Séamus Healy (Tipperary South, Independent)

There are two fundamental issues involving the health service, first, the two-tier nature of the system where access is based on ability to pay and not on medical needs and, second, inadequate funding. There is much evidence to prove that ability to pay is the determinant for access to facilities. I recently heard of a case involving a person awaiting an orthopaedic procedure, who was told that he would have to wait from eight to 12 months for an outpatient appointment. That person asked his general practitioner to refer him to a private consultant. As a result, he received an outpatient appointment within a week and the procedure was completed within ten days. That is the type of service available under the two-tier system, whereby if one has the money one will be looked after but if one does not, one will be on a long waiting list.

The second difficulty involves inadequate funding. Today's report by the ESRI states that Ireland is second last when it comes to health funding. Of the 22 countries surveyed, Ireland spends 7.3% of gross domestic product on health compared to an average of 9% for the other countries. That is a serious difficulty which has arisen.

Another matter identified in the ESRI report is that low-income families are not able to access GP services because they simply do not have the money to do so. Because it costs too much to pay for general practitioner services and medication there has been a huge fall-off in people attending their GPs, particularly those at the cut-off limit for medical cards. The Government promised an extra 200,000 medical cards yet not only do we not have them, but there are also 100,000 fewer medical cards now than in 1997.

I want to provide a flavour of what the eligibility limits are for medical cards. A single person on social welfare of €134.80 per week will not qualify for a medical card. A married couple aged between 65 and 69, whose sole income is from unemployment assistance or benefit, will not qualify for a medial card. A married couple aged between 65 and 69 whose sole income is from a contributory or non-contributory old age pension will not qualify either.

The Minister should immediately grant an extra 200,000 medical cards by making the eligibility limit at least the same as the minimum wage. I would prefer to see free access to GP services for all, although I know the new Minister will not do that. She should at least increase the eligibility limits so as to include everybody on the minimum wage.

For some time, facilities have been completed at Our Lady's Hospital in Cashel, including an Alzheimer's unit, a physical disability unit and two psychiatric units, which are all vacant. Funds should be made available to open these units immediately. I hope we will not have to take to the streets, as we did in Clonmel, to make these units available to the public of south Tipperary.

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