James Reilly (Dublin North, Fine Gael)

Deputy Jan O'Sullivan is correct in her assertion about homeless people. Many have come through the psychiatric service and have serious psychological damage and psychological issues. They will not pay the 50 cent charge. Many are on psychiatric medication and will go off the medication and end up presenting a serious risk to themselves and others. They will end up in hospital, costing the State horrendous amounts of money. I remember this as a major issue in the greater Dublin area when I was on the health board and chairman of the psychiatric hospitals committee. When people moved from one service to another, they fell off the wagon, stopped taking their medication and did not present for further injectable medication called depot preparations. Many of these people are not prone to compliance because of the nature of their illness. When they feel well, they do not like the idea of attending for injections. They must be monitored. I see terrible trouble if we include those who have got better to the point where they can depend on medication and then create a block between them and their medication. This Bill is unwise but if the Minister is hell-bent on proceeding with the Bill, so be it.

It speaks volumes that not a single Member of the Fianna Fáil and Green Party coalition Government is in this Chamber for any part of the debate. They saunter in for the vote, yet they can get exercised and agitated about puppy farms and stags. The country is quite upset that when there are so many important issues, these are the matters we spend what little time we have discussing, notwithstanding that they are important in their own right. This is particularly true of puppy farms.

Psychiatric patients represent a major issue. I alluded earlier to the long-term illness card. Most people with medical cards have dispensed with their long-term illness book a long time ago. Those with medical cards and with illnesses covered by the long-term illness book will be seriously disadvantaged unless the Minister accepts these amendments. There is no harm in these amendments; they empower the Minister. I note the Minister has the power to exclude other groups by ministerial directive. If she made it clear these groups were excluded in the legislation, it would go some way to protecting the most vulnerable in society. Those I would like to see covered include those with a mental handicap or mental illness, even though this only applies to those under 16 in respect of the long-term illness card, phenylketonuria, cystic fibrosis, spina bifida hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, multiple sclerosis, muscular dystrophy, Parkinsonism, conditions arising from thalidomide, acute leukaemia and high blood pressure. I also wish to include cancer care, asthma, congestive cardiac failure, chronic obstructive pulmonary disease, Crohn's disease, lupus and Huntington's disease. Many of these conditions are not even on the long-term illness scheme although they should be. The entire thrust of this measure is not simply about raising money. The Minister has been talking about trying to improve prescribing or at least to discourage the concept to which Deputy Jan O'Sullivan referred previously, which often is described as taking a pill for every ill, rather than looking to oneself and one's own lifestyle issues to address some of the problems one develops as a consequence of smoking, drinking too much, being overweight etc. If one wants to get away from this by including a prescription charge, that is one thing. However, to have a prescription charge apply to those who absolutely need their medication and, in its absence, whose chronic illnesses or condition will deteriorate, thereby necessitating hospitalisation, simply does not stack up or make sense.

Although I do not believe Members will get to it, I wish to give notice that I would table an amendment that also would cover people with disability who are adults. At present, as Deputy Ring and I pointed out previously, a family of two parents who have medical cards but who are getting on in years and who look after their intellectually disabled child, who may now be in his or her 40s, will face a maximum of €20 and not €10, per month. Consequently, they also should be included. In addition, I had hoped to include nursing home patients because notwithstanding the Minister's comment that there are many private patients in nursing homes, many such patients have medical cards and are on extremely limited incomes. They are the very people who are likely to have the full ten or 20 items on prescription but they are going to lose out. As already has been pointed out, they now have very little spare money as the fair deal scheme takes 80% of their income to pay for all their other needs, including clothing, therapies or any form of social activity and this measure will hurt such people and hit them hard.

Moreover, as Deputy Jan O'Sullivan mentioned earlier, this Bill raises an issue for pharmacists in respect of how they will manage to collect this money and how they would make decisions to deprive people of their medication, were they to fail to collect 50 cent from them. This simply does not stack up and somewhere along the line, they also will be obliged to bear the burden in this regard. In addition, this will not do anything for the pharmacist-patient relationship. Members have frequently discussed the massive issue pertaining to compliance. All doctors have visited people's houses in which one opens up the wardrobe, only for a load of stuff to fall out on top of one that has not been used. This is a huge issue, as is getting people to take their medication. People are not always as upfront with their doctors as they might be. Someone with high blood pressure might have been put on five different tablets because one is trying to chase after them but then one discovers the patient is either taking none of them or does so sporadically. Alternatively, people might swap and change their medication with their spouses and doctors come across all such scenarios. Compliance is a huge issue. It will not be achieved in the absence of a good relationship and the pharmacist must maintain that relationship with the patient.

As it is 6.55 p.m., I do not wish to take up any more time. I ask the Minister to indicate she is prepared to accept these sensible amendments that affect the very people who should be encouraged to keep taking their medication. They should not be penalised for being compliant with their chronic condition medication, which saves us money in the long run by keeping them out of hospital.

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