Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I move amendment No. 1:

To delete all words after "That" and substitute the following:

"in view of the fact that the Health Bill 2008,

removes automatic medical card eligibility for people over 70,

reneges on the commitment in the Programme for Government agreed between Fianna Fáil, the Progressive Democrats and the Green Party in 2007 to extend medical card eligibility,

represents a further step away from universal access to public health services based on need alone,

Dáil Éireann declines to give a Second Reading to the Bill."

Molaim an leasú i m'ainm ag cur i gcoinne an Dara Léamh den Bhille Sláinte 2008. I have proposed that the Dáil should decline to give a Second Reading to the Health Bill 2008. Sinn Féin is totally opposed to the Bill because it seeks to implement one of the most callous, ill-considered and bungled decisions ever made by a Government. Some years ago, with great fanfare, a Fianna Fáil-led Government gave everyone over the age of 70 years an automatic entitlement to a medical card. It never ceased to boast of the benefits it had provided for older people, of which this was the centrepiece. In the rushed budget the Government revealed once more that much of its policy was underpinned by a fundamentally flawed approach that saw vital public services not as rights but as benefits or favours that could be given and taken away at will. The pretext for the removal of the automatic medical card entitlement of those over the age of 70 years was that it was a cost-saving measure. Like the Government, we do not yet know what savings, if any, will accrue from this decision. A massive wave of protest from older people forced the Government to modify the measure. Its actions exposed the ill-considered nature of its original decision once more.

The Government has introduced a new payment for general practitioners of €290 in respect of all medical cards, including medical cards held by those over the age of 70 years. It did this in the shortest time possible because it was facing massive political pressure. It is clear that it did not have the political will to reset the fee before it made its bungling decision to end the automatic entitlement to the medical card of people over the age of 70 years. The debacle exposed the appallingly bad deal for the taxpayer that the Government had negotiated when it first introduced the entitlement of people over the age of 70 years. It allowed a far higher fee of €640 to be paid in respect of those entitled to the medical card by virtue of age alone. Similar confusion persists in respect of the new €290 fee. The Irish Medical News reports this week that the Department of Health and Children is unable to answer its queries about how the new fee will be introduced. It states three months notice is required to terminate the current GP contract that applies to those over the age of 70 years. I presume this means that the old fee will apply for three months after the Bill is enacted. Is that the case? I ask the Minister of State, Deputy Michael Kitt, to clarify this matter.

On the issue of costs and savings, the Minister said in the Seanad on 29 October last that the number of people over the age of 70 years who were in receipt of a medical card exceeded by 10,000 the number over the age of 70 in the State. She explained this anomaly by saying it "probably" had resulted from "people have passed away" continuing to be "factored into the equation". It is a damning indictment of the Minister, her Department and the HSE that, for all their bureaucracy, they are unable to ensure GPs are not paid medical card fees in respect of thousands of deceased patients. I agree with Age Action Ireland which has pointed out that "By improving the administration of the system and taking medical cards from the dead rather than the living, (the Government) can make half its targeted savings and ensure the economic running of the scheme for all older people".

Similarly, the Government should listen to the words of the chairperson of the Irish Society of Physicians in Geriatric Medicine, Dr. Shaun O'Keeffe; the president of the Irish Gerontological Society, Professor Des O'Neill; and the President of the Irish Association of Social Workers, Ms Ineke Durville. In a joint statement they warned of the impact the loss of the medical card entitlement would have for people over the age of 70 years. While they welcomed the changes made by the Government to the initial budget proposals, they said they remained concerned about those who would lose their entitlement to a medical card:

Free access to GPs facilitates preventative, as opposed to therapeutic, visits. Older people are the most likely to suffer from chronic disease. Optimal management of these conditions emphasises the importance of timely and frequent use of primary care to reduce personal suffering and societal health care costs, including costly hospital use. Since the introduction of the universal over-70 medical card, the first Irish longitudinal study on ageing — Health and Social Services for Older People II — showed a major increase in preventive healthcare uptake in the over-70s.

The three senior health and social service professionals in question pointed out that the loss of the medical card entitlement would involve the loss of services needed to keep older people with chronic illness in their own homes such as forms of medication and therapy and appliances like special beds and chairs. As social services are underdeveloped and home care packages are means-tested, people with annual incomes of up to €36,500 can find themselves financially challenged when they try to provide the supports needed. The three people mentioned argued:

Means-testing is a psychological and administrative barrier. It will erode the benefit of the scheme and probably cost more than providing the medical card to the minority of affluent older people who want one. Moreover, it is not only a matter of having enough money to pay for private care: for many, possession of the medical card is the essential gateway to accessing public services in circumstances where equivalent private services simply do not exist.

It is clear that the Bill is a retrograde step. It flagrantly breaks the commitment made in the Fianna Fáil, Green Party and Progressive Democrats programme for Government to extend availability of the medical card. The programme for Government promises to "index the income thresholds for medical cards to increases in the average industrial wage" and "double the income limit eligibility of parents of children under 6 years of age, and treble them for parents of children under 18 years of age with an intellectual disability". This is the least the Government should do. Poorer people suffer more illness and die younger. Many never reach the age of 70 years to qualify for a medical card in the first place. The all-island report of the Institute of Public Health, published in August, pointed out that health inequality was rife in the State. It shows that in the Twenty-six Counties 38% of those at risk of poverty reported suffering from a chronic illness, compared to 23% of the general population. In such circumstances, the Government is continuing to decrease people's entitlement to the medical card.

The partial climbdown by the Government does not go far enough. Universal medical card entitlement for the over 70s should be fully restored. I commend senior citizens for making their voices heard so loudly and clearly. They rocked the Government and brought about the partial climbdown which, I emphasise, does not restore the right that has been taken away. Sinn Féin approaches this issue from a point of principle — on the basis of health care as a right. We believe access to health services should be based on medical need alone. We want the State to move towards a universal public health system in which all citizens would be entitled to free health care services at the point of delivery. The Bill represents a move in the opposite direction. We want a universal system funded by fair and progressive taxation. We believe working people pay taxes in order that decent public services can be provided for them and their families. They pay taxes to ensure they are provided for in their old age. All children and all those who are unable to work or are out of work should be properly looked after.

Sinn Féin is in favour of a public health system that would employ general practitioners directly on set salaries. We have the ludicrous pretence that set GP fees for patients do not exist. We have the nonsense theory under competition law that people will shop around between GPs to find the cheapest one. We all know that does not happen in the real world. What has happened is that some GPs have shopped around instead. They have concentrated in more affluent communities mainly in the cities and in Dublin in particular, leaving less well off communities with a far lower proportion of GPs per head of population.

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