. It was very important to them. Yet, in the recent budget, the Government decided to take it away. Government members saw the reaction of elderly people, even though they thought those people were a soft touch. However, they were not a soft touch.
People who retire are labelled, although they have vast experience of life. They come from all professions and all levels of society. They are doctors, architects, managers, factory workers, carpenters, builders, educators and trainers, yet they are just labelled as retired. The Government decided to attack the service given to them, one that is very important to elderly people. As people get older, they experience disproportionate levels of health problems compared to the general population. Therefore, the medical card is very important to them. The Government witnessed the emotive reaction of people who saw that something they cherished very much was being taken away from them.
Another group that was forgotten included those who expected to obtain a medical card on reaching 70 years of age. These people will no longer receive the card and I do not understand how a decision like that could be made from a human point of view. I do not understand how the Government decided to do this from a political point of view either. Anybody with any knowledge of politics would know that to attack a vulnerable group would be extremely sensitive and that there would be a reaction. The Government thought these people were insignificant. It felt it was taking the easy option by withdrawing services from the elderly, as opposed to trying to achieve savings in the capitation rate for GPs, but that has been flushed out.
Since the Government unilaterally announced the withdrawal of the automatic entitlement to a medical card for those over 70, there has been confusion about the criteria used to determine those who will retain their medical card and those who will not retain it. We are told that most people will retain it, but we just do not know how many people will do so. The Government did not know how many people would be entitled to the medical card when it was introduced in the first place. Now there is absolute confusion about how many people will retain the medical card. It is clear that the Government put no thought into the withdrawal of the medical card. It made it up as it went along. The unprecedented show of public outrage, to which I have already referred, forced the Government into a climbdown from the budget day decision.
Under the terms of the Bill we are discussing, the gross weekly income threshold for medical cards for people over the age of 70 is €700 per week for a single person and €1,400 for a couple. From next January, people who turn 70 but do not have a medical card at present will have to undergo what the Department of Health and Children describes as a "simplified means test" to establish whether their income exceeds the €700 limit. I would love to know how "simplified means test" is defined. Anybody over the age of 70 who has a net income of more than €595 in the case of a single person, or €1,135 in the case of a couple, will not be entitled to a medical card. These figures, which do not include PRSI, show that contrary to the Minister for Finance's suggestion, people who are not millionaires will lose their medical cards. Many ordinary people who have an income above these limits, including retired public servants such as teachers, gardaí and nurses, will lose their medical cards.
I would like to give an example of the manner in which the people to whom I have referred, who have served their country well, will be affected by these changes. I will highlight the position of retired teachers in this regard. The revised means test figures, to which I have referred, will make most retired teachers ineligible for the medical card on the basis of a relatively small level of income. While the limits seem generous on the face of it, they are not favourable to most retired teachers. All income will be calculated as gross income for the purposes of this scheme, as I have said. The pension a teacher receives after 40 years of service is now almost €32,000. If he or she enjoys a slightly higher pension on foot of a modest promotion or qualification allowance, he or she will exceed the limit by a small amount. This will also be the case in households with two pensions — if two retired teachers are married to each other, or a retired teacher is married to a person who is in receipt of a different occupational pension. Like all Members of the House, the Minister of State, Deputy Moloney, will accept that the teaching profession has contributed as much as any other sector, and more than most of them, to the development of Irish society. The standard of living of people in this country has increased as they have availed of the opportunity to participate in the educational system. Our primary, secondary and third level teachers have facilitated such change. This decision will hit the teaching profession hard.
All gross payments for substitute, resource or temporary teaching work undertaken by a retired teacher will, of course, be added to his or her pension for the purposes of calculating his or her income. It will probably cause the gross income of a teacher to exceed the means test limit. Other forms of income, such as savings in excess of a certain amount, interest and dividends from banks or credit unions, are also taken into consideration in the means test. The Government's proposals will have a strong impact on one of the benefits retired people enjoy. There is confusion about the total saving that will accrue from this measure. The Government does not know the exact figure. I would welcome it if the Minister, in her response at the end of this debate, could outline the extent of the savings that will be made as a result of the cruel and unacceptable decision to take medical cards from people over the age of 70.
While I welcome the opportunity to speak on this Bill, I do not agree with its contents. When it suited Fianna Fáil and the Progressive Democrats to encourage people over the age of 70 to vote for them in the 2002 general election, they offered free medical cards to all such people without a means test. We were advised that the measure would cost approximately €17 million per annum. Like many other proposals, such as decentralisation, this proposal was implemented without any preliminary discussions or negotiations with the doctors or other relevant personnel. Of course, the final cost of the scheme was closer to €57 million than to €17 million. The organised propaganda of Fianna Fáil involves blaming the doctor who represented the doctor's organisation at the time for the cost of the scheme. The doctor in question, Deputy James Reilly, is now the Fine Gael spokesperson on health. His job was to get the best deal he could for his members. It is somewhat far-fetched to try to transfer to the Deputy the blame for the Government's mismanagement and incompetence in this case. However, it is typical of this Administration.
The best way of reversing the outrageous decision to remove the automatic medical card entitlement from those who have given such service to this country is to ensure the moneys in question are saved in other areas. I suggest we cut some of the substantial waste in the administration of the health service. I will give an example of such waste. Some time ago, the HSE invited me to attend a meeting to discuss an issue of relevance to the head of that body. Approximately 95% of my questions were answered at the meeting, which lasted an hour and at which nine HSE managers were present. I was the first of the Members of the Oireachtas who represent the Cavan-Monaghan constituency to be dealt with on the day in question. My colleagues were dealt with in a similar way after I was finished. There was no need for nine managers to be absent from their desks for a whole day. They could have met the Members of the Oireachtas from the constituency in a single group and dealt with the issue within two hours. This is one of many examples of cases which exemplify the need to examine HSE structures. Professor Drumm has admitted he does not understand what some people in the HSE administrative system do. I accept that there are some brilliant and hardworking administrative staff in the system. However, I do not doubt that the money needed to pay for the automatic provision of medical cards to everyone over the age of 70 could have been found if the Minister and Professor Drumm wanted to find it.
The Government has done something of a U-turn by providing for more realistic income levels to be applied to the medical card means test. It is sad that the provision of a cervical cancer vaccine to 12 year olds was deferred to facilitate this change. The Minister, Deputy Harney, and the HSE need to examine the manner in which significant sums of taxpayers' money are spent in the health system. All services were available at Monaghan General Hospital when it was run by Monaghan County Council. The Minister, Deputy Harney, has never found the time to visit the hospital. Her only interest, and that of Professor Drumm, is to close the hospital as quickly as possible in spite of the fact that €17 million has been spent on it.
I learned today of a patient with a broken arm who entered Cavan General Hospital on Monday and was transferred to Our Lady of Lourdes Hospital, Drogheda, on Tuesday. Along with 27 other orthopaedic patients, she slept on a trolley at the latter hospital. Her arm was reset and generally dealt with while she was under local anaesthetic because it was not possible to get her a full-time bed, with full anaesthetic services, for a number of weeks. The level of suffering she and a number of others endured, as a consequence of the fact that only local anaesthetic services were available, is unacceptable in any caring health service. This incident happened at a time when the orthopaedic unit at Our Lady's Hospital, Navan, has been closed as a result of the mismanagement of our health system.
I have been ordered by the HSE to attend a meeting regarding the reconfiguration of the Cavan-Monaghan hospital group, with particular reference to the transfer of the acute medical unit at Monaghan to Cavan. It is relevant that this meeting has been organised at St. Davnet's psychiatric hospital complex, as only those with psychiatric problems would consider what the HSE is doing with full ministerial and governmental support. At present Cavan General Hospital cannot cope with its own patient intake and the hospital in Drogheda had to be taken off call a few weeks ago.
Clearly the Minister with the support of her Fianna Fáil colleagues is prepared to treat the people of Monaghan as guinea pigs for a new system that is completely untried and unworkable and will cost lives. This is the advice I have received from highly qualified people not directly working in Monaghan who originally supported the HSE management but now realise it has no idea how to manage its funds or how to run a safe system.
The budget proposal on medical cards caused serious stress and pain to all those over 70 and all those who care for them. As pointed out by Deputy Neville, regardless of the changes made there is still a tremendous fear amongst couples who realise that when one of them passes away the other member will be subject to a much tighter means test and may lose the medical card. At that age the death of a spouse is enough to deal with without having to go through the trauma of a means test and the possible loss of a medical card.
Clearly better negotiations between the HSE, the doctors and all concerned could have avoided this entire trauma. However, as one representing the counties of Cavan and Monaghan I cannot ignore the difficulties within the means-test system for all other medical card applicants. It is totally unacceptable that a county such as Monaghan has only approximately 32% of its population availing of medical cards while Donegal, for instance, has 52%. Other areas such as Cork where incomes are higher than Monaghan have a much higher percentage of medical cards available. While the medical card is extremely important for those in frequent need of doctors' calls and medication, never mind hospital, it is equally of major importance for families living in rural areas who will get a free bus pass, clothing allowance and book allowance it they have a medical card but without which they get none.
There is also a problem for people who are terminally ill. I understand there are question marks over whether these people will get the medical card in future which is extremely serious. For years I have battled in Cavan and Monaghan to try to minimise the trauma those people suffer. They still need to go through a full means test. I remember one case in which a self-employed person with cancer had lost part of his tongue. The HSE insisted that he prepare his accounts for the previous year before deciding whether he would get a medical card. This is the ridiculous gone mad.
At the start of her speech, the Minister for Health and Children emphasised that 95% of people will get the medical card in future following this great dramatic change. One wonders what this is all about. How many of those who were eligible for medical cards actually applied for them? Would some of those super rich people that the Minister and the Taoiseach mentioned have bothered to apply for medical cards? If so how much use did they make of them? Did it cost the State a fortune? Those people would have had private medical insurance. How great will the saving be so that we can judge whether this is a good deal?
Clearly no thought was put into this proposal before it was put on the table. The means test was originally pitched at a level below ordinary social welfare levels. Obviously with the scare of the thousands of people at the gates of Leinster House new thinking needed to be put in and the Government has made a change. Is there any justification for this proposal?
As I have already stated there are major problems in the structure of the HSE. There are major problems in the wider health service with mismanagement etc. I recently heard people talking about what had happened in the other part of this island, the Six Counties, since it got its own Minister. That Minister has sat down and talked to the people. He has asked that they do a little extra each. He has got co-operation from them. Although he did not ask for an increase in budget, he has improved services. Our Minister and the Government could learn from that. A little more involvement with the people who work in the services could do a lot.
I welcome the opportunity to speak on the Bill. Like everybody I fully realise the importance of the issue before us. I am also aware of the background and the response some weeks ago to the budget proposal on the withdrawal of the universal scheme. I would like to make a few points about issues that have come up not just during this debate but in recent weeks. As we are all aware the issue was part of a Government budgetary structure by way of responding to the serious financial issues that face the Government on the economic front.
I wish to clarify that this was a Government decision. For some time members of the public and some Members of the Opposition tried to tie it down to a single decision made by the Minister for Health and Children, Deputy Harney. The decision taken to withdraw the universal scheme was a collective Cabinet decision supported by the parties in Government. It is important to make that point. Much discussion in this debate has centred on wondering how people in Government could make such a mistake as to withdraw medical card cover. In response to that it is fair to point out that normally people on this side of the House are accused of being too cute, as it were, when it comes to dealing with the public. We have often suffered that accusation. I respond by saying that the issue would never have come before us were it not for the times we are in.
A few minutes ago a Deputy mentioned that the greatest sin was that when medical cards were given to all the over 70s in 2002 it created an expectation of medical card cover for life. Access to free medical cards for the over 70s was granted along with many other fringe benefits quite properly and deservedly awarded over the years, including the free travel and other free schemes. Again I emphasise that they are people's entitlements. I find it difficult to square up the fact that people and Members of the House have a difficulty with the Government withdrawing the universality of the scheme and yet in 2002 we had little support. We certainly did not have universal support for the introduction of the scheme.
The Minister of State, Deputy Moloney, always had that support when I was around when we were on the health board together.
He forgets those days.
I do not forget. I am referring to the fact that a few minutes ago one of the Deputies' colleagues made the point that we badly mishandled the introduction of the scheme in 2002.
None of us here now said that.
No, absolutely. I make the point that in 2002 it was a very brave decision by a Government that was clearly in different economic times. It was not an election or political stunt. It was an attempt to continue the support of the elderly over the years. I will not go into all the figures that were before the Dáil this evening in respect of income levels and limits and the means test nor will I go into the funding set aside over the past five years for the care and support of the elderly. There was the entire issue of increased subvention for the elderly in nursing homes and, more important, the recent reform bill by way of the subvention. The suggestion that the Government turned its back consistently on the elderly does not stand up to scrutiny. The very fact that these schemes and those supports——-
These are the people who paid high taxes in the 1960s, 1970s and 1980s.
I will not interrupt Deputy Bannon when he speaks. I have only a few minutes remaining.
I am trying to be fair to the elderly.
The Deputy can be fair when he makes his own speech.
With regard to the issue before us, there was a consistent attempt to provide for the elderly in good times but, unfortunately, when the times turned down we were faced with a particular difficulty. I stress again that any party in Government is not in the business of creating unpopularity for itself. That is a given. The reasons for this decision must be examined. It is important to point out to the House that 1.4 million people in this State are entitled to medical card cover. Of that 1.4 million, 355,000 are over 70 years of age. I support what was attempted by the Government. I said so on budget day and although Members on this side of the House have been accused of applauding the budget and later on——-
The Minister of State did so. He clapped.
I did and had no difficulty doing so. I support my party in Government.
Would the Minister of State do that again?
I would. I believe the Government's attempt to deal with the issue of medical cards was a brave attempt to ensure that the very scarce resources available in the health services would be spread around those who are most in need of support. Of the 355,000 people aged over 70, this decision did not affect 230,000. I will make a further point, and it is not by way of trying to waffle away from the issue that Deputies have put before me, if they say that the budget strategy and the announcement on budget day were somewhat different, it would be difficult to explain the situation in the three minutes available. I do not believe that the hysteria and fear generated from that day——
The Minister of State agrees it was rushed.
Deputy Bannon will have his turn.
I do not say that. The budget was not rushed. There were deliberations for weeks on the budget. I do not even use that as an excuse, far from it. I make the point that on the day of the budget announcement of the medical card issue the belief was created that all cover for people over 70 years of age was to be withdrawn. Nothing could be further from the truth. As I pointed out, the measure did not affect approximately 230,000 of the 355,000 concerned.
There is no point in changing one's tack because the crowd says different. I still support the Government decision. I believe it was an attempt to achieve more. I do not hold with using the names of so-called wealthy people. Such names were well quoted recently but I will say that a certain 20,000 or 25,000 people do not need cover. The strategy was to withdraw cover from people in that category and try to spread what might be saved. The figure was €100 million. Before Deputy Crawford left, he asked if I could confirm where that saving could be secured. It might have been secured by way of the renegotiation of the capitation charges. I insisted at the time that I had no difficulty in that regard in the negotiation with the IMO and the Department. Along with the reduction of overall cover of people in the scheme, that would have provided——-
Does the Minister of State believe the voting machines could have supplied——
Now, now, Deputy Bannon.
That would have provided the savings. The policy in that regard was to ensure that by taking from those who did not need that cover, savings of €100 million would be spread around new services within the Department of Health and Children. It is worth noting that the overall reduction to the health Estimate was a figure of approximately €800 million. On the other hand, new services in the region of €700 million were provided for health in this budget.
Without trying to squeeze the last cent, somebody must look at the process and examine the considerable demands for new health services. Now that the cancer strategy is in place under Professor Keane, it is time to move on to provide expert cancer services for other types of cancers. Professor Keane made that point himself. That again requires new money and a figure of €15 million was put towards that. The commitment has been such that whatever funding was required to support the national cancer strategy it would be secured each year by an increase in the budget strategy for the Department of Health and Children. We tried to get an amount from the medical card scheme for those aged over 70 by reducing the numbers eligible. The savings were to be specifically diverted to progress new strategies.
It is fair to point out that there are many other areas in health for which there were considerable demands in this budget. We discussed the new children's hospital for which funding must be secured to provide that very much needed service. Naturally, all the public attention and that of non-Government parties in the House focused on the medical card issue. There are other issues on which people did not focus, for instance the need to fund a Vision for Change.
What is the Minister of State's view on the money that was wasted on the PPARS?
This is not Question Time.
I thank the Ceann Comhairle. I am not here for questions.
I mean that——
The Deputy can try that tomorrow.
We need Deputy Penrose.
I am almost spoiled as most of the questions have already been asked. It is not merely a matter of reducing medical card cover for the sake of it. It is a matter of taking everything into context. There was a huge reduction in tax receipts coupled with the very great demands on the Department of Health and Children for further new services. In that regard I must support the strategy. I still do.
As the Government faces issues in that area, it must respond to the demands on the street. I do not believe that the demands from the street were part of any change, or any attempt to present a different strategy by way of medical card cover. I was there to meet many of the people on the street who had been convinced——
The Minister of State was very much apart from his colleagues.
In the argument about care for those aged over 70, people were convinced that not only would they lose their medical cards but, as I heard myself in the church down town, that unless they stood to fight on the medical card removal issue they would also lose their free travel and other benefits. That was never in the debate at all. I hope at this point that advocates for those aged over 70 might see that a certain strategy was behind the entire process.
Certain questions came up in the last hour of the debate. I believe I have covered the issue of where the funding will go and what can be secured. I make the point again that the figure in question was €100 million. Deputy Neville mentioned how the issue affects an elderly couple in the event of one party dying. I take his point. There is then a reduced income which remains above the means test for a single person. I understand that issue and I know that a great difference is created in health demands for the now single person. The Minister for Health and Children, Deputy Harney, acknowledged this. She is prepared to look at the matter as the Bill goes through, recognising that the change of status from married couple to single individual would create certain difficulties.
I take the point the Deputy made about retired teachers. It is a much larger issue than that and affects all retired people. I suggest that by taking the comments of Members today, the Minister indicated it is an area she intends to revisit. On the reaction to the public demonstration, if the budget as announced on the day had contained more explanation of the specific details of the scheme and made people fully aware they were not losing their entitlements, the demonstrations we met — and quite properly so — would not have been as tense.
The Minister of State is implying that the Minister for Finance is inexperienced.
I am not saying that. I am making the point — and I have suggested this to my parliamentary party — that the necessity for the Minister for Finance to come into the House and discuss so many major issues within an hour and a half is something we should all think about. Years ago, as I know from running a pub, the big fear at the time of the budget was that the local publican would go out and stock up in advance of budget day to make sure he had enough beer, fags and spirits in the house for the period between the budget and later on. The issues are now so huge that in the run-up to the budget it would be fair for the House to discuss the different aspects of a possible budget strategy to obtain Members' feelings on various matters. Nowadays it is not about how much stock one has in at 12 o'clock on the night before the budget announcement; it is far more important for us all to realise that we are dealing with a slowdown in the economy and, more importantly, trying to support a massive health expenditure of something like €16 billion. The difference between this recession and the previous one is that funding in health has increased. The last time out, it was a decrease.
It was not the Opposition that guillotined the debate. It was the Government.
We cannot have a running commentary.
I am not worried about guillotines or heads rolling or any of that stuff.
We would have plenty of time if the Government gave it to us.
I am just referring to the issues that were raised.
It was asked what would be the outcome of this measure for people with properties. To reiterate what the Minister, Deputy Harney, has already stated, this Bill gives effect to the Government's commitment not to impute income from property. For the purpose of assessing gross income under this Bill, income will not be imputed from any property, whether it is a family home, a holiday home or any other property, unless it is rented, and only the net rental income, calculated as gross income less any costs necessarily associated with renting the property will be included for this purpose. I do not want to use the word "concession", but there is a realisation that property owned by the elderly will not be taken into account in the means test. I have also been advised that people who are 70 years of age before 1 January and hold a medical card on the basis of automatic eligibility under section 45A of the Act, prior to the enactment of this Bill, shall notify the HSE no later than 2 March 2009 if they have concluded their incomes exceed the gross limits. It is important we acknowledge that the Government wants to ensure the process of self-assessment for persons covered under these arrangements will be much simplified compared to the means assessment process required under the existing hardship-based scheme. Consequently, the HSE has been asked to ensure that any assistance with self-assessment required by a person who is currently over 70 be made available on an administrative basis.
Everybody who has been involved in politics, local or national, over the years — somebody earlier mentioned our time on the health boards — will be aware that often, if somebody was over the income limit but was able to provide medical evidence of certain hardships, he or she would be provided with a medical card. This is not a smokescreen or a cop-out. While some may ask how many of the 20,000 we claim are above the income limit never obtained a medical card, we can also point, on the other end of the scale, to the number of people who were over the income limit but were given medical cards because of hardship or health problems.
The Bill also includes a provision to amend the Health Contributions Act 1979 to provide an exemption from the health contribution for any person who is or reaches the age of 70 on or after 1 January 2009. The amendment will exempt everybody over 70 from paying the contribution regardless of whether they fall into the existing categories exempted under section 11 of the 1979 Act.
I fully support everything the Minister, Deputy Harney, has done, is doing and will do in her attempt to reform the health service. I take every opportunity I can to say that. I also try to avail of every opportunity to say that I have full and total confidence in the HSE. After our days as health board members when we saw extensive duplication of services, it is a welcome change to have one entity in charge of health.
Was the Government not going to change it back very early on?
That was with regard to regions, possibly, but there would still be one entity in charge.
Back again.
There is one boss in charge.
It is a pity the debate should come down to personalised charges against the Minister for Health and Children. I have heard of a poster campaign, to which I am totally opposed. I wish her well as she continues with the health reform programme.
I wish to share time with Deputies Breen and Bannon.
That is agreed.
Anybody who fails to recognise the anger of the many elderly people who protested outside the gates of Leinster House and on the streets of Dublin in the recent past misses the whole point of the need for this legislation. It is unprecedented that a Government would introduce legislation to withdraw a service to the elderly — those over 70 — regardless of the times that are in it. If the present Government cannot find areas other than the withdrawal of medical cards and associated services in which to make savings of €100 million, we know it must have scant regard for the elderly.
The Minister of State spoke about savings. Earlier this afternoon I heard the statement of the Minister of State, Deputy Hoctor, in which she diverged from her prepared script and indulged herself by mentioning statements made by other Members of the House — usually this side of the House — ten to 12 years ago on the availability of medical cards. One wonders whether she considered the waste of time and energy for the officials who had to research that information. She probably has such a large number of support staff within her Department that she could waste their time to make a political point.
What is the actual cost of the implementation of this legislation when one considers drawing up the legislation and the changes that must be implemented as a result? We learned from the Minister's speech when she introduced this legislation to the House on Second Stage that there are now three sets of conditions and criteria for special categories of the over 70s. The people who are to implement this on the ground are already confused by statements issuing from on high and from all sorts of places when they are assessing people, legitimately, for medical cards. The Minister of State said he remembered the discretion allowed by health boards. We all remember that. Where is the discretion today when cancer patients in this country are being refused access to the services provided by a medical card, regardless of their age? If that is not the nail in the coffin for many people I do not know what is. Now the Minister of State is talking about withdrawal of medical cards from the elderly. Every single Government speaker on Second Stage has stated that 95% of people will retain the medical card. That statement is inconsistent because the Minister of State has said in his contribution that the majority of people would retain the card. In a matter of four or five pages, the number has been reduced from 95% of people being more or less guaranteed retention of the medical card to that of a bare majority. There is not a scintilla of proof available from anybody, including the Minister of State, with regard to how many people will benefit and how many people will lose out. It is certain that far more than 5% of those currently holding a medical card will lose them. To cap all that, it is stated in section 4 of the Bill that entitlement may be index-linked. Surely if the Minister wanted it to be index-linked she would use the phrase, "It will be" index-linked on 1 September each year. This will not happen as it is only a notion that could or might happen; it is not a guarantee that it will happen. Many more people will, after a year or two, lose out and will be beyond the income limits.
The Minister of State referred to the example of where a spouse dies. If a person is just one single euro over the limit, he or she will lose that facility. The limit is €700 for a single person and €1,400 for a couple. I hope somebody in the Department looked at this before the Government included this provision in the budget. I am certain the majority of people on public service pensions would lose the medical card. I refer to retired nurses, gardaí and teachers who will probably lose out as a consequence.
There are now 350,000 people over 70 years of age and by the year 2020, there will be many more. We are living longer and we have to plan for this. Elderly people live longer as a result of better health services but this will become a burden on the State. If that is the economics behind it rather than the consideration of health needs, then so help any of us if we live beyond that dreaded age of 70.
I can see that the spirit of Scrooge is alive and well and like Scrooge, the ghost of Christmas past is coming back to haunt this Government.
I remind the Minister of State of the Fianna Fáil Ard-Fheis in April 2007, just prior to the general election, and of what the then Taoiseach Deputy Bertie Ahern said during his live television address. He claimed that Fianna Fáil is the party to take care of pensioners. He said: "They talk; we deliver. Just ask pensioners all across Ireland." It seems that today the ghost of Christmas past sits on the back benches. The Minister of State should ask any pensioners now what they think of this Government and the promises it made. The Government has abandoned and betrayed the pensioners. They have very little to cheer about this Christmas. It is not a season to be jolly for many of our older people because they still remain worried and confused about the medical card situation.
The decision to end the automatic right to a medical card for the over 70s was taken for purely financial reasons. This decision was wrong and it should not have happened. Our older people built this country; they have made their contribution. In the twilight of their years they should not have to worry about how they will be cared for in their old age. During the height of this debate they were assured by the Taoiseach, the Minister for Health and Children and the Minister for the Environment, Heritage and Local Government, that this decision would mostly impact on retired public servants and High Court judges but this is not the case. Deputy Neville spoke about retired teachers. A deputation of retired teachers met me to express grave concern about their future considering the contribution they had made to society. They believe many of them will lose their medical cards. Other groups of people affected will include retired nurses, gardaí, former Aer Lingus and Aer Rianta workers in my own constituency and local authority workers will now be excluded.
Statistics show that approximately 215,000 out of the current 350,000 people over the age of 70 have a medical card based on an assessment of means. The Government is telling us that only 20,000 of the remaining 140,000 people will now be affected under the revised scheme but I am not convinced by that argument. In my own constituency of Clare there are more than 9,046 pensioners over the age of 70 who were issued with a medical card as at 31 October 2008. These pensioners and their families in County Clare were put through unnecessary distress by this ill-thought out proposal. I have met many of them and listened to their concerns.
In the case of a medical card expiring in 2012, what is the situation if the person believes he or she is over the income limit and still continues to use the card? Many people are confused. How many of these pensioners will fall into the "excluded" category? Under pressure from the grey revolution the Minister has agreed to alter the income limits for the fifth time. However, confusion still reigns. There is very little information available as to how the entire scheme will operate.
Another one of the promises of the ghost of Christmas past was to index link all medical cards to increases in the average industrial wage. This commitment should be written into this legislation instead of leaving it to the discretion of the Minister for Health and Children to seek consent from the Minister for Finance to adjust these income limits in future years. Under this legislation the responsibility now falls on the old age pensioner to declare his or her income by 2 March 2009. Many older people still have a fear of filling out forms. What about older people who have long-term debilitating diseases like Alzheimer's? What provision is being made for these people and who will bear the burden of responsibility?
The proposed means test will be a fiasco. It is just another botched attempt to try to pull the wool over our eyes. If the Government is now putting the onus on the pensioner to comply with the regulations, how in the name of God can it do so without first clearly outlining how income and savings will be calculated? The issues surrounding the qualifying criteria and how a person's property is to be assessed should be clear and transparent. It should not be an official State secret.
In order to squeeze every last penny out of every hard-pressed pensioner, this Bill also proposes that the health expenses relief will now only be granted at the standard rate of 20% as opposed to the rate of 41%. While the Minister claims that those unfortunate to have a terminal illness, for example, can apply for a discretionary medical card on the basis of their health situation, there is no guarantee that they will receive it. When the older people who will now be branded in the excluded category go to visit their accident and emergency department, need to stay in hospital or have to pay for their medicine they will face additional costs.
It is not too late to change this legislation and leave a legacy for our older people of which we can be proud. It is not too late either for the Fianna Fáil backbenchers who claim that they are sorry for the anxiety caused to our old people to act. We have listened to many Fianna Fáil backbenchers saying how sorry they were. I urge them to stand up and be counted when a vote is called tomorrow evening. I ask them to join the ghost of Christmas yet to come and show compassion for our old people. Join with us and help restore some festive cheer for the old people at Christmas.
The former US President, John F. Kennedy, once said:
Today in there are those who would shut the door of hope on our older citizens — who would deny them benefits adequate to eliminate poverty and despair. But there are others who will not let that door be closed — who intend to fight for the right of all men to live out their lives in dignity and in health. That rescue party is on the way — and there are more of us — and we are stronger — and we will prevail.
We can prevail and we have the courage. I ask Government Deputies to join us tomorrow evening in reversing this decision to end the automatic right to a medical card for the over 70s.
Debate adjourned.