James Reilly (Dublin North, Fine Gael)

The Bill is vehemently opposed by the Opposition with good reason. It will be aimed at the most vulnerable, sickest and weakest in our society and, yet again, as I pointed out to the Taoiseach on the Order of Business yesterday, he has long-fingered, along with the Minister, the tough decisions that have to be made about generic prescribing through which hundreds of millions could be saved and goes after an area where the Minister might save €25 million in a full year. I wonder whether she will and whether this legislation will transpire to be penny wise and pound foolish because it puts an obstruction between those with chronic illnesses and their medication.

Anything that discourages people from taking their medicine results in them falling ill, developing complications and having to attend hospital, often being admitted. A single day in hospital more than wipes out the cost of drug treatment for an entire year for the vast majority of people. These might be savings in theory but, as has so often happened previously, they might transpire not to be savings at all.

The Minister said: "Section 1(c) provides that any regulations made under section 59 shall be made with the consent of the Minister for Finance." Again, more control will be devolved to the Minister for Finance and his Department, as if they do not have enough control already. I remind the House that this is the same Department of Finance that got all its predictions wrong on both our way up and our way down. It is the very Department that led us blindfold into the current mess, no doubt encouraged by the Government. The cost of our economic mess should not be laid on the people who are least able to bear it.

The Minister spoke about off-patent price cuts and the reduction in mark-ups, saying significant progress has been made in recent years. It is only in the last year that any improvement has been made with the main manufacturers of the drugs they produce off-patent. Why is it the case that a cholesterol-lowering drug in this country was costing €28 per month for the brand leader and €27 per month for the generic product while a mere 45 miles up the road in Newry it could be bought for £1.40, or €2? That is one-fifteenth of the price. Clearly, there are huge savings to be made in that area and that is where our focus should be.

This 50 cent charge might not appear to be much to the Minister or me, but it is for many low income families. International research shows that any disincentive for people to take medicines should be avoided, as certain patients will inevitably end up in hospital. The nearest jurisdiction to Ireland, Northern Ireland, has abolished prescription charges. We are going in the opposite direction. Wales has also abolished these charges and the Welsh Assembly document called "Helping to improve health in Wales" found there was no increase in the number of prescriptions dispensed in Wales following the removal of the charge. One wonders why this country is going in the opposite direction. In the remainder of the United Kingdom where these charges still apply, and when they did apply throughout the United Kingdom and Northern Ireland, they have never applied to the lowest one third of income earners, the people who comprise the vast majority of the people in this country who hold medical cards. There is no precedent for this in these islands or elsewhere. By taking this course, the Minister will discourage people from taking their medicines, with dire consequences for them and serious financial consequences for us. It really makes no sense.

The Bill provides for some exemptions. As a general practitioner, I am aware of people with long-term illness cards who subsequently receive medical cards while retaining their long-term illness card. These people will not have to pay for medicines relating to their illness. What about those who have a medical card but have never had a long-term illness card, and never saw the need for one due to having a medical card? They will be subject to the prescription charge. Surely that is inequitable. The Minister's list of exemptions should include the entire list of illnesses on the long-term illness card, such as mental handicap, mental illness, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, multiple sclerosis, muscular dystrophies, Parkinsonism, acute leukaemia, high blood pressure and cancer. The last two are not on the long-term illness card, but they should be, as well as Crohn's disease and asthma. It is well known that if people stop taking their asthma therapy, they will feel fine for a while but that predisposes them to an acute attack which could be fatal and in many cases will hospitalise them.

The Minister referred to the 50 cent and the consumer price index. The Taoiseach this morning made it very clear where this is going. He was patting himself on the back for starting the charge at 50 cent when Mr. Colm McCarthy had recommended €5. However, it is clear that once the Minister gets this charge under the door, it will continue to increase. Is the Minister prepared to give an undertaking to the House that it will not happen? Even if she gave that undertaking, what would it be worth? The Minister referred to the Health (Amendment) Act 1996 which provides the equivalent of a medical card and free health care to those who suffered hepatitis C infection through contaminated blood products. Of a total of 54 women who were in the course of attending that tribunal, 24 were accepted as having hepatitis C even though their titre was not measurable. The Act was changed in 2006 and now they cannot get a Health (Amendment) Act card. I met those women this morning and was told that the Minister had given them her word that she would address that, but they are still waiting for her to keep her word.

It is not my intention to use the full 30 minutes as there are important amendments to examine. How will the Minister administer this? How will she administer reclaims? If I have a medical card and am on holiday with my family, and all I will be able to afford is a trip to Kerry, Cork, Monaghan or Cavan, and one of my children gets sick or I run out of my medication and have my prescription with me or I go to a local general practitioner and have the medicine prescribed for me, how will I reclaim that if I am not at my regular chemist? There are all sorts of logistics involved. What price has been put on that? Please do not tell us it will not cost anything to administer this because we know there will be a cost. Administration comprises a large part of the bill for the black hole known as the HSE. The putative savings of this scheme are questionable and the cost of administering it is unclear.

In the provisions of the Bill dealing with exclusions and definitions, section (1E) states: "In subsections (1A) to (1D) .... 'dependant' in relation to a person with full eligibility, includes an adult person with full eligibility, so long as that adult person is under the age of 21 years and receiving full time education and is wholly or mainly maintained by the first-mentioned person." Where does this leave parents on medical cards caring for disabled adult children who also have a medical card?

They are not part of the maximum €10 charge because they will be outside it. I humbly suggest the Minister modifies the Bill to avoid this.

I have spent half an hour outside the gates of Leinster House today with parents of disabled children who are having their respite services removed. I spent Monday evening at the Brothers of Charity care centre in Galway with Deputy McCormack and it is very clear that these parents are under terrible pressure. In view of a penny wise, pound foolish HSE initiative, which the Minister approves, they will lose their respite care. Parents who are getting on in years cannot cope without it and will give up, much and all as it will hurt them to do so, and these children will end up in full-time care, costing the State many multiples of the money required to provide respite care. I ask the Minister to consider using her prerogative on Committee Stage to ensure that adult children with disabilities are included with the remainder of the family in the maximum payment of €10 per month.

I have received representations from Nursing Home Ireland whose members are very concerned about the impact of this charge on nursing homes. They are concerned that patients with medical cards who are also in receipt of the old-age pension will have to give up 80% of that pension under the Fair Deal arrangements. They will be left with a very small sum of money and up to €10 a month could be taken from their remaining €40. That is not fair and the Minister should examine this area.

I am utterly opposed to this Bill as it is penny wise and pound foolish. It hurts the weakest people in society. The amount of money it will save is questionable while the amount of money it will cost to administer the scheme is unknown. Ultimately, the Exchequer will lose out, as people end up in hospital because of difficulties with affording their medication.

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