Mary Harney (Dublin Mid West, Progressive Democrats)

I refer to the latter issue first. A brother and sister cannot apply for an old age pension or any other social welfare benefit together. I do not mean to be smart but we operate on the basis that families are recognised for the purposes of medical cards. When a member of a family qualifies for a medical card, the spouse and the children are included on the card. When the automatic entitlement was introduced for the over 70s, even where a spouse was substantially younger, by perhaps 20 or 30 years, although this was exceptional, they were entitled to a card as well without reaching the age. That was done on the basis that we could not interfere with families and, therefore, the card was granted to both the husband and the wife. No one would argue two brothers or two sisters should be considered a couple for the purposes of acquiring a medical card. They would be considered on an individual basis.

I refer to the three-year provision. I would have wished that a widow or widower could have retained the medical card indefinitely on the death of the spouse but the strong advice from the Attorney General is that is not legally sustainable and we are not free to discriminate between somebody in that position or, for example, somebody who never married, which is understandable. I was advised three years is a reasonable period. It is neither indefinite nor lengthy but it is reasonable and that is why that provision is being introduced on the basis of legal advice. It has been suggested many times that, immediately on the death of a spouse, the medical card would be whipped away. The HSE's practice is to leave the card with the surviving spouse until it expires.

The practice regarding the expiration of cards differs throughout the country and it is being standardised. Generally, cards are renewed on a yearly basis but older people who are out of the workforce can renew the card sometimes every three years. The validity of a card is based on the legislation and not on the date written on it. That is why it was necessary to amend the legislation to change the capitation fee paid to GPs, which was negotiated on foot of the legislation, and to reintroduce the new basis on which medical cards will be granted to the over 70s. I have heard of examples of dates far hence written on cards. If people felt they were entitled to a card on reaching the age of 70 and had a date put on it, that was not good from a psychological point of view but the date printed on cards varied from place to place. One Member stated 2020 was written on a medical card. However, the basis on which people retain cards is the legislation and the date on the card does not matter.

Given we are in the Christmas period, the HSE will communicate with the over 70s to explain the new arrangements. From 1 January, new cards will be granted on the basis of self-assessment. The vast majority of older people are honest, perhaps more honest than other generations. For example, 60% of those entitled to repayments in lieu of public nursing home charges did not apply and did not want a refund. Many people said they were happy with the care they received or, in some cases, people were happy with the care their parents received and they did not want the money back. I do not say anyone who sought the return of their money was not fully entitled to it but I am impressed with the number of people who decided not to do so. That indicates the self-assessment process will work.

Like all health schemes, under this scheme, if people receive a benefit to which they are not entitled, the normal arrangements will apply and the HSE will be able to discontinue the card under the 1970 Act and it may charge people for services to which they are not entitled free of charge. I do not anticipate that many older people will be dishonest regarding self-assessment. The State has at its disposal access to contact with Revenue authorities, the Paymaster General and so on about earnings. Deputy Reilly asked how many people aged over 70 are working. I do not suspect there are many but, generally, such people are in receipt of occupational pensions. We are excluding approximately 5% of people in this age group under the legislation. Individuals may face difficult circumstances relating to nursing home costs. I was contacted recently by an individual with high nursing home costs of approximately €50,000 a year and, notwithstanding the fact the individual's income is outside the €700 weekly limit, the individual will benefit from the regular medical card, which is calculated on the basis of net income because all those costs are factored out.

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