James Reilly (Dublin North, Fine Gael)

We would like to be absolutely assured of that. It would help, because otherwise it would represent another blow to the elderly. As this fair deal fund is capped, many people will not be able to avail of it. There will be a queue to get into nursing homes, but many will not be able to afford it. A third of people currently in nursing homes would not satisfy the criteria of high dependency to which the fair deal will be limited. Many people who find themselves in excess of €700 will have no money left because they are paying €50,000 per annum to a nursing home.

The Bill is not clear on what is included in the means test, and the Department of Health and Children has published no information on what it means by a "simplified means test". Section 4(4) of the Bill states the calculation of gross income will include gross income from all sources. This includes pensions and investments, or savings with an income disregard of €36,000 for a single person and €72,000 for a couple, net rental income from property and any income from part-time employment. It is not clear how incomes on savings and investments are calculated, whether money gained from the sale of the principal private residence is considered, whether a person is eligible if he or she is in a nursing home and has income which exceeds the €700 threshold, but the cost of the nursing home care completely absorbs the income, or whether the person's income is absorbed by excessive health expenses due to serious illness. What happens to siblings sharing a home and associated property and who have shared their expenses all their lives? Are they considered to be single or a couple? How is their property assessed? I know people in their 40s who have given up work to look after their parents, sometimes because one of the siblings is a bachelor and has continued to work in the home. If that person dies, do the circumstances change for the person who is still earning? Will the capital of any property other than the family home also be assessed?

How is the fluctuating nature of income on such investments to be calculated? Dividends and interest rates vary, sometimes dramatically. Will this mean that an individual may qualify for a medical card in one year, but lose it the following year? What about interest on post office products, savings bonds and savings certificates? Are these included in the calculation of gross income? Savings bonds are exempt from income tax, and the income levy is not paid on income from savings certificates, which is administered by the Revenue Commissioners. Will people who were encouraged to save under the SSIA be penalised for their savings? Is income from the rent a room scheme included?

The budget is changing the health expenses relief, yet the Minister tells us today that the Minister for Finance is not considering interfering with that relief. That is to be welcomed, but we would like to see it in the Act so that we can be sure of it, because there have been many U-turns recently.

People who are terminally ill have significant medical expenses. Many of them are above the limit, but historically they could apply to the HSE for a discretionary medical card and it would be given without any questions asked. Now they are being made jump through loops of red tape when they are at their weakest and most vulnerable. Many of them have been refused. We are not talking about millionaires, but about ordinary people. As I have said in the House previously, people who live in Walkinstown, Ballyfermot and many other places have been refused. The people in question are not millionaires. There is no guarantee that such people will receive a discretionary medical card. The means testing regime that is to be introduced was not previously in place. Medical cards were given to people who did not have long to live as a token of their service to the State. The provision of medical cards eased the concerns of such people about the cost of medical equipment, some of which is not available or is difficult to get outside the public health system. Are people to be deprived of morphine pumps? Will it continue to be possible for them to get hospital-type beds and commodes in their homes to allow them to stay at home? These are the sorts of things we are talking about.

I asked the Minister a straight question at a committee meeting last week. I asked her whether she would remove the cap on discretionary medical cards for the elderly and bring an end to the means-testing of such people. She did not answer that question in the affirmative. The Department of Health and Children contacted a newspaper to say that the Minister had indicated that it would be the case. I will give the Minister an opportunity to answer my question with a simple "Yes" or "No". Will the cap on discretionary medical cards for the terminally ill be removed and will the means-testing of the terminally ill be brought to an end? I am quite happy for the Minister to answer the question now if she likes.

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