Joe Costello (Dublin Central, Labour)

That a budget should introduce a 50 cent levy on every item prescribed for medical card holders is the unkindest cut of all. The danger is not the quantity of money involved, but the category of patient covered. Many of the people who fall into such categories could easily find their situations deteriorating because of the bureaucratic process envisaged in the system. This provision covers a range of seriously ill, mentally ill and physically challenged people, including the terminally ill, those in nursing homes, recovering addicts, people in receipt of palliative care, diabetics, old age pensioners, Alzheimer's sufferers, the homeless and so on.

The category about which I am especially concerned is psychiatric patients. Clearly, this is an erratic category and such patients find dealing with change difficult. The greater burden of requirement placed on them by the new system will make ensuring they get and take their medicine more difficult. The idea that psychiatric patients must attend a general practitioner before a chemist seems outrageous. It inserts an extra layer of bureaucracy and is an obstacle to them. Apparently, the reason is that the GP must put a description on itemised General Medical Services, GMS, scheme paper. This is done for the purpose of dealing with the matter officially. I see no reason to bring the GP into the scenario. Why could this not be done in the chemist? There is no such thing as a standard, but going to the chemist is part and parcel of the well-worn path towards getting medicine to which mentally challenged patients are used. Sticking the GP in the middle of the process means many patients will not do it. Add to this the burden of a 50 cent levy and they will be confused and frustrated. Obstacles are being placed in their way. The danger is that many people who are seriously psychiatrically challenged will not take their medicine. This will also be the case with homeless people, alcoholics and drug addicts. Many categories of people will find taking the extra steps prescribed by the 50 cent levy difficult.

The Minister is expecting to get €25 million out of the levy and there is a cap of €10, but more than €25 million will accrue because there are many prescriptions being handed out that should not be. I am most concerned about the layer of bureaucracy being placed in front of medical card holders. Will the Minister review the levy to determine whether people could avoid the extra visit to the GP and whether the levy is appropriate to people who have difficulty dealing with the basics of getting their medicine without needing to jump through hoops?

Many carers were involved in the GMS scheme but no one who applies for carer's allowance will get the scheme. The caring side is deteriorating, as are the respite care and home help sides. The level of support is reducing constantly. We will find that people will not be able to meet the requirements and this will have serious implications for their health. Will the Minister of State review the 50 cent levy, particularly in respect of the categories to which I referred?

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