Michael Kitt (Galway East, Fianna Fail)

I am glad to contribute to this debate. I support what Deputy White has said about the importance of this legislation. The point stressed by her and other Members is that the medical card is being made available to those who are unable, without undue hardship, to meet the cost of health services for them and their dependents. This is important. When dealing with the automatic entitlement of people over 70 to the medical card, we refer to very vulnerable people but we are also talking about a situation that was difficult when it was introduced. Deputy Behan referred to that. GPs were getting four times the rate for people over 70 compared to those under 70. As our elderly population grows, we are in a difficult situation. I am glad to hear the Minister say that 95% of people will qualify because their income will be below the limits of €700 per week for a single person or €1,400 for a couple. The House will agree these are high limits. The phrase she used, in referring to payments made to those over 70 in the GMS service, was perverse incentive. This is a good point because there is no justification for that. I welcome the recommendation of Mr. Eddie Sullivan, who proposed a single fee capitation level of €290, which will be implemented next year.

We all agree that people over 70 used the medical card. People were more inclined to go the doctor, particularly the male population, who are notoriously poor at attending GPs. I welcome that. The Minister stated that we have the youngest population in Europe and the number of people over 70 is expected to grow substantially in the coming years. The figures will be 363,000 in 2011, 433,000 by 2016 and 535,000 by 2021.

Regarding criticism of Fianna Fáil and this Government, for many years there was great recognition of the elderly by this Government and various Fianna Fáil Ministers. A Fianna Fáil Minister brought in many of the packages for people over 66 years of age. We now refer to this package as household benefits and it includes free travel, free electricity, free telephone rental and the national fuel schemes. The late Frank Cluskey increased social welfare payments during his time in that Department. He did much better than Proinsias De Rossa, who succeeded him but who was not a great success in the Department. When Ray MacSharry was Minister for Finance in difficult times many years ago, he made provision for the medical card to be granted to everyone aged over 66. That lasted for a short while but he was succeeded by Barry Desmond in a coalition government, who did not retain this measure. Opposition Members should note this when they state Fianna Fáil is not being kind to the elderly. There was little protest about this reversal at the time.

However, nowadays there are significantly more elderly people and, in difficult economic times, we must examine what we are doing. Mr. Eddie Sullivan made a fair recommendation of a single capitation fee of €290 per patient. Dr. Michael Barry is examining the potential saving on drug costs. He is chairing a group to make recommendations on good practice, which will secure safe and effective prescribing for patients and maximise the potential for economy in the use of public funds, and its report has been submitted to the Department. That is another welcome development because the overall funding of the health budget must be examined and not only the medical card provision. This has always been central to Fianna Fáil policy and its Ministers in the Departments of Health and Social Welfare over the years.

I refer to the Age Action Ireland publication, The True Cost of Living Alone. The organisation has been lobbying for a long time to examine ways to help pensioners living alone. Its budget submission concentrated very much on the living alone and fuel allowances and the security of having a medical card. The Minister is confident the vast majority of people aged 70 and over will retain their medical card. The scheme is often used as a criterion for other schemes such as the school transport scheme, which is difficult to understand. If one has a medical card, one can qualify for free school transport. It is strange that because one has a medical card, one is entitled to other benefits. However, it is clear from the Age Action Ireland publication that the medical card provides security for elderly people.

I agree with Members that mistakes were made and there were communications issues in letting people know what would happen. We made changes but, as many Members said, perhaps the elderly were caught in the crossfire between the Government and the medical profession who were trying to resolve the fee per patient issue, which was €640 per pensioner at the time. I am sorry about that and, like other Deputies, I very much regret the way this was communicated. However, 350,000 people aged 70 and over are in receipt of the medical card and the number will increase in years to come, for which we must provide. I am glad the legislation provides for a gross income threshold of €36,500 a year for a single person and €73,000 for a couple.

It is important that we make it easier for people to access medical cards. The Minister explained the current position regarding elderly couples who seek a review of their income where one partner is aged 70 or over but the other is not. It is to her credit that she has increased income limits during her tenure by 29% and allowances are also provided for PRSI, child care, mortgage or rent and travel to work expenses. For example, over the past two years, 125,000 additional medical cards were granted and, currently, 1.27 million people have medical cards, which is the highest number since 1996 while 75,000 have GP visit cards. A total of 200,000 more people can visit their GP free of charge, which is the highest number since 1994.

Home care packages are also important because it is not enough to provide only a medical card as the elderly face issues relating to physiotherapy, chiropody and speech and language therapy services, although they are much improved. The Nursing Home Support Scheme Bill 2008, known as the Fair Deal, was another important contribution by the Minister and the Government.

I hope the House will agree we have greatly improved the way we deal with issues relating to the elderly. I am proud of Fianna Fáil's record going back to Ministers who provided social welfare and health packages over the years. I am delighted more people are in receipt of the medical card, particularly those in the over 70 category. I also hope the issue of providing easier access to the medical card scheme will be examined further. A great deal of paperwork is involved in some professions. There should not be as much paperwork involved in applications for the medical card. When the health boards were in place, I proposed that paperwork should be kept to a minimum and a print out was subsequently provided, which kept information to the minimum. I hope that will be the way forward and I will call on the Minister to make applications and interaction with community welfare officers easier. They are busy dealing with paperwork for various other schemes.

The legislation provides for a Government decision to end the automatic entitlement to a medical card and I hope the new arrangements will ensure the vast majority people aged 70 and over will continue to have medical cards under the new income threshold, which is realistic. I also hope the Bill is speedily passed through the House.

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