M J Nolan (Carlow-Kilkenny, Fianna Fail)

I wish to share time with Deputy Callanan.

I welcome the opportunity to speak on this legislation. It is the second time we have seen legislation of this type come before the House in the past few months. It is unfortunate that we now must have a second debate on this issue. The Bill sets down the legal framework for the payment for inpatient stay in publicly funded long-term residential care. Any fair minded person would see nothing wrong with the contribution being made by individuals or their families for the cost of the first class care that older people are getting in our long-stay residential care units. An unfortunate situation has arisen as the Supreme Court has struck down the previous legislation, which means we are debating this Bill for a second time.

Most Deputies who have spoken on this legislation agree with the need for it. Payment towards the cost of shelter and maintenance in long-stay institutions is something on which all parties agree. One aspect of this particular payment has not been highlighted enough. While charges will be made from now on to individuals who are in the position to pay, the State will pick up the vast bulk of the cost for patients who are staying in long-term residential centres. A recent report stated that the State is picking up around 90% of the cost. The Supreme Court has confirmed that it is in order for the Minister to legislate for charging patients.

The second part of this Bill deals with the introduction of medical cards for doctor visits only. This is a commitment which has been given by the Government and which was announced last November. A total of 200,000 individuals will benefit as a result of the introduction of this scheme. Previously I have spoken about income limits for qualification for medical cards. Previous speakers outlined the fact that the number of medical cards issued over the last few years has decreased. This is due to the relative wealth of the population nowadays. Having said that, there are cases of hardship in families where individuals might be marginally over the income limits for a medical card. While the health board has a discretion on individual applications, it would be better if there was a greater increase in the income limits for medical card qualifications. The Minister has stated that the new income limits for the doctor only card will be 25% higher than the qualification limit for existing full medical cards. I know of families who are marginally over the limit and have to pay €40 to €50 to visit the doctor. They also have the cost of medication on top of that. Many of the 200,000 recipients of the new cards may only go to the doctor and may not need medication following the visit. However, there is certainly a case to be made to look again at the income limits.

The Minister hopes that 30,000 additional people will obtain the standard medical card during the current year. Ministers in their statements will have acknowledged that people should not be discouraged from visiting their family doctors on grounds of cost. The introduction of the 200,000 cards will increase the number of people who avail of the opportunity to visit a doctor.

In the context of the inclusion in the Bill of inpatient-stay payments, we should acknowledge the work done by voluntary organisations in caring for the elderly. As the numbers in religious orders fall, we should recognise the role they have played over the years. In their place are a number of new voluntary organisations the members of which are carrying out a great deal of fine work. They are being provided with practical support by the Ministers for Health and Children, Social and Family Affairs and Finance, the last of whom provides much needed funding to the bodies in question.

I was glad to hear the Tánaiste state on the behalf of the Government the intention to make it as easy as possible for people who were overcharged for nursing home care to obtain refunds. I am concerned, however, to ensure that we do not see a repeat of the scenario of Army deafness claims. While individuals claimed and received compensation to which they were entitled for deafness resulting from Army service, much of the funding made available by the State was paid to the legal profession. I would not like to see unscrupulous members of the profession getting their hands on the funding being made available as the acknowledged due of the people affected in this instance.

The Tánaiste has established a body to review the medical card system under a number of headings. The management and control of the GMS register is one of the matters under consideration. We have seen press reports in recent months that individuals who were long since deceased remained on the GMS register. It is a subject which must be examined given the potential savings to the Department. The administrative process and standards are also being considered by the review body. While I can speak only about the former South Eastern Health Board area, it appears that the processing and administration of the medical cards system are efficiently and properly carried out by officials. An area in which there seems to be a problem, however, involves a lack of resources to deal with the backlog of appeals. It is unfortunate that congestion exists which leaves families on the medical card waiting list for months.

I wish the Tánaiste success in processing the legislation through the House. I hope she develops a simple formula which can be applied by individuals who wish to claim repayments as a result of last week's Supreme Court judgment.

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