Paudge Connolly (Cavan-Monaghan, Independent)

I welcome the opportunity to speak on the Bill which provides for the introduction of GP-only medical cards as well as providing a basis for levying charges on elderly persons in nursing homes and full-time care. Nobody doubts that the provision of GP-only medical cards, or "yellow pack" cards as they are popularly known, is a step in the right direction. However, the Bill appears to have a few ominous, restrictive qualifications that will water down the provision of such cards.

I call for a moratorium for people who currently have medical cards. Some form of instruction should be issued not to withdraw medical cards from those who have them, although that appears to be the trend. It is most likely that the people whose medical cards might be withdrawn will automatically become entitled to the doctor-only cards. Until the Bill is enacted and the new cards become available, we should avoid pulling the plug by withdrawing medical cards from those who currently hold them.

The Bill's provisions contain some restrictive qualifications, particularly the phrase "[for whom] it would be unduly burdensome to arrange general practitioner medical and surgical services for themselves and their dependants". The matter is left to the discretion of the new Health Service Executive, with no income guidelines specified in the legislation. It seems there will be a decrease in the number of medical cards provided.

One of the benchmarks for community welfare officers is an income guideline. It may not be the best method and on many occasions we have criticised such income guidelines but at least they provided a benchmark. I am concerned that the withdrawal of medical cards will now be left to the discretion of the chief executive officer of the Health Service Executive. The provision of 200,000 GP-only medical cards to bring borderline cases in line with regular medical cards would seem to be little more than a pipe-dream divorced from reality. The number of medical cards is being reduced. We were promised 200,000 extra cards but they are not coming on stream; they are being withdrawn.

Apart from the lack of guidelines for the provision of medical cards, the insufficient number of GPs to cater for 200,000 GP-only cards will have to be addressed. There is a crisis, particularly in some rural areas that cannot attract newly qualified doctors. That issue must be addressed as well.

Holders of GP-only medical cards will have to pay up to €85 for prescription drugs and hospital services. The cost of visits to a GP is a serious deterrent for people on low incomes. The provision of GP-only cards recognises this and is a step in the right direction in that it will be more likely that such card holders will visit their doctors and, therefore, that their illnesses will be diagnosed earlier. The medical evidence is that early diagnosis and intervention can lead to a more successful result from treatment. Early intervention means that patients will not have to wait while their illnesses deteriorate or face increased medical costs as a result. If they remain untreated, such people can become emergency cases availing of hospital accident and emergency units. These issues must be examined.

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