Jan O'Sullivan (Limerick East, Labour)

The Labour Party will be opposing this Bill. The people who will be affected by it are the poor and the sick and they are not the people who should have charges imposed on them because of the drastic situation in our public finances. They are the very opposite of those who should have to pay.

The Bill copper-fastens the inequalities in our society. It is a bit rich for the Minister to state that she was imposing this charge so that there would be more money for front-line services such as respite care and home help services. The very people who are being asked to pay this prescription charge are the people who need the home help and the respite care and all the other supports because they are the poorest people who qualify for a medical card on income or illness grounds. They are, by definition, already the most vulnerable people in our society. They are being asked to pay a charge of 50 cent on every prescription, subject to a maximum charge of €10 per month per family. A sum of €10 per month might not seem like a big deal to the Minister or even to those of us in this House with a reasonable income, but the people we are talking about had their incomes reduced in the last budget, in many cases, down to €196 per week, a reduction of €8 per week. The people in that category according to the list of social welfare cutbacks are those who are either widowed, ill, disabled, blind. Those people are now living on €196 per week. Carers and old-age pensioners are very slightly better off at just over €200 per week. These are the kind of incomes we are talking about.

These people already have heavy demands on their income because they are ill or disabled. They will also be facing a carbon levy in the near future and we still await details of the Government's plans to ensure that fuel poverty is not added to the burden of the poor. Already the cost of fuel is high but the introduction of the carbon levy will cause it to rise.

These people are the poorest of the poor. This is an unequal society that is becoming more unequal. Many of us will have read the book which shows that the negative effects of inequality are seen across a range of indicators, including physical and mental health. It should be noted that the wealth of the country is improved if society is more equal.

The Government is imposing cuts on the poor but it is noted that other, better-off sectors seem to get away with things. I refer to the information from NAMA yesterday about the amount of money that will be recovered. The predictions of return for the public purse are way lower than original estimates. These figures are blithely thrown out in their billions of euro. The charges proposed in this Bill may be very small money but it is money that can make the difference between being able to balance one's budget at the end of the week in the case of the people affected.

The Minister said in her contribution that €2 million per month would be saved by the imposition of this charge. This amount of savings is directly on the backs of medical card holders because nobody else will be paying it to the Exchequer.

It has been argued that this charge is an attempt to reduce the bill for medications and stop people over-using prescribed products. The Minister stated that 4 million extra prescriptions have been written in the period 2004 to 2009. This charge is not the way to address that problem, in my view. The very fact the Minister admits it will save €2 million per month does not indicate it will address that problem but rather it will be a money-spinner to bring in extra money every month.

The Minister often accuses the Opposition of not supporting her on initiatives but the Opposition supported the Minister's introduction of generic substitution and reference pricing as this is a good idea and a good way of saving money on prescription drugs. The pharmacists have suggested having a medicine use review which they say would considerably help to reduce dependency on drugs. Patients need to be educated and informed about the use of drugs. It should be explained to them why they may not need to take so many prescribed drugs. We need to focus on those who prescribe the drugs, the doctors and in some cases, nurses. If too many drugs are being prescribed, the focus should be on those who prescribe the drugs rather than those who take the drugs.

This is a case of using a sledge-hammer to address a problem that a sledge-hammer has not a hope of solving. People on drugs for cancer, diabetes or other long-term illnesses as listed by Deputy Reilly, have no choice but to take their drugs. They need them, yet it is proposed to incorporate them, most of them, into this system of charges. The Minister said there will be exemptions for children in care and with regard to controlled drugs such as methadone and for those with hepatitis C. There is a provision to make further exemptions. I have tabled some amendments about homeless people and those whose lives could be in danger if they do not take medication. We need to see a lot more exemptions if this Bill is not going to be of serious concern with regard to a number of categories of people. Under section 1(4)(a)(ii), the Minister is permitted to make regulations to exempt other classes of persons but I ask the Minister to outline the kinds of classes of persons for whom she will consider making exemptions. The list in the Bill is inadequate to deal with categories of vulnerable people. I received an e-mail from the nursing home organisation, which makes the valid point that people in nursing homes have only 20% of their disposable income, which is usually 20% of the pension, left for all personal needs. This includes therapies, an expense they did not have before. Previously, therapies were provided by nursing homes but in most cases people must pay for therapies from the 20% of their disposable income that remains. People in nursing homes are very vulnerable.

International evidence on the impact of the prescription levy indicates it places a financial barrier on the poorest in the community in terms of accessing vital medicines and has a negative effect on the health of the population. As mentioned by Deputy Reilly, Northern Ireland and Wales have got rid of prescription charges. We are going in the opposite direction to other countries that have tried it and decided it is inappropriate and has a negative effect. If people do not take drugs because they cannot pay for them, it endangers their health and will probably impose extra charges on the hospital system because people will not be able to control their illnesses in the community and are more likely to go to hospital. There are many reasons the Labour Party will vote against this Bill.

The question of how this will be administered and collected also arises. It will be an administrative nightmare. It will be difficult for pharmacists, who are now effectively becoming tax collectors. The amount of money will be taken from the sum paid to them and they are expected to collect it from the medical card patient. What will pharmacists do if a person says he or she cannot pay, will not pay or should not have to pay? Will the pharmacist contact the Garda Síochána, take the burden of the cost or fight with the patient? Generally pharmacists develop long-term relationships with regular patients in the community. This will fundamentally change the relationship and could create difficulty. I do not know what pharmacists are supposed to do because they are not tax collectors or the Revenue Commissioners but they must collect this tax. This measure is fraught with difficulties and many problems will arise with regard to the practicalities of the Bill. I am not sure the Minister will save the amount of money she believes.

It is true that we must save money on drugs. Reference pricing and generic substitution, along with other measures suggested, could achieve this. We need every single penny we can get in the health services for the delivery of frontline services. I support the Minister in this respect but this is despicable legislation in some ways because it targets those least able to pay.

I met the families outside Leinster House today. I have met many of them in the past weeks because the respite centre in my constituency has been closed for the past three weeks. Those with adults with intellectual disabilities in their homes who care for them 24 hours a day have lost their respite. We must restore that respite before we leave here tomorrow. It is as simple as that. Those people and vulnerable sectors must pay this levy. It is inequitable and will be extremely difficult to collect. It has been tried and has failed in other countries. It targets the most vulnerable and for those reasons the Labour Party will vote against this Bill. We will try to amend it but, even if we succeed in the amendments we propose, it remains a Bill that is wrong and should not be imposed on the poorest in our community.

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