James Reilly (Dublin North, Fine Gael)

I will begin with the point Deputy Barrett has explored. The children's allowance, which is universally available, is given to the mother for the reasons to which Deputy Barrett alluded, that sometimes all is not as it seems in households. A woman may, ostensibly, have the use of her husband's income but may in fact not, and may not be treated properly. That is why the children's allowance is always given to the mother, lest such a husband use it for purposes other than those for which it was intended. I do not denigrate all the married couples in this country, the vast majority of whom provide happy families in which to grow up but we know of instances to the contrary; social workers tell us of them and they are not numbered in tens or hundreds.

I return to what the Minister said a few moments ago about having to make choices and her comments on home help services and operations. Operations are being cancelled up and down the country. We want the Minister to go after the waste she acknowledges exists in the HSE, address the redundancies and retraining in front line services required and sort out the top-heavy administration and management. That is where the money can be saved.

I have already told the Minister that in the North of Ireland waiting lists were reduced from 57,000 to zero over 18 months, and money was not the issue. Perhaps some additional money was spent, but very little. The difference was that the relevant Minister took direct responsibility and formed a special delivery unit that went into hospitals to find out why waiting lists were long, provided solutions, and then reported back on a weekly basis — sometimes a daily basis — to the Minister about the progress in hospitals. Such a system leads to two things. It puts pressure on those in the hospital to perform, because they know the Minister is looking at them. However, unlike here, they also feel the Minister is behind them and not at a remove, which has been the effect of much of the Minister's recent legislation. It puts distance between her and her responsibilities.

I am saying to the Minister that she should go after the waste and not go after the over 70s. They worked hard, they are the people who paid the 60% tax, who left this country, worked abroad, came back and built this country into what it is today. They have asked for very little. They are the people who save their money — the people who, as other Deputies mentioned, made their own sandwiches rather than buying them.

I mentioned earlier the longitudinal study that was carried out, which the Minister questioned. I have before me the documentation for the study, which is called Health and Social Services for Older People, HeSSOP. HeSSOP I was done in 2000 and HeSSOP II was done in 2004. HeSSOP II studied a different cohort, but 300 of the people from the first study were also followed up. The study, according to the National Council on Ageing and Older People, incorporates the first longitudinal data on older people in this country. It was carried out in two health board areas, the Eastern Regional Health Authority and the Western Health Board. The study gave grounds for optimism about the health of older people, including a reduction in smoking among older people, and a much greater uptake of flu vaccinations — from 30% to 70%, which represents more than a doubling of vaccine uptake. This is very important because it reduces the risk of stroke and heart attacks among the over 70s by 16% to 30%, which is a major saving by anyone's measure and a major health gain. I am not talking just about big savings to the State but also to people in terms of suffering and pain.

The study also noted that the gains were less in the 65 to 70 year old age group, who do not have universal access to medical cards. An article written by a GP concluded that better access to health care for the over 70s resulted in better use of preventative cancer screening. The study is real and the facts are there, yet the Minister chooses to ignore them to pursue, for whatever bizarre reason, this idea that removing medical cards from the over 70s will save us money in the longer term. In the longer term it will probably cost us more money in admissions, in accident and emergency services, in long term care. It goes completely against the principle, as espoused by the Minister and Professor Drumm, of trying to keep people in their homes and out of hospital. What will happen? The Minister knows what will happen. People will wait; they will hang on. They will not go to the doctor. They will not buy the medicine. They will chance another day and then another day, and they will end up in hospital, costing the State and themselves a lot of grief.

I have a quote here from Dr. Shaun O'Keeffe, who is the chairman of the Irish Society of Physicians in Geriatric Medicine. He states: "The decision eight years ago to extend the medical card to all over-70s was an enlightened and cost-effective measure". The only thing I can say about that is that it has transpired to be very cost-effective and enlightened even if at the time it was a political stroke to win the grey vote. I said to the Minister earlier and I will say again, "Give a thing and take it back; never see the eyes of God again". I will tell the Minister one thing. She will not see the votes of the elderly again.

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