Beverley Flynn (Mayo, Fianna Fail)

I welcome the opportunity to speak on the Health (Amendment) Bill for a number of reasons. It is important to focus our attention on looking after elderly people within our communities and on low income families who found it so difficult to avail of GP services over recent years.

I welcome the legal framework set out in the Bill for charging patients for the maintenance element of inpatient services in publicly funded long-term care residential units. After 29 years, it is important that this be put on a sound legal basis. From speaking over the past few weeks to people in the community and those working for the former Western Health Board in my area, now the Health Service Executive, I know that people find it incredible that a situation like this could have been allowed to develop over the terms of successive Governments for 29 years.

The number of written and telephone inquiries to the Health Service Executive on this issue has been unprecedented and it is clear from public debate on the radio that people have been unable to get through to the helpline. Calls to my constituency office show that this issue will be a major one and an administrative nightmare over the next few months but in the end, people have a sound legal basis for their claims. I welcome the statement by the Tánaiste that this matter will be dealt with as quickly as possible.

Regarding nursing homes and people being looked after in the community, people recognise that nursing homes provide a valuable service. The contributions of people towards the cost of this service represent a small percentage of the overall cost so it is important that it is put on a sound legal footing.

The matter gives me an opportunity to raise an issue in the programme for Government which affects my constituency, namely, providing for elderly people in their own community. Coming from Mayo as I do, I draw the Minister's attention to the claim on behalf of the people of the Ballinrobe area who have been seeking a nursing home in the town for over 25 years. I was chairperson of the Western Health Board in 1999 and the board purchased a site for the purpose just before 2002, for £300,000. Unfortunately we are still waiting. It was not included in the national development plan for capital projects in the Western Health Board area. We were awaiting funding from the Department of Health and Children to honour a commitment given by the parties in government that they would provide for community nursing in the areas where the elderly people are. I hope that a nursing home in Ballinrobe will be considered a high priority by the Government in the near future because the community there has worked very hard in achieving its objective.

When the Tánaiste came before the Joint Committee on Health and Children a number of weeks ago, I raised the issue of the level of subventions paid in different parts of the country. It is completely discriminatory that within the former Western Health Board area a person can get a subvention only up to a maximum of €220 weekly, while someone living in Dublin or in the eastern part of the country can get up to €500 or €600 weekly. That is unacceptable. Looking at the costs involved, even for example the cost of providing a nurse on the east coast vis-À-vis the west, there is no massive discrepancy involved. It is unfair to expect nursing home owners in the west to provide an essential service when they are treated unfairly.

I congratulate the Tánaiste on the fact that she acknowledged to the committee that this was discriminatory. Indeed the situation is worse in the east where one could have a nursing home on one side of the road getting a €300 subvention per client while one on the other side of the road gets €600 per client. That needs to be addressed and I ask the Minister to look at it in the near future.

I welcome the Supreme Court decision that it was unsound that retrospective provisions would be put into a Bill making lawful the imposition and payment of charges for something that occurred in the past. That is welcome because it would have set an unfortunate precedent. One would have to call into question the legal advice given when the Bill was brought to the House before Christmas. It is important that we take our time with legislation that is vitally important to all citizens. We now have to deal with the position in which we find ourselves. It is important to move forward, to recognise the excellent work being done by the State and by private nursing homes in our community and to put them on a sound footing in the future.

The other significant issue this Bill deals with is the doctor-only medical cards. I draw the Minister's attention to the fact that within the former Western Health Board area, particularly in my county, we had the biggest decrease in medical cards in the country from the period 1997 to October 2004. In County Mayo during that period, 8,319 people lost their medical cards. I put a number of parliamentary questions to the Tánaiste at the time noting that income levels in County Mayo have not increased sufficiently to sustain that level of decrease in the number of medical cards. The programme for Government states that medical card eligibility would be extended in line with the recommendations of the national health strategy. How may that tally with a reduction of 8,300 cards in County Mayo? I welcome the 7.5% increase in the income threshold, which will result in the provision of 30,000 additional medical cards. I also welcome the provision of 200,000 doctor only medical cards. When the annual review of medical cards is carried out next year, I hope there will not have been another significant reduction in the number of traditional card holders in County Mayo and that there will be an increase in doctor only cards. I hope doctor only cards will not be a substitute for traditional medical cards because the value of such cards to families is significant. I welcome the provision of the doctor only cards, as they will enable many low income families to avail of GP services. Many of them have avoided bringing children to their GPs and, unfortunately, the consequences have been serious. I hope we will not witness the demise of the traditional medical card through its substitution by the doctor only card.

Under the legislation, an individual can attend a variety of doctors. Will the Minister of State explain how that will work? I tabled a parliamentary question to the Tánaiste and Minister for Health and Children seeking reasons for the loss of 8,300 medical cards in County Mayo and she replied that 8,047 cards were lost because the holders had died. A total of only 253 people, therefore, lost their medical cards on the basis of income. In addition, the doctors involved were paid as if the medical cards were still in use, even though the holders were deceased. That money will be recouped over time but it was a serious waste given that the money could well have been used to provide medical cards for people in need. The figures must be analysed and money paid on foot of a card held by a deceased person should be refunded.

The post polio group appeared before the Oireachtas Joint Committee on Health and Children recently. A finite number of people are affected by this illness, which they want covered under the long-term illness scheme. Unfortunately, the Department has not extended cover to illnesses under this scheme in recent years. I ask the Minister of State to consider adding this illness, as it affects a finite number of people who have suffered greatly. Their needs are quantifiable and while, in a number of cases, they are being looked on sympathetically by the Health Service Executive through the discretionary arrangement available to chief officers, unfortunately, the discretion is not applied consistently throughout the State, resulting in discrimination between HSE areas. When I sought the issuing of guidelines to chief officers regarding the use of discretion, I was informed that if guidelines were put in place, the discretion would be removed. However, there is discrimination between various HSE areas and the Department could easily solve this problem if it was willing.

While I welcome the legislation, it is unnecessary. If more time had been put into planning and drafting the original legislation before it was introduced in the House in December, we would not have to debate the issue again.

I ask the Minister of State to re-examine the position of Ballinrobe nursing home. The community has campaigned for 25 years because there is a serious need in the area. Both Government parties reiterated their commitment to the area in the programme for Government and it should be forthcoming. I look forward to a positive response in this regard in the near future.

See this speech in context