Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

The background to these revised Estimates is the austerity cuts regime, which has resulted in reductions in health spending year on year. A sum of €781 million was cut in this year's budget, more than €750 million in budget 2012 and an additional €130 million in August 2012, and all that followed a cut of €1 billion in 2011. Along with other colleagues, I have said from the beginning that such cuts were unsustainable and would cause major damage to health services and that has proven correct.

In the week of the announcement of budget 2013, the Minister had to ask the Dáil for an additional €360 million in a Supplementary Estimate to prevent services collapsing before the end of 2012, showing once again the unsustainability of the level of cuts imposed. In a report to the Committee of Public Accounts, the Minister for Public Expenditure and Reform blamed the Minister for Health for the December 2012 Supplementary Estimate and the €360 million overrun. Among the savings as distinct from cuts to services not delivered were the promised reductions in the cost of drugs. This has not happened. Medical card holders were made to pick up the tab when their prescription fees were increased threefold. Both the Fine Gael and Labour parties vehemently opposed, rightly, the introduction of such prescription charges by the former Minister for Health, Mary Harney, but since taking office, the coalition has trebled the charges to €1.50 per item and increased the monthly maximum payment from €10 to €19.50. The Minister failed to deliver the promised reductions in the exorbitant price of medicines in the State and, instead, he is passing on the cost to patients with higher prescription charges and the increase in the threshold for the drugs payment scheme from €132 to €144 per month. This latter cut is yet another attack on families and individuals on the margins of poverty, with whom we are all familiar. These people's incomes are just above the threshold for qualification for a medical card. They must bear the full cost of GP visits and up to €144 per month for medication. They were hit with the full range of cuts in budget 2013, especially the PRSI increase and the child benefit reduction.

The health needs of older people, in particular, were attacked in the budget. People aged over 70 with an income of between €600 and €700 per week have lost their medical card and have received instead the GP only card. All Deputies across the board will testify to the fact that medical cards are being taken from people with serious medical needs because of the harsher and tighter application of the income threshold and little compassion or discretion is being exercised in cases I have come across. Only this week, my office was contacted by a man - I can submit the details of the case if requested - with a disability since childhood and with a serious bowel condition and consequent high medical expenses. He had long had a medical card but it has been taken away on income grounds. His appeal has been turned down and such experiences are increasing to the point that they are almost legion. They are not reflected in the dry figures in this Estimate but they are the reality on the ground that I have to contend with.

Government policy claims that primary care and community care are the bedrock of the health service. I agree but these Revised Estimates will result in a reduction of 8.6% in this area between 2012 and 2013. A Government that has pledged to extend free GP care to all and to expand primary care is going in the opposite direction and the figures confirm this. I will revisit this when the opportunity to ask questions presents.

The overall Estimate for the HSE in budget 2013 was €12.32 billion. The Revised Estimate provides for €12.312 billion. Will the Minister account for this difference? According to a quick calculation, this amounts to approximately €8 million. Last year's bout of austerity resulted in the cutting of 950,000 home help hours. The Minister of State at the Department, Deputy Kathleen Lynch, made a claim that there was a commitment to restore these services in 2013 but spending was reduced with the allocation under subhead C1, primary care and community-led demand schemes, being reduced by 8.6%. What is the position regarding the restoration during the remainder of 2013 of the home help hour cuts in 2012? Those cuts have caused significant hardship to many of those most in need. Will older people and people with disabilities whose home help hours were cut in 2012 have them restored during the remainder of this year as indicated by the junior Minister?

Age Action Ireland representatives at the pre-budget forum in Dublin Castle last Friday outlined the reality of cuts for older people. They said the feedback they received during their national consultation process in March was shocking with older people relating how they were going to bed early in the evening to stay warm or using hot water bottles to stay warm rather than turning on their heating or seriously considering the option of getting rid of pets because they could no longer afford to feed them. I support Age Action Ireland's call on the Government to increase the funding for vital community services, home helps, home care packages, day care and meals on wheels schemes, which are intrinsic to supporting people to manage at home, something I must contend with in my own family; to cease the counterproductive policy of reducing medical care eligibility for the over 70s medical card; and to consider options to increase funding for the nursing home support scheme.

Subhead C2 concerns long-term residential care. It is contingent on the passing of the Health (Amendment) Bill 2013, Second Stage of which was taken last week. I oppose the passage of the Bill. The briefing document states the funding available for long-term residential care was reduced by €20 million in 2013. What are the implications of that for the remainder of the year? What will the result be for the nursing home support scheme, the so-called fair deal? Has that been assessed in the context of the reduced number of nursing home places supported by the scheme? Has an impact assessment been carried out?

What has been said about older people can also be applied to people with disabilities in terms of the range of cuts affecting them, many of which are in the health area.

The Disability Federation lists the direct reduction in HSE funding for disability services, cuts to the housing adaptation grant schemes, which is a very serious matter, reductions in special needs assistants in schools, targeting of the mobility allowance and the motorised transport grant, the reduction in the number of personal assistants and home support hours available, cuts in the household benefits package, increased prescription charges, increases in the threshold of the drugs payment scheme, the rolling back of free GP care for all and certainly for people with special illnesses as an initial step, and the reduction in the respite care grant. These have all taken place on the Minister's watch and there is nothing in these Revised Estimates to give hope that any of that is being reversed.

Subhead B3 confirms the budget cut of 5% to the drugs initiative, cutting supports for local and regional drugs task forces. This has caused huge concern and uncertainty across all projects that are trying to address addiction, reduce the harm caused by addiction and assist people to move on from addiction. Services have been directly affected - for example, the hours when centres and contact points are open for people to seek help or avail of continuing support. Again, it is another regressive and short-sighted cut, and one that will cost the State far more in the medium to long term than the so-called saving made in 2013, as it will see more people with addictions requiring hospital care or other residential care, and more of the other social problems caused by widespread addiction. The evidence of that is almost daily demonstrated on the city centre streets of our capital city. It is creating untold concern and, for some, real and substantial fears.

These are the realities of life that present, and the consequences of the cuts the Minister has presided over. I am deeply concerned that, in the Revised Estimates he presents both in regard to the Department and the HSE, we are not looking at any turning of the corner.