Liz McManus (Wicklow, Labour)

I support this amendment which addresses an important and central issue. We need clear Government policy on long term care of the elderly. Given that the population is greying it is becoming a growing issue and it is important there is a clear strategy, long term and short term, to deal with the major issues that have not been dealt with in the area of funding. Even allowing for the fact that people will be charged and have their pensions taken from them for the cost of public care, and allowing for a certain amount of pocket money, this only constitutes approximately one tenth of the actual cost of public nursing home care.

When it comes to private nursing home care a real problem is emerging that even with the enhanced subvention there are those on medical cards who cannot afford to pay the difference between what the enhanced subvention allows for, the pension add-on and the private nursing home charge. This is a real issue given that contract beds are being phased out. Therefore, there is no protection or security for these people, some of whom are extremely frail and vulnerable. The idea of forcing a person to move out of a nursing home because the costs are beyond their reach is unsavoury.

If this is to mean anything, it is bound to impose a potential charge on the State, unless we accept the idea that appears to have grown up because of practice, that one can have a strategy, as in the case of the health strategy, with no money provided. The health strategy was launched by the former Minister for Health and Children, even though the Minister for Finance had told him there was no money to support it. He went ahead with it and we all know what happened — it disappeared in a puff of smoke like a conjurors' trick. It appears that kind of mindset has percolated into this issue, where a strategy dealing with a huge area of costs, the funding of nursing home care for the elderly, is somehow deemed not to have a potential charge on the State.

I tabled an amendment which contains a modest suggestion that "the Minister and the Health Services Executive shall have regard to the targets announced by the Government" where money has already been allocated and there is a commitment by the Minister that 30,000 extra medical cards and 200,000 doctor only cards will be provided. Why should there be a charge on the State if that commitment has already been made? This is undermining any promise made by the Minister. If I accept what the Ceann Comhairle has said that my amendment is out of order, the implication is that the promise made by the Minister is worthless and that we will not get the 30,000 additional medical cards and the 200,000 general practitioner cards for financial reasons. That is a serious situation in which to find ourselves because I would have thought one could take the Minister at her word, include an amendment in the legislation providing for these targets and be mindful of them. It was not the Opposition who set these targets, rather it was the Minister. She made the commitment and must find the money to pay for it. How in any sane person's view this creates a potential charge on the State is hard to concede.

I cannot understand how an amendment which potentially means the imposition of a massive charge on the State, if we are to have full public nursing care paid for by the State — we are talking big bucks — is allowed while an amendment which simply holds the Minister to account for her own promises is not allowed. The reason I tabled this amendment is that the record is markedly different from the promise made by the Minister when she announced this in November. The record shows she promised 30,000 new medical cards. What has happened is that approximately 11,000 fewer people are covered by medical cards. I am fearful that pattern will persist. Promises have been made but nobody has to implement them. God knows, enough promises were made in the area of health care that never materialised. The promise of 200,000 medical cards did not materialise, we now have 30,000 medical cards, and when we try to include in the legislation a provision to ensure the Minister for Health and Children has regard to it, somehow it is found to be unacceptable because it might incur a charge on the State. That tells much about the Government and its approach.

I have no doubt that if the Minister had been willing to accept the amendment there would not have been any problem. Is it that she is like her predecessor in that she does not want to be reminded of promises she has made? She does not want anybody to point the finger and ask, "Minister, you said in November there would be 30,000 new medical cards and 200,000 general practitioner only cards and why has it not been delivered?". All that is being asked for is to have regard to the commitment which she made — nobody else made it — and yet that is deemed to be out of order. That is disturbing for those who are waiting for medical cards and it is undermining the credibility of the Minister if what is being stated here is that we cannot include this in the Bill, even though it concerns a commitment she made.

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