Damien English (Meath West, Fine Gael)

Much of the debate is focusing on broader issues than those with which the Bill is concerned. I might take the odd liberty myself in that regard. On medical cards and charging for prescriptions, my colleague, Deputy Reilly and others outlined what is happening in other countries where the trend is to row back on such an approach. I would like to know on what evidence the Minister based her decision.

When the possibility of a charge was first mooted in the past year, I agreed with it on the basis that it made sense and it might stop people from abusing the system. We are familiar with people who end up with too many unused medicines at home under the bed or on the locker. Those drugs go to waste. However, when I heard my colleagues speak at our parliamentary party meeting and in the House I realised that the research shows that certain people are prevented from getting the drugs they need. We cannot allow that to happen as the consequences of it would be serious, especially for a person with a long-term illness. If such a person does not take his or her prescribed medication, he or she will end up in the accident and emergency unit. The Minister's approach is not correct. Perhaps she will respond to me on the matter when concluding Second Stage.

The addition of 50 cent to each prescription has been mooted but the fear is that the charge will not remain at that level. In the past three terms the Government increased most of the existing charges by means of stealth taxes in every budget. People did not realise how much stealth taxes had increased until 2008 or 2009 but it happened incrementally from 2002 up to the present. The fear is that the same thing will happen in this case; that the charge will start low and rise to perhaps €4, which adds up to a lot of money. Last year, we saw the effect on people's livelihoods of losing €3 or €8 in social welfare payments. It is a lot of money. In general, medical cards belong to people who are in the lowest income bracket. Others have it that probably should not have it and some people do not have it who should have it but the majority of people with a medical card are on low incomes so we are again hitting people on low income in this case.

I listened to a comment yesterday about general Government decision making policy. Due to bad management in the Health Service Executive or a Department, we often introduce policies to correct bad management rather than fixing the management. In this case it is a combination of patients being allowed to abuse the prescription system and to get more if they get a chance. That could be the fault of the doctor, the Health Service Executive or the pharmacist. There are other ways of fixing the problem rather than introducing a charge. The response of most people is to introduce more legislation rather than to solve the problem in the first place. The other argument is that this is really only a sneaky way to make more money. Either way it is avoidable and does not necessarily need to be done.

I have seen many cases of that happening. Another example is where a Minister makes a statement that he is going to slash travel expenses for civil servants even when common sense might dictate that it should be done for a certain percentage. When one works out the travel arrangements in each office, it turns out that sometimes the rules are stupid and lack common sense. Money could be saved but the quick fix is to bring in a cut across the board. That is bad decision making policy to solve bad management rather than fixing the problem. We must address that issue as well.

I do not wish to say people have been conned for a long time in terms of medical cards and access to them but the doctor-only medical card is a good service if one still has income. People were led to believe that getting it would solve the problem but they must cope with exorbitant charges for drugs as well. The cost of drugs in this country is off the wall. I have listened to the Minister explain that it is the fault of the pharmacies or others. I cannot get my head around whose fault it is but if I am in France, Spain or another country, one can buy the same medicines for a quarter if not a fifth of the price. Something is wrong and I do not believe it is all due to the pharmacies making money. I have gone to pharmacies, talked to them and looked at their books. I agree that some make a lot of money but others do not. However, someone along the way is creaming it and people are suffering as a result. That must be examined.

I accept progress was made with the purchase of drugs by the Health Service Executive but, in general, people are not getting value for money and they are losing out. We must examine the matter. It is all very fine to say we will fix things. When the Minister was first appointed she talked about addressing the issue but I have not seen much progress in the area. This is an important issue. Members regularly have people come to their clinics who cannot afford to buy the medicine they need regardless of the drug payment scheme or the medical card. If one is on long-term medication, one has to spend €120 a month before one can avail of the free drugs scheme, which is a lot of money. It is €30 per week. If one is on the minimum wage that is almost 10% of one's take-home pay. We must examine the issue.

I understand there are budgetary constraints and that the Minister is trying to match everything up but ultimately we must look after the most vulnerable in society. We must also consider prevention. If a person becomes ill because he or she is unwilling or unable to spend money, the State will lose out because it will cost us more in the long run. The Minister knows that because she is an intelligent person when it comes to economics and figures.

My final point relates to health although not necessarily to the Bill. The Acting Chairman, Deputy Charlie O'Connor, who is from Tallaght will understand why I must mention Navan. We have discussed the hospital in Navan many times through correspondence and in debates, not always directly with the Minister. It is an issue of great concern to people in the area. The Health Service Executive and the Department had a good plan to build a new regional hospital for the north east which makes total and utter sense. As a Deputy for the town I fully backed the proposal. I even agreed that if it meant that the hospital moved up the road or down the road I would accept that because it was the right thing to do for the north east. Now that project is on hold even though a site was picked. A lot of work was done and money was spent in order to make the decision. The project should be going through the planning process. It is capital expenditure, not current expenditure. We should not necessarily be cutting back on capital expenditure in times of recession. The work could be done easily through a public private partnership or through other mechanisms to raise funding. The construction of the hospital would not be a waste of money because that would provide jobs and one would get good value for it at the moment.

My party is in agreement that one has to cut back on current spending but not on capital spending. In the meantime, one has to keep five hospitals open whether one downgrades services or not. The Health Service Executive and the Department of Health and Children are all the one. At the end of the day the Minister pays the bills. It is taxpayers' money. The Health Service Executive is the Government. It is a pity that the impression has been created that there is a separation in that regard when it is not the case. It is clear that they are one and the same. The plans for the hospital should be going ahead in terms of planning permission. A public private partnership could be easily put together and the hospital could serve the people of the north east. If half the people of Meath, Cavan, Louth and Monaghan who need an operation must be put on a waiting list for a hospital in Dublin, there is something wrong. It is improper that people are waiting for two or three weeks in hospitals in Navan, Cavan, Drogheda, etc., before being given a bed in a Dublin hospital. The Minister knows it is wrong. We should try to make progress in this regard.

I accept it will take a number of years to build the facilities I propose. Let us engage in the planning process and commence construction. The facility will be good for the taxpayer and the economy because it will save money in the longer term, in addition to saving lives and making life much more convenient.

There are plans to reduce the accident and emergency services in Navan hospital over the coming months or year because of the opening of the new accident and emergency unit at Our Lady of Lourdes Hospital, Drogheda. I have always held the view that if a service is better and worthwhile, we must accept change that allows it to be put in place. However, nobody in my area believes the accident and emergency unit at Our Lady of Lourdes Hospital, Drogheda, can handle the numbers the HSE will try to put through it. Up to 30,000 pass through the unit in Our Lady of Lourdes Hospital, Drogheda, approximately 10,000 or 11,000 pass through the unit in Louth County Hospital and up to 20,000 pass through the unit in Navan hospital. This amounts to nearly 60,000, which is far too many to try to put through one accident and emergency unit, namely, the unit at Our Lady of Lourdes Hospital, Drogheda. The latter cannot cope with that.

In the past few weeks, when the accident and emergency unit in Louth has been closed, Navan has been used as a backup to the facility in Our Lady of Lourdes Hospital because the latter cannot cope with the numbers. I accept this matter is not part of this Bill and, therefore, I do not necessarily expect the Minister to address it today. I ask her to examine it in any case. It is not right that so many patients are being asked to attend one accident and emergency unit, thus extending waiting lists and generating the possibility that certain patients may not be treated on time. There is a perfectly functioning accident and emergency unit in Navan hospital, albeit in a cardboard box. The staff and the service they provide are excellent. The unit should be kept open for 24 hours per day. The Minister has a say in this and I ask her to intervene because my argument is common sense.

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