Mary Harney (Dublin Mid West, Progressive Democrats)

I am pleased to commend this short Bill to the House. It has two purposes, to put reasonable charges for long-stay care on a legal basis and to provide hundreds of thousands of people on low incomes with the opportunity to visit their GPs without worrying about the cost.

Both purposes are guided by the single key principle that there should be legal clarity regarding public services and charges. Members of the public, patients and their families deserve no less. It is not tolerable that people, particularly vulnerable people and those suffering from ill health, should be uncertain of whether they qualify for a service, or whether and how much they should have to contribute towards the cost. People working in our health services can do a professional public service job if they operate in an environment of legal clarity.

In an increasingly litigious society, legal uncertainty is tested and exploited in many ways that are, to say the least, not always in the public interest. The cost to the public and taxpayer of achieving legal clarity is highest when it comes from protracted and repeated litigation. The cost is lowest when it comes from coherent policy, meticulous law-making and professional public administration.

That is why the Government welcomed the clarity provided by the recent decision of the Supreme Court about past charges for public long-stay places. I do not intend to dwell on the points I made when the House debated that decision two weeks ago. I will just say that this Bill stems from the Government's determination to provide legal clarity in the interests of patients, their families, taxpayers and better public administration.

On the repayment of past charges, the Government is working on a scheme of repayments that will be efficient, user-friendly and as automatic as possible. There are many practical and legal issues to be worked out in handling the repayments. It is important that people keep firmly in mind that the Supreme Court has found that repayments should be made and that the Government fully accepts that. The Supreme Court has decided there is no need now for people to go to another court. I assure Deputies that persons who were being charged need not employ a solicitor to get what they are owed. I look forward to bringing details of the repayment scheme to the House as soon as possible.

We could all agree that the full context for the repayments issue will only be known when the report by Mr. John Travers is available. It makes little sense to debate that report in advance of it being completed, let alone published. I expect to receive the report tomorrow and I will bring it quickly to the Government next Tuesday and to the House, as I have already indicated.

On some of the points made by Deputy Neville, the intention is that where we can identify people we will pay them their moneys. It will not be a question of making applications and so on. In the case of deceased persons, somebody will have to prove that they were the representative of that person. For those who are alive but of unsound mind, and as I have already indicated publicly, the Statute of Limitations cannot be applied to people of unsound mind. My view would be that we would identify those persons and repay their moneys.

This is a mammoth task for the State. We have never engaged in an exercise of this kind before in terms of the scale. We will need some outside expertise, perhaps even from outside the country, to help us with the task because in other jurisdictions people have handled mass claims in the past and they would have a good deal of experience. That could be of invaluable assistance to the Government. When the Travers report is to hand, hopefully tomorrow, we will be in a better position to indicate the nature of any scheme we will introduce, the timeframes and so on.

My colleague, the Minister of State, Deputy Seán Power, opened the debate with a detailed description of the main provisions of the Bill. I would like to concentrate on the policies behind it. There is close to all-party consensus in the House that it is reasonable that people in public long-term stay places should make some contribution, where possible, to living costs or shelter and maintenance. That policy has been in place here for almost 50 years. That consensus is clear, given that the policy was implemented by successive Governments and Ministers for Health, albeit on a legally flawed basis, for the past 29 years. It is also clear from public debate and debates in this House in the past three months that most people accept it is fair to require a reasonable amount to be contributed, considering especially that older people living at home must meet their living expenses from their pensions.

I was pleased that the constitutionality of legislating for these charges going forward was fully tested in the Supreme Court and was found by the court to be constitutional. For example, the court stated: "In authorising the Minister to impose charges on the specified category of person, the Oireachtas clearly intended that the resources of the Health Boards would benefit so as to better enable them to provide the services in question while at the same time seeking to avoid doing so in a manner which would cause undue hardship."

The court further stated:

The level at which charges can be fixed by the Minister is narrow in scope ranging from a nominal charge to 80% of the pension ... It was clearly the intention of the Oireachtas that any charges would not cause undue hardship generally or in individual cases and no doubt that is why it fixed the maximum charge at 80% of the pension.

It was useful that the court recognised the importance of this source of funding for health services, which is in the order of €2 million to €2.5 million per week. I have heard suggestions from the Opposition, however, that section 1 of the Bill may be unconstitutional. I am obliged to accept the advice of the Attorney General's office on this legislation, and we believe the Bill is constitutional. Ultimately, Bills are tested in the Supreme Court, perhaps under an Article 26 reference, which is what happened with the Bill we passed before Christmas, or in particular circumstances.

Section 1 refers to the Health Service Executive taking into account a person's overall financial situation, including the means of a spouse, in making a decision on eligibility for a medical card. Yesterday, the Minister of State, Deputy Seán Power, set out the reasons for this provision in the Bill. It reflects existing law, policy and practice and is based on long-standing constitutional principles that recognise the obligation of one spouse to support another. It is not unconstitutional.

Again, for the purposes of clarity I inform the House that I intend to bring forward an amendment in the Bill on Committee Stage to repeal section 140 of the Social Welfare (Consolidation) Act 1993. This is to prevent anomalous charges being raised through other legislation which are not in line with the exemptions provided for in the Bill now before the House. This will secure the exemption from charges of those persons involuntarily detained in mental hospitals and it is necessary to ensure consistency in this regard in future.

The provisions of the Bill on long-term stay charges are clear and unambiguous. The Bill is being brought forward in the light of the positive decision of the Supreme Court on exactly similar provisions in the 2004 Bill.

I am pleased also to use this Bill to propose to the House section 4 providing for new medical cards to make general practitioner services free for many thousands of people. This is an innovation for social justice and for the effective use of public resources. For many years, we all shared a concern that people on very low income should not be deterred from visiting their GP on cost grounds. In particular, we have agreed that parents should not be deterred on cost grounds from bringing their children to their GP. The Government is now acting to address those concerns.

The traditional medial card will continue to be held by 85% of medical card holders but with this policy, the same budget allows us to provide four times as many people with free access to their GP than with the traditional medical card. There are no industrial relations, administrative or legal barriers to doing that once we have passed this legislation. All we need is this short legislation amending primary legislation to establish a legal basis for doing so. If, as I hope, the legislation is approved by the Oireachtas this month, the Health Service Executive will be in a position to issue the new medical cards in April.

The policy of the Government is clear. We are providing the resources to fund these new cards. We are bringing forward the legislation to underpin the new cards. We want to see people taking up the new cards. We want people to visit their doctor and bring their children to the doctor as often as needed.

I intend to monitor closely the uptake of the new cards to ensure that the many thousands of people to whom we wish to give cards apply for and receive them. As Deputies will be aware, income guidelines are set for the Health Service Executive for eligibility for medical cards of both categories. These income guidelines are set on the basis of the best and latest information available on incomes and expenditure in the population. The income guidelines for new medical cards are 25% higher than for the traditional medical card.

It remains difficult, however, to set any income guidelines based on historic data to achieve an exact number of people to be covered prospectively. If we find significantly fewer people than expected take up the new cards because incomes are growing faster than we anticipate, we will revise the guidelines.

We are providing the budget, the administration and now the legislation so there is no barrier to the policy being implemented. The Government wants to make it easy for people to apply for these cards and to use them. I know the HSE will do all it can to ensure that happens, including constructive discussions with the Irish Medical Organisation on implementation.

Providing GP cover to many thousands more people in this way is effective social justice. We are providing graduated benefits according to income. It is much better that State benefits are not "all or nothing". We know from our experience of reducing unemployment how important it is, for social justice reasons as much as anything else, to avoid poverty traps. Graduated benefits are a fair and effective way to help people at different levels of income.

We are using scarce public resources to help those who need help, not those who can ably provide for themselves. The alternative to channelling resources to people most in need is "one for everyone in the audience". I do not agree with that. To give everybody a medical card, at an average of approximately €1,000 a year, would cost an extra €3 billion over and above the current position. I have not heard any party openly propose tax increases of €3 billion to pay for medical cards for all, and I doubt I will ever hear it from parties who are serious about being in Government.

The policy of the Government is based on a coherent and integrated view of economic and social progress. The new medical card is one innovation within the strategy and I hope it will stand the test of time for many thousands of people in the years ahead.

Deputy Neville raised a number of matters in connection with the Health Service Executive. The executive has only been in existence for two months and does not yet have its full cohort of staff. It is intended that it will have a fully resourced public affairs division to deal with public representatives. I have spoken to the acting CEO and the chairman and they are anxious to establish the division as soon as possible. It is hoped it will be up and running, if not before the summer then shortly thereafter. As regards a role for public representatives at regional level, we will progress that matter as soon as possible.

I intend to pursue many of the issues — incontinence pads etc. — to which Deputy Neville referred. I will reflect on what were people's entitlements and communicate further with the Deputy. We cannot have a situation where, in respect of people who require institutional care, particularly in the private sector, families will not be given support to allow them to care for elderly relatives at home. If a mistake was made in the past it was that too many of the resources went towards the institutional side and too few towards home or community support.

I hope the Government will be able to finalise its views and policy perspectives in respect of long-term care later in the year. Currently, 12,000 people reach the age of 65 and 1,500 reach the age of 80 every year. There will be major demographic issues for society going forward in terms of how it funds care of the elderly. Greater emphasis must be placed on community and family support because we could not afford, as a society, to fund institutional care for everyone. We must, therefore, have institutional care where it is necessary and unavoidable which will be supported but we must also give serious consideration to how we might support further activity in the community. Currently, the home care and home help systems are in place. The new home care package, which forms part of the overall A&E package, is a start in terms of trying to help people to remain at home with their families. That is when people do best in medical terms and are happiest. If they wish to remain at home, people deserve to be able to do so.

See this speech in context