Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

If the Acting Chairman read it, he would be amazed. It was basically a press release that got a little bit longer and he had to keep filling things into it - timelines, commitments made, 2016, etc. It is utterly farcical that we are discussing small hospital frameworks, the establishment of hospital groups and universal health insurance when the Minister has not even a notion of what he is doing. The Labour Party's proposal was for a social insurance model for universality. The Minister for Health, on the Fine Gael side, is proposing that private health insurers would fund health cover in the years ahead. If we are to change fundamentally how we are to fund our health services, one would think the Minister for Health would have an idea as to what he is doing. He should have been able to publish some form of vision of where he is going. We are two years on and are still awaiting a White Paper on universal health insurance and I do not know how close we are to it being published. In the meantime we have a health service that is being dragged from pillar to post in terms of the Minister's whims about how it is to be funded and the direction it is being taken, which is simply not credible.

For all its faults and ills, the Health Service Executive was established on the premise of having a centralised system giving strong governance to health and removing it from political interference. Every day of the week something else comes out about political interference in the delivery of health care. These are not allegations but statements of fact - primary care centres, hospitals in Wexford and Kilkenny, etc. These are things happening on a continual basis. While we have limited resources, we need absolute certainty that decisions on the basic provision of health care are not being made for political reasons. I accept Ministers always make representations - nobody is denying that. However, when resources are scarce and decisions are being made to prioritise hospitals, we need clear accountability and clear criteria laid out to ensure they are awarded on the basis of need as opposed to political decisions or whatever goes on behind closed doors at Cabinet.

The Health Service Executive (Governance) Bill also gives the Minister significant powers. I cannot understand why the Government is doing this. It beggars belief that it is now introducing legislation to give sweeping powers to the Minister in the governance of the new health structure. It provides that the Minister may decide on many issues. I accept the Minister should have accountability to the House here but he should not be able to direct where health services should go.

This is a dangerous road to go down, one in respect of which Fianna Fáil was criticised in the past. To introduce legislation in this Chamber which will give a Minister more power in terms of the running of the health services is fraught with danger. This Bill also gives the Minister extraordinary powers to, if he or she so wishes, reduce people's rights and entitlements. For all those reasons, I urge caution.

Older and Bolder and many other organisations representing people at the coalface also have difficulty trusting what the Government says. Only last year the Government launched an all-out assault on home helps. It withdrew home help hours from those who most needed them, and in an arbitrary way with promises of reviews and instructions to the HSE regarding the process of reducing hours. The Minister of State, Deputy White, and I know that people's lives were turned upside down during the time home help hours were reduced dramatically, in some cases without prior notice. I know of an 85 year old who was told by way of letter that his home help hours were being reduced from eight to four hours. There was no consultation with the man concerned. This type of behaviour is unacceptable.

I am concerned about the implementation of policy decisions by the Department and how they impact on people on the ground. During the past two years, Members of the Opposition have been highlighting and pinpointing the difficulties in the medical cards process. I accept there have been some improvements. The Minister of State's predecessor, Deputy Róisín Shortall, gave a commitment in January 2012 to address the issues people were experiencing in accessing emergency medical cards. There have been some improvements. However, on the broader issue of medical cards, there is a lot to be desired.

On eligibility, during the 20 years I have been a Member of the Oireachtas I always assumed, obviously wrongly, that a person diagnosed with cancer was entitled to a discretionary medical card on health grounds. Following representations which I made previously to the former health boards, patients were awarded a card on discretionary health grounds. I have received representations from a woman diagnosed with cancer who, despite having had a double mastectomy, cannot get a medical card. I have previously brought this to the attention of the Taoiseach in the Dáil and have, at his request, forwarded the information to him. I have also raised this issue by way of parliamentary question, the response to which has been that the woman concerned does not qualify for a medical card because she does meet the income criteria. However, I did not ask if she met the income guidelines, rather I asked if a medical card could be provided on discretionary health grounds. This situation is repeated throughout the country.

The Government should following this debate, and having endured the whims of the Opposition in highlighting these issues, seek to rectify the situation whereby people with life threatening and often life limiting illnesses are being refused discretionary medical cards because they are over the income qualifying criteria. Like many other Deputies, I had always assumed such people were entitled to a medical card. The reason this was assumed is because previously people were given discretionary medical cards on health grounds. This entitlement has been reduced dramatically. There has been much mention from Government and others of the increase in the number of medical cards granted. The reason for this increase is the downturn in the economy, which means more people qualify on income grounds. The Government needs to give serious consideration to the issue of discretionary medical cards on health grounds. It needs to undertake deep analyses of the blockages and the reason people diagnosed with bowel cancer and so on, who are over the limit by only a few euro, are being refused cards. I have outlined many instances in this regard in the Dáil and have, as I stated earlier, forwarded the information to the Taoiseach, at his invitation.

Why can such people not get a medical card? Why is it that in this day and age, taking account of all our difficulties, people with serious life threatening and in many cases life limiting illnesses cannot because they are a few euro over the income criteria obtain a medical card? The power to grant medical cards on a discretionary basis has all but been abolished. There is no doubt but that this is the result of a policy decision by the Department of Heath to save money. The bar, in terms of eligibility on health grounds, has been raised so high people cannot qualify, resulting in their having to not only suffer the difficulties of their illness, but the financial vagaries of life in terms of dealing with it. It is shameful that this Government has chosen to make it almost impossible for people to qualify for medical cards on a discretionary basis. This is being said not alone by me, but by Deputies on all sides of the House and advocacy groups.

On the Government's comments around changes in eligibility, income guidelines, fair budgets and having looked deep into its heart to ensure there would not be an attack on the vulnerable, in my view a person who has been diagnosed with cancer and has had a double mastectomy is vulnerable, as is the person diagnosed with bowel cancer and the person with a life limiting illness, yet they are being refused medical cards. The Government should be addressing this issue in this legislation. It should also address therein the issue of eligibility for people with life limiting illnesses.

There were alternatives in terms of how the health services and government services in general could be funded. The Labour Party almost walked out of Government. Labour Party Ministers walked out of the discussions, down the corridor and then went back in again. I am still puzzled as to the reason they went back in. I have asked myself on numerous occasions what it is they went back in for. It has been said that the reason they walked out is the Labour Party wanted an increase in tax on those earning over €100,000 and that they fought very hard for it, including walking out of the discussions. However, when the budget was presented, the only change in terms of income revenue raising measures was a reduction in eligibility for people over 70. There was no increase in tax for people earning over €100,000.

What changed? Why did the Labour Party Cabinet Ministers turn around and run back to the Cabinet table? I would like an answer to that question. I will never get it because of Cabinet confidentiality, safety in numbers, running back to the herd and taking cover in the flock. What I do know, however, is that the budget did not address fairly the imbalance in our society. It disproportionately affected those on low incomes. The Minister of State, Deputy White, need not take my word for that. The ESRI has said the last two budgets were the most regressive in recent years. While Fianna Fáil in government introduced fairly tough budgets, they were not as regressive as were the last two budgets introduced by this Fine Gael-Labour Party Government.

This issue is another indication of this Government targeting groups as opposed to showing genuine solidarity by ensuring those with the widest and broadest shoulders bear most. As I said, the ESRI stated that the last two budgets were regressive. This legislation is further proof that when it comes to making decisions this Government chooses to hit people with disabilities, older people and other vulnerable groupings in society as opposed to standing up, being brave and making decisions that will ensure that those who have most pay most. This Bill is not part of any such measure and I reject it.

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