Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I will try to be as brief and clear as possible. Deputy Kelleher mentioned the fair deal scheme, which I will deal with. Others will speak about the Portiuncula Hospital issue. Both the Deputy and I agree that orthopaedic treatment is a serious pressure point as it keeps people mobile etc. We must deal with it.

We have managed to reduce the fair deal backlog with additional funding, although I fully accept it is not enough. I will continue to pursue the idea that the fair deal scheme should be demand-led and that element should ensure a more structured and planned mechanism so people do not continue in hospital where it is not necessary. I dispute all the time how we deal with ourselves and our needs as we age. It should not just be about long-stay care. It always strikes me that in the three areas where I have responsibility - mental health, disability and older people - I am charged with taking people out of institutions with two areas but with older people, I am almost charged with putting them into institutions. I will get to Senator van Turnhout's point, as I agree with her substantially. There must be a balance but the fair deal scheme must be demand-led. That will take substantial resources, although the country does not have them at this stage. We will have those resources in future.

Deputy Ó Caoláin mentioned the mental health legislation, which I received approximately four week weeks ago. We had other issues to deal with and we will publish it very early in March. The Deputy will be very happy with what the group has formulated. There was no interference and it is a very independently minded group. The work it has produced is incredible. With regard to employment, education and stigma, we must remember that the Mental Health Act is really about detention and treatment, so the new legislation cannot deal with what the Deputy mentioned. We can consider stigma and education of the people in general, rather than people with a difficulty with mental health, as something separate that needs to be enhanced. We need to put a greater focus on such matters. Each and every one of us has done a substantial job with mental health issues and there is no disagreement. Perhaps we need to start having a clearer focus on removing the stigma. We always perceive mental health to be at the extreme end with a "no recovery" model but we all know there is the possibility of recovery. People can have poor mental health and good mental health at different stages in their lives. This will be a substantial improvement. The process is human-rights based and it is geared towards ensuring that when the capacity legislation is published and enacted, it will dovetail with that work. The Deputy will be happy enough when that happens and we will have briefings for the Opposition at that time.

Senator van Turnhout commented on medical cards and the only way we will get to the point where we will not have the hard cases is when we all have medical cards. I understand perfectly where the Senator is coming from and the specific cases which she raised and which we have been working on. The legislation is written not in terms of the convention but family circumstances. If people want to change that, it is a different campaign entirely. Even two specific and recent reviews still tell us that we should not move to a condition-specific process or from the realm which stipulates that it must be based on financial means. These were independent studies.

Senator Crown may know more about this than anybody. The members can take my word, although we may not have said it aloud, that there is no barrier to treatment for cancer in this country, whether one has a medical card or not. It is one great service that has emerged over the past number of years. I give credit to both the previous Government and its predecessor in this respect.

When we have a serious look at medical cards, we know it is not always about medical access, as there may be issues with aids and appliances. We have separated that sector and aids and appliances will not be given according to clinical need. That is important to note. There is a GP card, long-term illness card and the drugs refund card. We are managing to deliver to people who are in the greatest need, although they do not fit criteria. We are managing to deliver to these people a comprehensive medical system, as far as possible without fees.