I thank Deputy Wallace for sharing time. The content of this Bill has been the subject of much debate over recent weeks and I am glad to have the opportunity to speak on it. The decision taken by the Government to end the automatic entitlement to a medical card for all those aged 70 and over was not an easy one. When the commitment was made to enact the practice of automatic entitlement we faced very different times. Ireland was in darkness for many years and is experiencing significant changes in its economic environment. Things were on the way up and the Government was in an enviable position whereby it could provide such measures. However, things have changed and we are now in a global economic crisis which has resulted in a situation where expenditure has had to be cut across most Departments.

Cuts are never easy to endure, contrary to what the Opposition would have one believe. Decisions on where cuts may be implemented are difficult. I realise the Minister and Ministers of State in the Department of Health and Children faced tough decisions when balancing its books. The Minister has presided over a radical overhaul of the health service which is ongoing. The overhaul was necessary and courageous. We have all heard the negative issues which have plagued our health service over the years. The overhaul was and is necessary to ensure we can provide a world-class health service.

Unfortunately the issue of automatic entitlement to a medical card for those aged 70 and over had to be reviewed to make necessary savings to continue to provide other critical services in the health sector. It is vital to point out the criteria which will take effect with this Bill. The vast majority of those aged 70 and over will continue to have medical cards under the new income thresholds. The income threshold has been set at €700 per week for a single person and €1,400 per week for a couple. This is a sizeable income per week.

Furthermore, should an individual find themselves to be above the income thresholds outlined there is a process whereby they can apply for a medical card subject to personal circumstances causing undue hardship. There has been anxiety amongst older people which we have all experienced in our constituencies. There has been a great deal of scaremongering, which is not helpful.

Those aged 70 and over who currently hold a medical card will have their entitlement fulfilled under the new arrangements. They will not be subjected to any means test and will continue to hold their medical card. Those who will turn 70 before the end of this month are also automatically entitled to a medical card. Those who turn 70 after the end of this month will be subject to a simplified means test whereby their gross income will be examined to establish if it is below the new income threshold.

We would prefer to be in a position to offer automatic entitlement to medical cards to all those over 70 years of age, but it is not possible in the current economic climate. We have reorganised the scheme to ensure the elderly most in need are protected in terms of medical card entitlement.

It is fair that those who are financially secure and in a position to pay for their health care should be asked to do so at this time. This debate also raised the issue of capitation fees for GPs, which have been paid since 2001 for those over 70 in receipt of medical cards due to age rather than means. These fees have been financially unsustainable and I commend Mr. Eddie Sullivan's efforts in securing an agreement where a single fee capitation level will be paid to GPs in respect of medical card holders over 70 years of age.

Irish people are living longer and healthier lives. I read yesterday that Irish children were ranked first out of 41 countries for physical activity and general health in a WHO survey. We enjoy very high standards of living in this country, which is something that does not receive enough attention. However, much of that is due to the standards in our health services. We have a young population in Ireland, but this is expected to change in the future, as our population ages and people are expected to live longer than in the past. We must plan for this and it is within these terms that the medical card scheme has been adjusted. It is vital that the scheme continues to be sustainable in the years that lie ahead. Therefore, I believe that this Bill provides a fair and equitable method of medical card provision for the ageing members of our society. They deserve to be looked after, and they deserve fair access to health services. That is why the issue had to be addressed at this time. Those most in need are those we are endeavouring to cater for most in this Bill.

The health service has been a hot topic in the past number of years, but that is what is to be expected when an overhaul is in progress. The Minister, Deputy Harney, has overseen the biggest overhaul in the service in recent years, and I commend her and Professor Drumm on their efforts.

See this speech in context