Seán Crowe (Dublin South West, Sinn Fein)

I wish to share time with Deputies Finian McGrath, McHugh and Gormley.

Through this Bill, the Government is acting swiftly to ensure that long-stay patients in residential care who can be charged in the wake of the Supreme Court judgment will now be charged without further delay. The Government states it has lost €2 million per week in payments since the charges were found to be illegal and it has been very quick to clear up this part of the equation, but we are still in the dark regarding many other matters. What about the money lost to people who were wrongly charged? How will they be reimbursed?

My office has been inundated with queries from families with elderly relatives in nursing homes. The common denominators are words such as "hardship", "difficulty" and "small income". It might be a small amount but it represents a huge difference in quality of life for people in nursing homes. These families want to know what their position is now and what they must do to receive their entitlements. The helpline established by the Health Service Executive seems constantly engaged. The Government must do much more to inform people and must make hard decisions as soon as possible about how people will be repaid the money that was taken from them illegally.

The Dáil has not been given the information by the Government. The Minister for Health and Children said the Government got legal advice as far back as 1978 stating that the legal basis of the charges was not sound. This is an amazing admission and a damning indictment of successive Governments. The Minister should publish the advice from 1978 given to her predecessors, as well as the 80-page legal opinion sent by the South Eastern Health Board to the Department in 2002. Why did her predecessors, since 1978, including the Minister, Deputy Martin, not act? The Oireachtas and, more importantly, the public and relatives of the elderly have a right to know.

The second part of the Bill implements the Government decision to introduce the GP-only medical card. This was announced in November and, with the Estimates and budget, flagged as one of the great initiatives of the new caring, sharing coalition. I welcome the extension of the entitlement to free GP services to more people. Sinn Féin has called and campaigned for this, a fact about which my constituency colleague, Deputy O'Connor, should have no doubt. However, I question the attempt to present this as a fulfilment of the promise made by Fianna Fáil and the Progressive Democrats before the 2002 general election.

It does not fulfil that promise for two reasons. First, these are second-class medical cards which have been described as "yellow pack" and not the real thing and certainly not of the same quality. They only cover GP visits and represent a quarter of the value of the real medical card. Second, the Government is once again playing a numbers game in an effort to con the public. More than 100,000 people have lost their medical card since this coalition first took office in 1997. Almost 65,000 people have lost their medical cards since 2002. If the Government is claiming to stick by its word, the figures do not add up.

More important than figures are the real people who need access to health services. They are all our constituents. Their income is above the very low level of the medical card income guidelines and they cannot afford private health insurance. Many of them may now qualify for the GP-only card, but they must still pay the cost of medicines up to the value of €85 per month after yet another increase imposed by the Government. They must still pay hospital charges.

Yesterday a Deputy pointed out that the number of medical card holders with full entitlements will possibly decrease and will be gradually replaced by those entitled to GP-only cards. This would represent a significant cutting back in public health services, a situation which must be fought tooth and nail.

There is no consistency in the Government's health policy. A few years ago it granted the medical card to all those over the age of 70 regardless of their circumstances. That is fine because in doing so it recognised the principle of equal access to health services for all. However, this only applied to those over the age of 70. A very wealthy retired person on a large pension is entitled to free medical care, whereas a family with young children, struggling to survive week to week, must be almost destitute before qualifying for free medicine and medical care. It does not make sense.

A 2003 survey showed that 33% of men and 45% of women identified financial problems as the greatest factor preventing them from improving their health. This sums up the inequality at the heart of the health service and this Bill will do nothing to challenge that.

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