Fiona O'Malley (Dún Laoghaire, Progressive Democrats)

Little did any of us think we would be welcoming legislation of this nature so early in the new year. There is much reason to welcome the Bill. However, the fact that this is happening so soon after the introduction of the Health (Amendment) (No. 2) Bill 2004 must make us aware of the dangers of bringing forward hasty legislation. I do not believe anyone on this side of the House was not aware of the difficulties of bringing forward such legislation in an attempt to save the State some money. The previous Bill was brought forward on good advice from the Attorney General, and a Minister can only act on such advice. The President, in her wisdom, saw fit to refer the Bill to the Supreme Court to test its constitutionality. We must be grateful to her for that because it has been determined that the previous Bill was unconstitutional. It is our job now to remedy the situation.

I welcome the Bill because it provides legal certainty in respect of charges. I do not believe the House is divided on the question of charges. Everybody recognises that the State is not in a position to provide total care free of cost. With one or two exceptions, no one in the House is seeking that the State make such provision.

We must thank the Tánaiste for her swift action in terms of dealing with this issue. It has been stated that people knew the position regarding charges for over 20 years. True to form, the Tánaiste was prepared to do something swiftly about it. The only criticism one could level at her is that she moved hastily but, as stated, there were good reasons for her doing so.

With the Bill before us, we are now in a position to deal with the legal certainty of providing for the imposition of charges. The House is not really divided on that matter. However, this is an area in respect of which we must act responsibly. Demographics indicate that the population is getting older and we must consider how we will provide for care of the elderly. The latter is particularly relevant because we will all grow old in the not too distant future and we would like to believe that there will be adequate services available to us. One of the Government's priorities is to put in place a proper and sustainable care programme for the elderly.

I wish to refer now to the difficulties that arise when dealing with the monolith that is the Department of Health and Children. The Department must be reorganised and streamlined in order that the money goes to the patient and not necessarily be spent on infrastructure or bureaucracy. I accept that beds and buildings must be provided. Where these are in existence, however, they must be opened and operated in a cost-effective way. In the area I represent, beds are available at the Blackrock Hospice and Leopardstown. I would like the Tánaiste to ensure that these beds are opened to elderly members of the population in the area I represent, Dún Laoghaire, who need them.

I welcome the provision in the Bill relating to GP-only medical cards. When one is in a position of responsibility, as is the case with all governments, one must set priorities. The Government cannot sign blank cheques to be used for the provision of services. Of course we would like to provide optimum services for every patient but that is not feasible. When the Tánaiste recognised that parents frequently did not go to their doctors, either in respect of themselves or their children, because they could not afford to do so, she determined to provide them with the reassurance of access to free visits. We had been faced with an either-or situation, namely, should we provide more full medical cards to a smaller population or provide the security offered by free GP-only medical cards? The Government has wisely chosen the latter route. Even Deputy Twomey knows these cards are a good idea and I am sure he will support them, particularly as they represent an effective use of the resources available.

As a result of the Supreme Court decision, resources will be ever more stretched. We need to ensure, therefore, that resources for patients are provided in the most appropriate way. The IMO has welcomed GP-only cards and the Health Service Executive is about to enter into discussions in respect of them because of anxieties relating to administration of the scheme. However, I am sure the latter will not delay the introduction of the cards. We all know a GP's priorities are for the patient and swift intervention so that any anxieties are allayed or that the required treatment may be undertaken as soon as possible. That will not be much of a barrier because when both parties to any negotiations have the same objective in hand, there is no reason consensus may not be delivered quickly.

The question of legal certainty for the future is another matter that is welcome. It was something that needed to be addressed and the Minister has courageously decided to do this promptly. That it is being done through legislation dealing with medical cards is significant as well. I suppose a type of belt-and-braces approach is being taken in that it is not being done by means of a statutory instrument so that we will not find ourselves in the current position in future.

I welcome the introduction of the Bill. I hope it has a swift passage through legislation. I hope people who deserve whatever recompense they are entitled to because they had their contributions taken from them, illegally as it now transpires, avail of the service. It is the least the State can do to provide a more transparent service for people while making a charge for what is a very good care service.

See this speech in context