Liz McManus (Wicklow, Labour)

I welcome the Minister of State. I am astonished that he and not the Tánaiste is taking the Bill. I do not see this as a matter of sorrow, as Deputy Twomey does. Rather, it engenders in me a certain suspicion. The Minister developed a reputation over the years for shouldering responsibility and telling it as it is, yet it is noteworthy that she is absent. At a time when a Bill is being introduced in the House relating to two issues central to Government policy, it is remarkable that the Cabinet Minister responsible is absent.

This Bill deals with two unrelated matters. It provides for charges to be levied for nursing home care in line with the Supreme Court judgment on the Bill recently struck down. It also provides for the new general practitioner-only medical cards. While they are unrelated, the two issues are linked. In 2001, when the Government drew up legislation to extend medical cards to the over-70s, the anomaly regarding charges being levied against those in public nursing homes came into sharp focus. This was the moment when the fudge that had prevailed should have been faced up to. That point was made by the Supreme Court and begs the question why the Government parties, Fianna Fáil and the Progressive Democrats, did not deal properly with issue then. It was the Government's decision to change the law on medical cards, which has proven to be extremely wasteful and costly for taxpayers. It was a decision made for opportunistic electoral purposes.

Now that she is presiding over this fiasco, the Minister is desperately trying to wrap the mantle of 11 Governments around her for protection. She referred back to the McInerney case in 1976 in her attempt to spread the blame. She also referred to senior counsel opinion provided by Ronan Keane in 1978, but there is no published record as to what that opinion states. She has an obligation to publish that opinion so that we can see what precisely is the basis of the argument used in her damage limitation exercise. If there are matters arising from that opinion which are in the public interest, I strongly urge her to publish it now.

She also needs to tell the House when and why exactly she changed her view on the nature of the problem. In her speech of 16 February 2005, she stated:

In my statement to the House last December I stated that the charges had been levied in good faith. The Taoiseach made similar statements, both of us on advice and on the basis of the information available to us at that time. The Supreme Court decision today does not make a judgement whether the charges were made in good faith or bad faith, but in the light of the Supreme Court judgement and in the light of information that came to light in preparing for the hearings at the court, I would not now characterise the levying of these charges in the way I did in December. For example, legal advice was provided in 1978 by then Senior Counsel Keane and McCann that the basis of charges was not sound.

This statement has very serious implications. If a public official or office holder purports to exercise those powers, having received legal advice that such an exercise would be contrary to the law, he or she leaves himself or herself personally open to accusation of malfeasance in public office. One can only presume that the Minister for Health and Children had chosen her words carefully, so her words open up the scenario that cast doubt on the competence, integrity and liability in the civil courts of public officials and public office holders.

It is important that the Minister clarify the time she changed her view and the information that led her to arrive at such a potentially damning conclusion. We do not need to wait for publication of the Travers report since she made these statements in the House and should be able to reveal the basis for them in this House. I hope that she does this by the end of Second Stage. Despite her commitment to publish the Travers report swiftly and her indications that the report would be on her desk yesterday, we now know there is a delay in bringing it to Cabinet. The Taoiseach's reply this morning did not engender confidence that this report would quickly be in the public arena. Will we have to wait until after the by-elections before the public can have the full information to which it is entitled? It certainly seems that the process is being delayed unduly, which is not acceptable to anyone from the Opposition and does nothing to enhance the Minister's already bruised reputation.

We know that the issue of charges and their legality were clarified with the introduction of the over-70s medical card scheme. In 2002, the South Eastern Health Board sent an 80 page legal opinion to the Department relating to long stay care and the legality or otherwise of the charges. We know it was also circulated to other health boards, but we do not know what was in that legal opinion. I have sought that the legal opinion received by the SEHB be published, but again the Minister has refused to do so. It appears that she prefers to drip feed selected items of information as it suits her, to put some gloss on her own deplorable record of trying to legalise retrospectively unlawful charges against vulnerable people. Again I ask her to publish this legal opinion and, with the Keane opinion, to open it to public scrutiny.

She has published the minutes of a very high level management advisory committee and CEO meeting which was attended by three Ministers, Deputies Martin, Tim O'Malley and Callely, as well as senior departmental figures and health board CEOs. It is interesting that the Minister who was not at that meeting is here today for this debate. The issue of long stay charges was the third item on the agenda and a clear decision was made to refer this matter to the Attorney General to have an assessment of the need for a stand-alone Bill. The then Minister for Health and Children, Deputy Martin, stated that he was not present for that particular part of the meeting, yet it is simply incredible that he did not read the minutes of that meeting nor understand the importance of the matters involved.

It beggars belief that the then Minister for Health and Children, Deputy Martin, can maintain such a position. He has serious questions to answer and he should come into the House to answer questions on his entire role in this fiasco. He cannot wash his hands in the manner of Pontius Pilate, no matter how hard he tries to do so. The Minister of State with responsibility for older people was in attendance all the way through the meeting, as was the Minister of State with responsibility for mental health. What have they to say for themselves? How do they explain their negligence on an issue that was the subject of a central discussion at a meeting at the highest level of their Department? Deputy O'Donnell defended the Minister in this House, claiming that Ministers were being kept in the dark and that this was the problem. That may be part of the problem, but it is very clear from this meeting that Ministers were not kept in the dark and that the issue was discussed in their presence.

During her speech on the original Health (Amendment) Bill 2004, which has since been struck down, the current Minister for Health and Children stated:

Arising from that meeting a small group was convened within the Department to prepare a position paper on the legal issues surrounding charges for long stays in public institutions. This position paper was drawn up at the end of January 2004, as was a letter to the Office of the Attorney General requesting legal advice that would have been signed by the Secretary General. Unfortunately, this letter was not sent at that time.

Was any Minister involved in any way with this special group? Was there involvement in any way by the senior Minister in respect of the letter to the Attorney General not being sent? We are having a debate on these issues and asking legitimate questions, yet we do not have the essential information that this House needs to ensure proper scrutiny of the Government record. The Travers report is delayed and that fact can be used as a handy shield for the current Minister for Health and Children, but there is nothing to stop her from fully answering the questions posed today that need to be answered. It might redeem her in the eyes of some, at a time when she needs it.

In the most recent opinion poll, one third of the population now thinks that the health service has deteriorated under her watch. This is a remarkable come-down for a Minister who promised so much on taking office. She stated: "The one thing I want for the country I love is to have a health service that is accessible to every citizen regardless of their wealth." She went on to speak about a world-class health service. We now find that six months later, one third of the population is convinced that during her term of office, the health service has deteriorated.

All we have seen from the Minister has been the administrative change in the establishment of the Health Service Executive. In a tremendous rush before Christmas and following a disgracefully guillotined debate it was established on 1 January. Now that it is in existence, I can compare it only to a headless chicken running to stand still. It is without direction, leadership or a chief executive officer. As we saw in recent days, the body the Minister vaunted as the great hope to manage the health service cannot even organise and manage a phone helpline. Hundreds of people could not get past a voicemail message to obtain the information they needed on the hospital charges debacle. I recall my constituency colleague, Deputy Roche, making great mileage out of the ending of the voicemail culture in the public service. I wonder what his criticism would be of his Cabinet colleague's failure to ensure the successful operation of a helpline.

It is important that we receive answers on the Travers report. The Minister for Health and Children, Harney commissioned the report was commissioned and undertook that it would be completed quickly and published. This morning, my party Leader asked the Taoiseach to indicate when the report would be published, but the latter refused to answer the question. He evaded it and failed to indicate a timeframe, saying it was already in the public arena, which it is not. It should be. It is important to ensure that publication of the report does not depend on what is in it, but on the public's right to know. While the Minister herself has described the fiasco as the result of systemic maladministration, she has not explained in detail precisely what she means. She is noted for shooting her mouth off on occasion as we saw in the impact such behaviour had in the context of a tribunal issue. When a Minister uses such language, she has a duty to explain precisely what she means and should not leave her words to hang in the air and cloud an issue in a malign way.

Somebody must clarify what people qualified for public nursing home care but did not receive it, as indicated by the ombudsman. Perhaps the Minister of State, Deputy Seán Power, has the answer. The people in question entered private nursing homes and were forced to pay for the care they received. We must hear a Government view on whether they have rights, including the right to compensation.

As Deputy Twomey pointed out, there are significant issues to address, which have nothing to do with charges and everything to do with long-stay care. There is a shortage of public nursing home beds. Quite apart from future needs, we lack the capacity to deal with today's demands. The Government promised to fast-track the delivery of 850 community long-stay nursing home beds through public private partnerships. Years after the promise, not one bed exists on a drawing board let alone in a completed facility. It is an indication of the lack of planning and strategising that has characterised the Government's policy on care of the elderly and it is a matter of great concern.

As we are all aware, the population is ageing. While we are fortunate that our population has a younger profile than those of many other member states, I would have thought it provided us with the opportunity to get things right ahead of time rather than to lay the foundations for a future crisis. Nursing home residents and their spouses are being pauperised as subventions are not enough to cover the costs of nursing home care. Some cannot manage to pay for care without losing everything, while others cannot pay even after losing everything due to their low incomes as pensioners. The Government must deal with a set of strategic issues in this context.

While everybody understands and accepts the principle that the State should meet a portion of the costs facing people in public nursing care, the parliament for older people has pointed out that the proportion of a person's pension left for pocket money may be too low. When one itemises the costs for newspapers, haircuts, presents for relations and cigarettes, it becomes apparent that the proposal to limit pocket money at a low level requires review. I hope we receive more information on the way in which the compensation scheme will operate. In the case of the drugs refund scheme under which moneys were illegally deducted from people's funds, it was enormously difficult to access the sums owed. The onus was placed on individuals to make their cases to the Department instead of on the Department as the body that made the mistake. If the system of compensation is difficult to understand and places the onus on people to prove their cases, it will be unfair. Enough unfairness has been levelled against vulnerable people like those in long-term care.

We are finally seeing legislation on the general practitioner only, yellow-pack medical cards. It is important to place the proposal in the context of the difference between the Government's promise and reality. The Government promised 200,000 new medical cards, not 200,000 yellow-pack cards. The original promise implied access to a great many services including drugs provision as per the entitlements under the security of medical card cover. It is important to note that since the Minister announced in November or December that she would provide 30,000 new medical cards, between 10,000 and 11,000 people have lost their cover. It is indicative of the difference between the Ministers' promises and reality as experienced by patients who find it difficult to pay their bills.

Opposition Members often complain that they do not have the resources required to make their cases. I am delighted we are to be provided with researchers in the near future. I pay tribute to the small, dedicated Labour Party staff who do a great deal of work to ensure that we have a sound basis on which to make our arguments in the House. Labour Party staff did excellent work in tracking the Government's record on medical cards as opposed to the spin. We produced a document recently, entitled A Cruel Deception, which tracks the story of the loss of medical cards during the term of office of a Government which promised to increase the number issued.

It is worth looking at what the Government has said. The national health strategy stated there would be significant improvements in income guidelines to increase the number of persons on low incomes eligible for a medical card and to give priority to families with children, particularly those with disability. The 2002 Fianna Fáil manifesto stated the party would extend medical card eligibility to more than 200,000 extra people with a clear priority given to families with children.

These are the promises, but since 1994 the percentage of the population covered by medical cards has plummeted. Some 36% of the population was covered in 1994, but by 2004 that figure was down to 25.7%. The GP's contract allows for up to 40% of the population. We are a very rich country and we can afford to provide medical cards for people on low incomes who cannot get to see their family doctor and pay the drug bills to keep their families well.

This is a cheap "Lidl style" medical card. Money is being diverted elsewhere by the Government into less important causes. What can be more important than a family having the security of a medical card? They could have that without legislative change. They could have it immediately without new deals with doctors, or awful deals such as that struck with regard to the over-70s. It should be straightforward; it is all there.

The only thing required is a Government to commit the money and live up to its promises. However, that is what we do not have. We have a Minister who claims she is now delivering 200,000 new "yellow pack" GP cards. Shame on her. People need the security of knowing they can access care when they need it. A family-only doctor card is better than nothing, but are we really that cheap in this country? Have we not developed in ways that we can afford to? Are we going backwards? One only needs look to the past. The former Fianna Fáil Minister, Erskine Childers, delivered and ensured there was fairness in the system. He created a way of ensuring people could access care, yet now when we are so much richer and more capable of providing for people we are doing proportionally less for them. That is deeply disappointing and adds to the cynicism people feel about the Government.

While the number of medical cards has plummeted, medical costs have also plummeted. Our document showed, for example, that there has been a 62% increase in health inflation since 1997. The industrial wage went up by only 51% and the increasing rate of inflation by 29.4%. Until the recent changes the increase in income threshold for medical cards was only 27.88%. One must look at the actual costs that people without medical cards must meet. Inflation in the health sector is up 62% since 1997; inflation in the cost of doctors' fees is up 75.6%; and inflation in the cost of hospital fees is up 108%. The drugs threshold has increased greatly. People simply cannot afford to care for themselves and their families.

We now have a cut-rate deal which may or may not work. The Minister promised 30,000 medical cards, but fewer people are now getting cover than when she took office. She is stating that this Bill will bring in 200,000 people under the "yellow pack" scheme, but there is no link between the Bill and the figure of 200,000. She may say that, but the evidence is not there. We must tease out this matter on Committee Stage.

Last night I attended a meeting of post-polio sufferers and the issue of medical cards and long-term illness cover came up. This issue was raised at the Joint Committee on Health and Children and there was all-party unanimity that post-polio sufferers and their support group need to be prioritised. These people are suffering the severe effects of polio later in life even though they contracted it years ago. There is only one generation; there will be no more. However, these people are still in our community and still experience great difficulties. I urge the Minister to ensure this small category of vulnerable people are properly provided for.

I thank the Secretary General for coming to the committee and I thank the Minister for providing €300,000 for this group. However, the protection of the medical card scheme and long-term illness cover would substantially improve their lives. That type of intervention would prolong the quality of life for those who suffer so much, and we should look after them.

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