Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I again apologise for being unable to attend for the opening remarks. We all accept the difficulties and pressures the Government is under in terms of cost reduction and trying to remain within the budget targets. Within that, medical cards, for example, are an issue. While the Minister refers to the fact that 44% of the population have medical cards, they are primarily getting them based on a financial assessment of means as medical cards are awarded under that. What is definitely happening in the system is that the discretionary element with regard to medical need is being grossly undermined. That area must be looked at. Previously, while there was no automatic entitlement, people who had cancer would get a medical card based on medical need. We now have a situation where people simply cannot get medical cards on discretionary medical grounds. That must be looked at. While we accept that there has been an increase in the numbers, it is primarily due to the downturn in the economy, as the Minister so eloquently tells me on a regular basis. This must be looked at in the context of the Estimates for the year to come because we cannot have a situation in which people with very serious illnesses who face massive costs and dislocation of their families cannot access the basic medical card on discretionary grounds. That should be revisited. The budget last year featured the withdrawal of 40,000 medical cards. When one looks at how they are being randomly picked for assessment, it beggars belief. It is certainly very random because we have situations in which letters are being sent to people asking them whether their financial or medical circumstances have changed. Clearly, any cursory look at their files would suggest that they have not changed. Is it necessary to send out such letters to those individuals? There might be some other method of profiling people in a better way, as opposed to this random selection process that seems to be happening with the withdrawal of 40,000 medical cards.

I welcome the decisions regarding high-tech drugs that the Government has decided to fund. In respect of the savings on drugs of over €440 million over three years, if one looks at the decisions that are being made, clearly there will not be as much of a saving over the next number of years as the Government had anticipated because there will be an increased cost due to the decision to cover these high-tech drugs that were not covered heretofore. So while the Government is pencilling in savings, I do not think they will be realised to the extent the Government hopes. Could the Minister comment on that issue? When one looks at the Croke Park agreement and the sacrifices staff have made under the FEMPI Acts and through changes in work practices and the pressures they are under, one can see that we need to acknowledge that there is huge pressure on front-line staff. There are huge pressures in our maternity hospital in Cork. It was originally recommended for 5,000 births a year, was built for 7,000 and is now at about 9,500 births per year. Many of the complex cases also come to Cork University Maternity Hospital because it has a good neonatal system and is a tertiary hospital. If one looks at the staffing levels on key front-line areas, one can see that the situation must be revisited very quickly. I accept the need for an embargo in broader staffing terms in the public service but in key front-line areas, it is too arbitrary at this stage. The Government must look at opening up that area, particularly in front-line emergency departments or maternity hospitals throughout the country and other key front-line services, because they are simply unable to cope with the huge pressure and stress. When one talks to individuals who work there, they say there is now a risk to patient safety. That is quite clear. Some very senior clinicians have come out and stated that they are concerned about work practices and pressures on front-line service providers and the impact on patient safety. That must be looked at before we have a tragic case on our hands in an emergency department or maternity hospital.

I know the Government has had legal difficulties with the roll-out of free GP care but the difficulty is that those legal difficulties were identified last year. We have now waited another year and still do not have a blueprint for how the Government intends to roll out its proposals for free universal GP care over the next two and a half years if this Government runs its full term. Will it be pencilled into the budget arithmetic in October 2013? Will the Government have a definitive blueprint of how it plans to roll that out? If some of those issues have already been referred to, I do not want the Minister to have to be repetitive. I can get the information from the blacks later on.

The Minister referred to us as criticising, advocating and highlighting, as an Opposition is sometimes prone to do. It is our duty to do that. At no stage have we been disrespectful to staff when we highlight inefficiencies and deficiencies in the health service. We are primarily targeting the policy decisions of the Government and criticising the fallout from them. I do not think any Deputy around here ever says that the people involved in the health service are doing anything other than giving 100% all the time, and sometimes above and beyond that in the call of duty.