Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I move amendment No. 1:

To delete all words after "That" and substitute the following:

"Dáil Éireann declines to give the Bill a Second Reading as prescription charges represent an unjust imposition on medical card holders and undermine the General Medical Services Scheme.".

Sinn Féin totally opposes this Bill, which enables the Minister for Health and Children of the day to impose prescription charges on medical card holders. It is a disgraceful item of legislation that targets the least well-off in Irish society. As I indicated on the Order of Business, it is a sneaky and dishonest Bill. When initially signalled by the Minister for Health and Children, it was listed as the Prescription Charges Bill. This was changed to the Health (Amendment) (No. 2) Bill in the vain hope of taking the bad look off it.

The legislation sets a charge of 50 cent per item up to a maximum of €10 per month. The Bill has been sold politically and in the media on the basis that the charges are small. The opening contribution of the Minister for Health and Children on Second Stage referred to the charges being modest. The most dishonest thing about this Bill is where the fees are cited. It is a smokescreen, a device to get the Bill passed. When Government representatives are challenged their main argument has been that it is a charge of only 50 cents and a charge of only €10. However, that is pure deception because section 1 empowers the Minister at any time in the future to make regulations to vary the charges. We know this Minister and future Ministers will increase the prescription charges for medical card holders. I warrant that will happen if this Bill is passed.

At the end of last year it was leaked to the media – deliberately perhaps – that the Minister's officials were seeking a charge of €2.50 per prescription. This was after Mr. Colm McCarthy recommended a €5 flat fee for every prescription in the notorious report of an bord snip nua. I might add in passing that Mr. McCarthy's prescription for the ailing Irish economy was a strong dose of deadly poison across the board. The Government deserves no credit for prescribing a slightly lesser dose because it is deadly poison nonetheless.

On 19 November last year, the Minister addressed a body much in the news lately, the Fianna Fáil Parliamentary Party. She floated the 50 cent prescription charge and it was reported afterwards that Fianna Fáil Deputies and Senators supported the proposal. Only one Deputy was reported to having expressed concern and, to give credit where it is deserved, he hit the nail on the head when he said he was worried the charge could be increased in future years. At least someone saw the train coming down the track.

The Minister, Deputy Harney, saved the day because, we were told in a newspaper report, "Observers said Ms Harney made clear that no final decision had been taken", and the Cabinet was saved from rebellion in the ranks once again.

Then came the budget with its savage cuts to public services, including health, and its confirmation that prescription charges would indeed be imposed. Did one hear the faintest protest from the ranks of that Fianna Fáil Parliamentary Party? Not a whimper. After all the talk of rebellion in the Fianna Fáil Parliamentary Party in recent weeks, where are they when a Bill comes before the Dáil that clearly and undoubtedly will affect the least well-off and the most needy in Irish society? I note that not a single Member of that party is present. The Minister is an Independent member of the Cabinet but not a single Member of either of the two parties in the coalition is represented in the Chamber during this Second Stage debate. Will even one of them stand up for the people who are being penalised by the prescription charges provided for in this Bill? The backbenchers have been much concerned lately about hounds, stags, hares and related matters but it seems that last night, the sheepdog from Clara barked at them and the sheep now are being herded exactly where he wants them to go, that is, voting as he, the Minister and the Government dictate. There is not a bleat out of any of them regarding this Bill.

One should make no mistake but that any Deputy who supports this Bill is opening the way for higher prescription charges in the years to come. Moreover, Members will not be obliged to wait too long before the first evidence of this will present itself. This Bill, therefore, undermines the general medical services scheme in a fundamental way. Access to essential medication free of charge always has been a cornerstone of the medical card scheme. It has lifted a potentially huge financial burden from people on low incomes and especially from families with young children. It not only has lifted a financial burden but undoubtedly also a great concern regarding the challenge with which any family struggling to make ends meet can cope or can afford at any given time.

In addition to being penalised financially, people with medical cards are being scapegoated for the high cost of medicines in this State. As previous speakers have indicated, all Members agree that the cost of medicines to the State and to individuals is unacceptable and simply is too high. Everyone acknowledges there is wastage and over-prescription of medicines and all agree that measures must be undertaken to address these problems. However, the very last way to address this is to punish those who are least able to pay. I agree with Age Action Ireland when it states:

Over-prescribing and inappropriate prescribing is a problem in Ireland but the Minister needs to address this issue with the doctors who write the prescriptions, rather than hitting their patients. The patient is not the person writing the prescription so ... penalising them will do little to change prescribing practices.

For many older people in receipt of a State pension who are reliant on medication, this Bill will mean an additional annual burden of €120 each. Moreover that is only the initial cost, as there will be an as yet unknown higher amount when the Minister or her successors or both inevitably increase the charges.

These prescription charges on low-income individuals and families come in the wake of the abolition of the social welfare Christmas bonus and the reduction in social welfare payments generally. Furthermore, this is only on the payment side as services for people with medical cards and for all who rely on the public health system are being reduced on a weekly basis. Dental treatment for medical card holders has been confined to what are called emergencies but the HSE has failed to state what constitutes an emergency in the context of dental treatment. That said, I have met many people who have suffered and who consider that their situation was an emergency but for whom the system no longer provides. Public hospitals are in deeper crisis now than ever. Waiting lists and queues are worsening, the promised primary care network has not been delivered and now this disgraceful Bill has been introduced. This is hardly a record of which the Minister should be proud.

The Government claims that the purpose of this legislation is to make savings and to reduce the State's drugs bill. For years, Sinn Féin Members and others in this House have called for greater use of generic drugs and for control of the gross profiteering by pharmaceutical manufacturers and distributors. The Government and successive Ministers for Health and Children from 1997, throughout this existing Government formation anchored by Fianna Fáil, have failed repeatedly to act. Belatedly, the Minister for Health and Children has moved on the issue of generic substitution. She also has promised to introduce a reference pricing Bill but it has not been published. Instead, she has rushed in with this legislation to penalise the least well-off for a problem that clearly is not of their making. There was no equality in the Minister's intent or endeavour to bring forward the reference pricing Bill as this was the easy option.

As I stated earlier, there is widespread agreement that the cost of medicines to the State must be reduced but it already has been shown that huge savings can be made without imposing prescription charges. Last February, an agreement between drugs manufacturers and the Minister for Health and Children made projected savings of €94 million in a full year. One should add to this the further savings that will be made through the use of generic drugs and reference pricing and then set that against the estimated €20.5 million that will be raised by these charges. While the figure of €20.5 million has been cited repeatedly, I note from the Minister's contribution at the outset of the Second Stage debate that she has added a further €3.5 million to it and now claims the figure will be approximately €24 million in a full year. These charges are, in my view, that of the collective Opposition and I daresay of at least some of those who sit on the Government benches, totally unnecessary from a budgetary point of view, as well as being unjust and unfair.

The Government would accuse the Opposition of not coming up with alternative proposals. However, Sinn Féin and the other parties have indeed come forward with such proposals. In Sinn Féin's pre-budget 2010 submission, The Road to Recovery, the party proposed measures to reduce the cost of medicines in the health system, including the establisment of wholesale distribution of drugs by the State. Based on figures provided to Sinn Féin by the Department of Finance, these measures would have saved €200 million annually, which is nearly ten times what allegedly will be raised by the prescription charges being introduced under this legislation. Ending the notorious co-location scheme would save €100 million in 2010 alone or nearly five times the revenue from the proposed charges. Moreover, I understand the figure would rise to approximately €400 million over a seven-year period. I note these are figures provided by the Department of Health and Children. Instead of making real savings and targeting the profiteers in the drugs industry, the Government once again has gone for the easy targets, namely, the elderly, the infirm and low-income families with children. All of this has been seen before and Sinn Féin has cautioned against it. We have repeated our challenge to it repeatedly and it is as shameful now as it ever has been before. It is doubly disgraceful in the face of all that already has happened to those families and individuals who are struggling to make ends meet.

Even at this late stage, on my own behalf and that of my colleague Deputies in Sinn Féin, I call on the Government and specifically on the Minister, Deputy Harney, to withdraw the Bill. If the Government does not do so, I call on every Deputy with a conscience to vote against this Bill at every point of its passage today. I want to see the same commitment to the interests of the 1.3 million medical cardholders in this State as was exemplified in recent weeks by Government backbenchers regarding other issues. It is time that Members began to address in a real and effective manner the terrible vista the Government has imposed and continues to impose on the lives of so many. Members will see whether the Fianna Fáil backbenchers have any backbone. While I do not know what to expect from their Green Party colleagues in government, 1.3 million people expect a result that will give them some breathing space and relief and that will not effect a further imposition and penalty for them to bear in an economic situation that is not of their making. I reject this Bill outright.

See this speech in context