Mary Harney (Dublin Mid West, Progressive Democrats)

In the first instance, the Government had to secure the stability of the banking system, which is fundamental to the operation of the country. Against the economic backdrop that the Government faced, its priority was to secure the economic and social future of the country. This was foremost in our minds in all we did in framing the budget. The Government wished to ensure that where choices were made it protected, as far as it could, those most vulnerable in society.

I heard reference to health spending, which has increased in Ireland in the past ten years by, on average, 8.8%, the second highest among OECD countries. Health spending in Ireland today accounts for 9% of national income, which is on a par with OECD countries, even though 11% of the population is over 65 years, whereas in the UK the figure is 18% and in some other European countries it is more than 20%.

We have a substantial base of funding of the public health system. The challenge is not merely to invest more funds as they become available, but to reform the manner in which we provide services, which has been the focus of much of what we have done in recent years. In particular, we must ensure we provide services that are quality assured and driven by patient safety. Nowhere is that more important than the area of cancer care. The outcomes for cancer treatment in Ireland are not as good as in other European countries, with the exception of the treatment of children's cancer, in which we are top of the class worldwide. The reason we do so well in the treatment of children's cancer is that we have centralised the treatment in one hospital, even though patients can receive services in 16 different places throughout the country. The diagnosis, initial surgery and treatment are planned at one designated centre. We see significant benefits from this system with the outcomes and we seek the same for the treatment of other cancers.

The Government faced spending choices between, for example, more investment in cancer services to ensure the eight designated centres will be in place as quickly as possible and other choices. All breast cancer services will be moved into the new centres by March of next year. During next year, Professor Tom Keane will be involved in moving prostate and lung cancer, the next two priority areas, into the eight centres. Professor Keane sought funding to assist with the transition of the services and to recruit the expertise we need to provide multi-disciplinary teams of physicians in the eight cancer treatment centres, including pathologists, radiologists, surgeons, medical oncologists and so on.

The Government has approximately €454 million available in extra funding for health next year. This amounts to 3.2% year on year and when the once off payments during 2008 are factored out, such as the long-stay repayments, the figure is 4.2%. Inflation is forecast to be 2.5% next year. The position is not the same as it was in 1987 and 1988 when the Government reduced spending on health by 3.5%. Faced with these choices, the Government decided to invest in the eight cancer treatment centres for next year and to invest in the fair deal. There is more than 20,000 older people in long-term care. Approximately half of those are in publicly funded facilities and have 90% of their care costs met by the State. Those not in that situation have approximately 40% of their costs paid for by the State. That is unfair and inequitable and places a heavy burden on the older person and his or her family. It causes great distress to many older people who have had to sell their houses or whose children have had to remortgage their houses to pay for their parents' care. That is why the fair deal is so important. It will ensure, for the first time, that those in publicly funded long-stay facilities and those in privately funded facilities are treated equally. It will greatly relieve the stress older people and their families associate with going into long-term care.

There has been a great deal of debate about medical cards. There are 350,000 people over the age of 70 in Ireland. Approximately 215,000, or 60%, of them have a medical card based on an assessment of means. They will not be affected by the decision that was announced yesterday. The other 40% of this country's over-70s — some 140,000 people — have a medical card not on the basis of their means but on the basis of their age. We estimate that 14,000 or 15,000 people from within this group will get a full medical card when means tests are carried out. A further 30,000 or 35,000 people will get a doctor-only medical card. That will mean that 80% of people over the age of 70 will not have to pay to go to the doctor. Of the approximately 70,000 people not in this category, those who earn less than €650 a week, or €1,300 a week for a couple, will be able to avail of a health support payment of €400 for an individual, or €800 for a couple, to meet the cost of going to the doctor. Approximately 5% of those over the age of 70 will be outside the limit threshold and will not get any support.

When we considered our options, we decided to prioritise the need to invest in cancer care and the fair deal. We are focusing on the recruitment of approximately 120 speech and language therapists for children with special needs who have been assessed as being in need of such services. We are helping the 53,000 families at the bottom of our society that avail of home help services. We are assisting the 10,000 older people who receive home care packages and medical support in their own homes. Such packages prevent them from having to go into long-term care. The decisions we had to make were not easy. I believe we made appropriate choices, in light of the resources available.

I remind those over the age of 70 who do not get a full medical card, or a doctor-only card, that they are eligible to apply for a hardship medical card. Some 70,000 people currently receive the benefit of that card. It is given to individuals on the basis of their circumstances. The hardship medical card helps people with particular illnesses or ongoing health requirements, for example. As a result of this flexible approach, 70,000 people currently avail of the hardship medical card. It will continue to be available to people over the age of 70.

Reference was made in the House this morning to the VHI. The VHI has informed me that contrary to what Deputy Gilmore said, there is no evidence that people over the age of 70 stopped subscribing to the VHI, to any great extent, when the over-70s medical card was introduced. The VHI has said that the proportion of its clients who are over the age of 70 has increased from 5.5% to 6.5% in recent years. The fact that a higher percentage of older people now have health insurance contradicts what Deputy Gilmore said in the House. There is no cross-over between the services available under the medical card and those offered by the VHI in 2001 and 2002. As the Taoiseach said this morning, the services in question were hospital-based. The only expense covered by both the VHI and the medical card was the inpatient charge, which one pays for a maximum of ten days when one is in hospital. If one has a medical card, one does not pay that charge. The VHI has told me that if anyone wishes to return to its plan P, to which approximately 25,000 people currently subscribe, they will not be subject to any kind of waiting period. It is important to clarify that the suggestion made by Deputy Gilmore this morning was incorrect.

The increase in the accident and emergency charge is one of the other health service issues mentioned during the course of today's debate. The increase will raise about €10 million per annum, which is a small amount when compared to the overall level of expenditure. It is obvious that medical card holders do not pay the charge. The purpose of the increase is to encourage many of those who come to accident and emergency departments for relatively minor matters to contact their general practitioners in the first instance. Those who are treated by GPs do not have to pay the accident and emergency charge. As I have said previously, Ireland enjoys very good working-day and out-of-hours general practitioner services. There is evidence in Ireland, unlike many other countries, to suggest that many of those who attend accident and emergency units would be better served by first going to general practitioners, who can deal with between 90% and 95% of our health needs.

I wish to speak about the charge for private beds in public facilities. It has long been Government policy that the taxpayer should not have to fund, or subsidise heavily, private beds in publicly funded facilities. Such facilities were paid for by the public purse and their staff are paid from the public purse. As insured patients have preferential access to private beds in public facilities, it is not unreasonable that the taxpayer should not be asked to subsidise such beds heavily. That is why we have been increasing the charge for such beds to private insurers over recent years. The charge is being increased by 20% this year. That will add 4% to the cost of private health insurance. Beds that are not available to everybody on the same basis cannot be heavily subsidised by the taxpayer. I do not believe anybody would regard that as being fair. The increase in the charge for long-stay care, which was mentioned in the House earlier, is in line with the increase in pensions over recent years.

The fundamental challenges this country faces are to restore the public finances and to protect employment as quickly as possible. If we do not succeed, this country's future challenges will be much greater than those we currently face. We need to prioritise the challenges I have mentioned. Fine Gael has suggested the Government did not go far enough with its proposals to reduce public spending. Deputy Bruton suggested health spending should be cut by a further €700 million next year. Quite honestly, I do not see how we could take such a level of funding away from the public health services in 2009.

See this speech in context