Liz McManus (Wicklow, Labour)

I ask the Tánaiste to clarify some of the points she made. I understand the point she has made about the discretionary allocation of medical cards resulting in unevenness across the country. A discretionary scheme would not work properly if it were absolutely uniform as people's experience will vary in different parts of the country. For example, some counties have no hospital and people may have great difficulty in accessing services. It is important to retain a discretionary element in whatever scheme is devised. The relationship of the director of community care — I am not sure if that title is still used — in the old community care areas is appropriately close to both the service and the population. We need the local knowledge of directors of community care.

It is not always possible to define a scheme that will not discriminate unfairly against somebody who may qualify for a medical card on grounds of sheer hardship and suffering, but if required to comply to a particular rigid scheme simply cannot access the card when needed. The scheme that allows disabled drivers grant aid and assistance uses extremely discriminatory criteria, which are grossly unfair on people who just fail to meet the particular requirements. The Minister should ensure that such rigidity is not included in this system, which seems to work pretty well at the moment. The only difficulty is that medical cards are available to so few people. While approximately 700,000 cards have been issued, many more people are covered.

Since the Tánaiste was in a position to increase the income eligibility limits, everybody presumed increasing the limits would result in additional medical cards reaching the point of the 30,000 new ones. However, while she has increased the income limit, it is clearly not enough. I do not want to debate that people are working, etc. We know that medical bills, the cost of drugs and hospital charges have increased hugely. The increased cost per patient is very steep compared with the increase in the income eligibility limits. Clearly the new limits are too low to enable the additional 30,000 cards to be issued. What is the Tánaiste doing about that matter? I ask her to give some more detail about the 200,000 cards. How can she avoid a time lag resulting in these cards not being issued as a result of income changes? I accept her observation that incomes are changing. However, people's needs are unchanging and there is a significant cohort above the limit who simply cannot access a doctor. It is to be hoped this need will be partially addressed through this measure.

In regard to the ten point plan, Deputy Twomey spoke about the specific commitments and arrangements that were to be in place to address the issue of elderly people or those in rehabilitation who were still inappropriately located in acute hospitals. How many have moved under this plan and how many will be moved in the future? I hate to use the term but there has been a significant number of "bed-blockers", or those inappropriately placed, especially in the large Dublin hospitals where there are particular problems. My colleague, Deputy Costello, has raised the case of a 73 year old who was on a trolley in the Mater Hospital for five days, long after the ten point plan was published. Such a situation is difficult for anybody to endure and it is inexcusable in the case of an elderly person. What has been the success rate on the commitments made under the ten point plan?

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