Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

This is a dual purpose Bill. First, it gives effect to those parts of the Health (Amendment) (No. 2) Bill 2004 that were found to be constitutional by the Supreme Court and, second, it introduces the GP-only medical card announced by the Government last November. These are two distinct and separate matters and I must question their inclusion in one Bill. I also question the rush to enact the first part of the legislation in the absence of clarification on how those people wrongly charged by the State for long-term residential care are to be reimbursed.

The Government is moving swiftly to ensure that those inpatients receiving long-stay care who can be charged following the Supreme Court judgment will be charged as soon as possible. There is no similar rush to repay those unlawfully charged over a period of many years. In the memorandum to the Bill, the estimated cost of the loss of income to the State since 9 December 2004, when charging was stopped, is €2 million per week. Where is the estimate for what those mostly elderly and infirm people are owed by the State?

We have been informed that a Cabinet sub-committee has been formed to decide on the scheme of reimbursement. However, I detected a distinct lack of urgency on the part of the Government. It is certainly in contrast to the swift production of this Bill. This is all the more unacceptable, given that we now know about the extent of the knowledge within the Department of Health and Children and successive Governments about illegal charging of long-stay patients over many years. The system knew people were being wrongly charged but did nothing to stop it. Since this issue came to light there has been widespread concern and confusion among the families of people in long-stay residential care. Following the Supreme Court judgment, they are still none the wiser about the next steps to be taken and the implications for their personal circumstances. We learned this week that the Health Service Executive had allocated only six staff members to the dedicated helpline. An additional four staff has made no appreciable difference as long delays in answering calls are still experienced. I tried that line before coming into the House for the recommencement of this debate and I had to hang up in total frustration after waiting for a long period.

My fellow Sinn Féin Deputies and I have had many inquiries to our offices on this matter. I presume other Deputies have been contacted by many people seeking information, and there is none. There is a dearth of information. The State's response to date has been disgraceful. The Government must start to make decisions and get the information out to the general public. Above all, it must repay all those entitled to repayment.

I now turn to the second part of the Bill, the doctor-only medical card. What has become known as the "yellow pack" medical card appeared out of the blue last year. Whether it was inspired by the blue sky over Inchydoney is anybody's guess. There was no indication previously that the Government would take this route. During the 2002 general election campaign, the Fianna Fáil Party promised to provide a further 200,000 people with medical cards. It is often forgotten that the PDs made a similar promise when its manifesto in 2002 ensured eligibility criteria would at least keep pace with movement in income. Not only have the promises of both coalition partners not been fulfilled, but the situation has gone into reverse. There are now 64,478 fewer people with medical cards than when those promises were made in 2002. There are 109,767 fewer people with medical cards than in 1997 when the current coalition came into Government. It gets worse, however. In January this year 6,296 people lost their qualification for medical cards. The figure for the month before was 2,068, so since Deputy Harney took over as Minister for Health and Children well over 8,000 further people have lost their medical cards. Where does this leave the Minister's estimate that in the region of 200,000 should qualify for the doctor-only medical card?

It is a convenient figure for the Government, which has been haunted since 2002 by its own extravagant promises. Does the figure have any meaning? The reality is that many of these cards will go to people who were previously entitled to full medical cards but who lost them because their incomes rose above the disgracefully low level of the income guidelines.

On budget day, I tabled a parliamentary question to the Minister for Health and Children, asking the approximate cost of the doctor-only card compared to full medical card. She stated that the doctor-only card would cost approximately €250 per year while the annual cost of the full medical card is €1,000. Both in terms of the numbers qualifying and the value of the new card, it is clear that Government's claim of generosity is by no means all that it would like the public to believe. We also have to take into consideration the Government's hiking of hospital charges and medicine costs to see that it is giving with one hand and taking away with the other. While the extension of free GP services is welcome, as far as it goes — how far remains to be seen — the Government cannot fool people into thinking they are getting the full value of the medical card. They will still bear the heavy cost of medicines, which together with hospital charges, represent three-quarters of the value of the real medical card.

This Government has been responsible for a succession of steep rises in the costs of medicine. Those who fare worst are people whose incomes are just above the medical card income guidelines and who must take regular medication. A year ago they had to pay €70 a month before they were entitled to a refund under the drugs payments scheme. After two rises in the threshold over the past 12 months, they must now pay €85 per month. For people on low incomes, especially those dependent on ongoing medication for their very lives, this is a disgraceful rise.

This Bill maintains the myth that entitlement to a medical card is based on undue hardship. The reality is that the entitlement is based on income guidelines drawn up by the Minister and her Department within the constraints set by the Minister for Finance in the annual Estimates. Only in the most exceptional circumstances will people above those income guidelines be considered for a medical card, no matter how much undue hardship they and their dependents experience. All Deputies, without exception, will have had experience of representing people in such circumstances who have been denied medical cards. This Bill introduces a further euphemism. It states doctor-only cards will go to people for whom payment of GP fees would be "unduly burdensome". Again the reality is dictated by the income guidelines and not by the individual circumstances of each applicant, no matter how heavy the burden they may carry.

This Bill in both its parts, adds another rickety extension to a ramshackle, ill-planned, inequitable and inefficient health service. It comes at a time when the Minister, Deputy Harney, is accelerating the development of private medicine and giving favoured treatment to the private health business. The accident and emergency crisis continues in all our hospitals. Local hospitals are being denuded of services, including those in my own constituency. The development of primary care, supposedly the cornerstone of the Government's health strategy, has been put on the long finger.

The Government may be rushing this Bill through in time for the by-elections. The Minister denied there was any connection when I asked her this question about a week ago. However, I do not believe the good people of Meath or Kildare will be fooled.

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