Tim O'Malley (Limerick East, Progressive Democrats)

I thank Deputies for their contributions to this debate. The Government brought forward this Bill to establish a sound legal basis for the policy of requiring some contribution towards shelter and maintenance of people with full eligibility in long-term stay institutions. The Supreme Court has confirmed that it is constitutionally sound for the Oireachtas to legislate for this policy. The issue is being put beyond legal doubt after nearly 29 years.

The other matter addressed in the Bill, the introduction of a doctor visit medical card, is a major step forward in ensuring that people on low incomes have access to general practitioner services and advice. The Health Service Executive, as the body established to administer the health services on a national basis, will be in a position to commence the introduction of these cards as soon as the Bill has been enacted.

It is a long-standing feature of our system, and one which has been policy under Governments of all the major parties over the past 30 years, that most people in publicly funded long-term care should make some contribution to the cost of this care. Quality care is expensive and, even with a contribution from those receiving this care, the bulk of the cost of providing a high standard of quality care must be borne by the Exchequer. The charges to be imposed on those in public nursing homes under the provisions of this Bill represent approximately 10% of the overall cost of care.

The income foregone by the Health Service Executive for as long as these charges cannot be raised is estimated in the region of €2 million per week. A statutory framework that puts the long-standing policy on a sound legal footing and safeguards the income generated from this source is vital. The provisions of the Health (Amendment) Bill 2005 will secure this source of income, which has been an essential element of the funding of our health services in the past and must remain so in the future.

The introduction of a doctor visit medical card is the most efficient way to help a significant additional number of people to access primary care. It is in line with the commitment contained in the health strategy to ensure that the allocation of medical cards is on the basis of prioritising groups most in need of those services and is intended to benefit approximately 200,000 people.

I will take this opportunity to respond to some of the points made by speakers during the debate. With regard to the provision in the Bill referring to 80% of the maximum old age non-contributory pension, it must be remembered that this is the maximum weekly charge that can be levied. If this is taken together with the provision in the Bill to allow the Health Service Executive to reduce or waive the charge imposed on a person to avoid undue financial hardship, 80% of the maximum non-contributory old age pension is a reasonable upper limit to set for the charge.

A number of Deputies expressed concern that the percentage of the population covered by a medical card has declined over recent years. However, they neglected to mention that this is attributable in large measure to the economic success we have enjoyed, which has reduced many people's need for State support to meet health care and other living costs.

Furthermore, the Government's objective is to ensure that people most in need can have a medical card rather than simply to achieve coverage of a certain percentage of the population or to issue a specific number of medical cards. It is to give effect to this targeted approach, and many Deputies in the past have sought such a targeted approach, that, at the request of the Tánaiste, changes to the income guidelines have recently been introduced by the Health Service Executive and are intended to ensure that an additional 30,000 medical cards can be issued in the current year. This is in addition to the doctor visit cards which will be introduced subsequent to the passage of this Bill.

There is no question of the Government seeking over time to reduce the number of standard medical cards in favour of issuing increased numbers of doctor visit cards. Several Deputies were worried about this. This initiative is intended to complement the existing medical card arrangements which have been in force for many years.

The Department of Health and Children has recently written to the interim chief officer of the Health Service Executive to indicate formally that the Government's objective in bringing forward this initiative was to enable approximately 200,000 medical cards to be issued in respect of general practitioner services and that the Tánaiste wishes to have the necessary administrative arrangements in place to enable the new cards to be issued from April. Deputy Twomey and other speakers welcomed the introduction of the doctor visit cards. It has also been welcomed by many groups in the community. It is recognised that for many people, particularly mothers of small children, visits to the doctor were a problem. This applied to people whose incomes are just above the medical card threshold. They were afraid to visit the doctor because of the cost involved. That will no longer arise because with the doctor visit cards they will be able to visit the doctor free of charge.

The Health Service Executive has been requested to have the necessary preparatory steps taken and operational guidelines developed such as will enable applications for doctor visit medical cards to be accepted as soon as possible after the enactment of the relevant legislation and the cards subsequently issued to persons who meet the relevant criteria. With the establishment of the Health Service Executive, the administrative arrangements for this card will be operated on a standardised basis throughout the country.

While the Health Service Executive intends initially to set the income threshold for the doctor visit cards at 25% higher than applies for the standard medical card, this threshold will, if necessary, be reviewed in light of experience to ensure the desired number of cards are issued to those intended to benefit under the scheme. Therefore, if there are not sufficient applications for the cards, the thresholds will be raised until the level of 200,000 cards is reached.

The Bill will bring clarity to the issue of charges for long-stay care where it is clear there has not been a sound basis for the practice going back nearly 30 years. The legislation will also ensure the income flow from charges imposed to date is secured and that it will continue to support the provision of quality services for those in long-term care. I am pleased to note that none of the major parties has registered any difficulty with the principle involved here. The introduction of a doctor visit medical card is a supplementary initiative which will enable 200,000 people from lower income households to attend a doctor free of charge. This will help to overcome barriers to assessing GP services for many individuals and families who are above the standard medical card income guidelines.

Many Opposition Members referred to the imminent Travers report. I do not wish to comment on the report because it will not be released for a few days and I have not seen it. Obviously, there will be further debate in the House on the report. As one of the Ministers who attended a certain meeting, I presumed legal advice would be obtained and this is what I told anyone who asked me about the matter.

See this speech in context