Seymour Crawford (Cavan-Monaghan, Fine Gael)

While I welcome the opportunity to speak on this Bill, I do not agree with its contents. When it suited Fianna Fáil and the Progressive Democrats to encourage people over the age of 70 to vote for them in the 2002 general election, they offered free medical cards to all such people without a means test. We were advised that the measure would cost approximately €17 million per annum. Like many other proposals, such as decentralisation, this proposal was implemented without any preliminary discussions or negotiations with the doctors or other relevant personnel. Of course, the final cost of the scheme was closer to €57 million than to €17 million. The organised propaganda of Fianna Fáil involves blaming the doctor who represented the doctor's organisation at the time for the cost of the scheme. The doctor in question, Deputy James Reilly, is now the Fine Gael spokesperson on health. His job was to get the best deal he could for his members. It is somewhat far-fetched to try to transfer to the Deputy the blame for the Government's mismanagement and incompetence in this case. However, it is typical of this Administration.

The best way of reversing the outrageous decision to remove the automatic medical card entitlement from those who have given such service to this country is to ensure the moneys in question are saved in other areas. I suggest we cut some of the substantial waste in the administration of the health service. I will give an example of such waste. Some time ago, the HSE invited me to attend a meeting to discuss an issue of relevance to the head of that body. Approximately 95% of my questions were answered at the meeting, which lasted an hour and at which nine HSE managers were present. I was the first of the Members of the Oireachtas who represent the Cavan-Monaghan constituency to be dealt with on the day in question. My colleagues were dealt with in a similar way after I was finished. There was no need for nine managers to be absent from their desks for a whole day. They could have met the Members of the Oireachtas from the constituency in a single group and dealt with the issue within two hours. This is one of many examples of cases which exemplify the need to examine HSE structures. Professor Drumm has admitted he does not understand what some people in the HSE administrative system do. I accept that there are some brilliant and hardworking administrative staff in the system. However, I do not doubt that the money needed to pay for the automatic provision of medical cards to everyone over the age of 70 could have been found if the Minister and Professor Drumm wanted to find it.

The Government has done something of a U-turn by providing for more realistic income levels to be applied to the medical card means test. It is sad that the provision of a cervical cancer vaccine to 12 year olds was deferred to facilitate this change. The Minister, Deputy Harney, and the HSE need to examine the manner in which significant sums of taxpayers' money are spent in the health system. All services were available at Monaghan General Hospital when it was run by Monaghan County Council. The Minister, Deputy Harney, has never found the time to visit the hospital. Her only interest, and that of Professor Drumm, is to close the hospital as quickly as possible in spite of the fact that €17 million has been spent on it.

I learned today of a patient with a broken arm who entered Cavan General Hospital on Monday and was transferred to Our Lady of Lourdes Hospital, Drogheda, on Tuesday. Along with 27 other orthopaedic patients, she slept on a trolley at the latter hospital. Her arm was reset and generally dealt with while she was under local anaesthetic because it was not possible to get her a full-time bed, with full anaesthetic services, for a number of weeks. The level of suffering she and a number of others endured, as a consequence of the fact that only local anaesthetic services were available, is unacceptable in any caring health service. This incident happened at a time when the orthopaedic unit at Our Lady's Hospital, Navan, has been closed as a result of the mismanagement of our health system.

I have been ordered by the HSE to attend a meeting regarding the reconfiguration of the Cavan-Monaghan hospital group, with particular reference to the transfer of the acute medical unit at Monaghan to Cavan. It is relevant that this meeting has been organised at St. Davnet's psychiatric hospital complex, as only those with psychiatric problems would consider what the HSE is doing with full ministerial and governmental support. At present Cavan General Hospital cannot cope with its own patient intake and the hospital in Drogheda had to be taken off call a few weeks ago.

Clearly the Minister with the support of her Fianna Fáil colleagues is prepared to treat the people of Monaghan as guinea pigs for a new system that is completely untried and unworkable and will cost lives. This is the advice I have received from highly qualified people not directly working in Monaghan who originally supported the HSE management but now realise it has no idea how to manage its funds or how to run a safe system.

The budget proposal on medical cards caused serious stress and pain to all those over 70 and all those who care for them. As pointed out by Deputy Neville, regardless of the changes made there is still a tremendous fear amongst couples who realise that when one of them passes away the other member will be subject to a much tighter means test and may lose the medical card. At that age the death of a spouse is enough to deal with without having to go through the trauma of a means test and the possible loss of a medical card.

Clearly better negotiations between the HSE, the doctors and all concerned could have avoided this entire trauma. However, as one representing the counties of Cavan and Monaghan I cannot ignore the difficulties within the means-test system for all other medical card applicants. It is totally unacceptable that a county such as Monaghan has only approximately 32% of its population availing of medical cards while Donegal, for instance, has 52%. Other areas such as Cork where incomes are higher than Monaghan have a much higher percentage of medical cards available. While the medical card is extremely important for those in frequent need of doctors' calls and medication, never mind hospital, it is equally of major importance for families living in rural areas who will get a free bus pass, clothing allowance and book allowance it they have a medical card but without which they get none.

There is also a problem for people who are terminally ill. I understand there are question marks over whether these people will get the medical card in future which is extremely serious. For years I have battled in Cavan and Monaghan to try to minimise the trauma those people suffer. They still need to go through a full means test. I remember one case in which a self-employed person with cancer had lost part of his tongue. The HSE insisted that he prepare his accounts for the previous year before deciding whether he would get a medical card. This is the ridiculous gone mad.

At the start of her speech, the Minister for Health and Children emphasised that 95% of people will get the medical card in future following this great dramatic change. One wonders what this is all about. How many of those who were eligible for medical cards actually applied for them? Would some of those super rich people that the Minister and the Taoiseach mentioned have bothered to apply for medical cards? If so how much use did they make of them? Did it cost the State a fortune? Those people would have had private medical insurance. How great will the saving be so that we can judge whether this is a good deal?

Clearly no thought was put into this proposal before it was put on the table. The means test was originally pitched at a level below ordinary social welfare levels. Obviously with the scare of the thousands of people at the gates of Leinster House new thinking needed to be put in and the Government has made a change. Is there any justification for this proposal?

As I have already stated there are major problems in the structure of the HSE. There are major problems in the wider health service with mismanagement etc. I recently heard people talking about what had happened in the other part of this island, the Six Counties, since it got its own Minister. That Minister has sat down and talked to the people. He has asked that they do a little extra each. He has got co-operation from them. Although he did not ask for an increase in budget, he has improved services. Our Minister and the Government could learn from that. A little more involvement with the people who work in the services could do a lot.

See this speech in context