Jan O'Sullivan (Limerick East, Labour)

My party leader raised a point this morning about people who gave up their voluntary health insurance because they felt they did not need it following the introduction of free medical cards. Those people are now trying to go back into an insurance system in order to cover health costs. The point made this morning was that if people had an existing condition, then they would not be covered for a number of years if they went back into a voluntary health insurance scheme. Since risk equalisation has been struck down by the courts, elderly people who broke their insurance cover and who wish to go back are in a very uncertain situation.

I want to address some of the other issues that relate to health in this budget, especially the charges that have been introduced. The increase from €66 to €100 for a visit to an accident and emergency department is a huge burden on people who are sick. When Fianna Fáil went into Government back in 1997, that charge was £12, so there has been an 800% increase. There have been increases in charges for hospital beds. The threshold for the drug repayment scheme has been raised to €100 per month per family, which is up from €90. These charges impose huge hardship on families.

The reason the health sector is suffering these increased charges, which are estimated to come to €100 million, is largely due to the complete failure to reform the health services. When the HSE was formed in January 2005, the Minister stated that it would provide efficiencies, save money, cut down on administration and provide funds for the patient at the coal face. It has done precisely the opposite and the Minister for Finance admitted yesterday that there has been an increase of 1,900 administrative staff since it was set up. That is hardly a reduction in the burden of administration. The formation of the HSE was rushed for political reasons so that it could be put in place by 1 January 2005, but it was destined to fail. It was designed simply to stick 11 health boards together and put another layer on top. It was designed to be a centralised dinosaur, with very little power to make decisions at the patient level. As a result of that, it has understandably failed to work. There has been an increase in the budget, but the money has not produced any better results for patients. Bureaucracy has been increased and has made it difficult for people who are directly looking after patients to make decisions in the interests of those patients.

The Labour Party put forward a plan on how the HSE should be reformed. I am glad to see that a little bit of it is being taken on board, as there is an effort to thin out the layers of administration at the higher levels. However, we really need more power for those who are directly working with the patients so that they can control their budgets and decide how those budgets are spent. That has not happened. As a result of the lack of reform, there has instead been a chopping at the edge of the budgets, which will only hurt the patients. It has been admitted that services to patients will be affected by this. The 2% increase given to the HSE will not enable it to cope with the extra demand or with wage agreements that have already been signed. Nor will it enable the HSE to cope with consultants' payments, which have also been increased by agreement. It will not deal with medical inflation, which is probably higher than general inflation.

This winter, we will see more people on trolleys and waiting lists. The Taoiseach made the point this morning that those over 70 who are to lose their medical cards will be all right because they are entitled to free care in the hospitals. They will be so entitled, but how long will they have to wait? We all remember Susie Long, who died on a waiting list because she was a public patient. Are the people who are now losing their medical cards going to have to wait on lists that will grow longer? I understand that health workers in the north east have already been told that their budgets will be cut back by 10-12% in hospitals, and we all know what is going on in Drogheda at the moment.

The health sector has been deeply damaged by this budget, and the vulnerable people in our society, the old, the sick and the disabled are those who will suffer most. They are taking the brunt of it and that is not how it should be. We were told in this budget that the Government was going to protect the vulnerable, but it has done everything except protect the vulnerable. The Government has exposed people to worries that they might not be able to look after themselves when sick.

The leader of Fine Gael raised the issue of the "fair deal" and the ability for someone to offset health expenses against tax. The reply was that it would not come in at the lower rate until the fair deal was in place, so things were fine because people would be covered by it. However, we need to read the small print of the fair deal. To qualify for the fair deal, one has to be assessed as being in a state of maximum dependancy. There are many elderly people who have to leave acute hospitals and go to nursing homes because they do not have enough support to go home, but who are classified as being of medium dependency. From reading the legislation on the fair deal, I believe that such people will not qualify on the basis of the medical assessment. I accept that there is a social assessment as well, but I have no doubt that many in nursing homes will not qualify for this new scheme. Therefore, the families of those people will be affected by the change in the rate of tax that can be written off against medical expenses and expenses for long-term care.

There are many aspects to the budget that will affect sick people. It is a very sorry day for the health services. It will take a long time to recover, yet we still do not know what allocation the HSE will get next year. I have no doubt those figures will have a serious impact on health services in hospitals and in the community. I support the Government's wish that where possible people should be cared for in their own community. I predict we will see cuts in home help hours and in the many other kinds of home supports needed if people are to stay out of hospital.

This is a sorry day for the health services. I wished to highlight the manner in which the over-70s have been treated and how they will now be means tested for medical cards. Many of them are very worried tonight.

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