John Browne (Wexford, Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on the Bill. I listened with interest to Deputy Twomey, who is also a doctor. I agree with many of the issues he raised, in particular about home help, community nursing and primary care centres. However, I am not in favour of many of the measures being introduced by the Minister. When he was on this side of the House he was critical of what Fianna Fáil did in power. I will not spend my time criticising the Minister, Deputy Reilly, who has done so many U-turns that he has gone beyond criticism.

I wish to bring to the attention of the Minister of State, Deputy White, the issues that require attention. Older people have suffered dramatically in recent budgets due to cuts in ESB allowance, fuel allowance and to many other areas that affect them. Many organisations representing older people are concerned that the Minister is implementing changes to medical card eligibility without any discussion with stakeholders. It is important that the Minister would engage with groups such as Older & Bolder which wish to support and assist him with ideas and suggestions on how to save money without implementing the cuts proposed by him in certain areas.

One area that should always be exempt from cuts to medical card eligibility is cancer care. On a number of occasions in recent months we raised issues relating to cancer patients not being granted medical cards. Serious discussion is required on the issue. Many cancer patients cannot afford their disease treatment and others use their entire savings to pay the associated costs of treatment. Cancer should be treated as a chronic disease in the same way as multiple sclerosis, MS, and other long-term illnesses.

As we know, when people are suffering from cancer it can cause many problems within the home. In many cases people have to hire in home help and child minders to take care of their children. They also incur enormous costs travelling to and from hospital for treatment. In some instances, their spouses have to spend time at the hospital too, paying for overnight accommodation and so forth. I ask that discussions take place with those involved in the treatment of cancer to ensure that it is easier for cancer sufferers to get medical cards. In fairness to the HSE, it must be said that those dealing with medical card applications try, where possible, to help those with cancer to acquire a medical card. However, the delays that sometimes occur can result in major burdens being placed on families.

I do not know what the Minister intends to do with the savings to be made from these changes. This Bill has been rushed in but reference was made to a saving of €12 million for the latter half of this year and €24 million in a full year. Will some of that money be diverted to the home help service, which is particularly important for older people? In Wexford there is no money available for additional home help hours and we are only in March. I was told at a recent meeting with the HSE that a new applicant will only be given home help hours if an existing service user dies or has his or her hours reduced. This is an area that merits serious examination. It is a matter of grave concern that in the month of March there is no budget for home help in Wexford and I am sure it is the same in many other counties.

Deputy Twomey mentioned nurses in the community and perhaps Deputy White could lean on the Minister for Public Expenditure and Reform, Deputy Howlin, to consider releasing community nursing from the current recruitment embargo. Community nursing is very important in terms of keeping older people in the community and out of long-term care or hospital. However, in every area of Wexford - I am sure it is the same in other counties - there has been a reduction in the number of public health nurses. As a result, the remaining nurses are not in a position to provide the services that are needed. Deputy Twomey alluded to that and the fact that people are finding it very difficult to get public health nurses to call to their homes. When older people are discharged from hospital, they are not getting the after-care they need because of the scarcity of public health nurses in the system.

I have a problem with primary care centres. Many doctors have upgraded their practices in recent years. Others have amalgamated with colleagues and provided their own one-stop-shop for health care. There are often two or three doctors, a nurse and other trained medical staff. In many cases, doctors have provided their own primary care centres without any Government support and in that context, I am not sure that we should be wasting money on the provision of primary care centres. Furthermore, in some areas, doctors are not one bit interested in getting involved in public primary care centres. They want to stay in their own upgraded practices.

I could say that this Bill is shameless, scandalous and that these changes should not happen but they will happen because the Government has a majority. This Bill will be passed and the number of medical cards will be reduced. In that context, I wish to focus on what will happen with the money that is saved. There was uproar recently with regard to the withdrawal of the mobility allowance for people with disabilities. I ask the Minister of State to use whatever influence he may have to ensure that the mobility allowance is restored to people with disabilities as quickly as possible. I know there is a four-month window but many people with disabilities are worried about what will happen at the end of that period. It is important that funds be restored immediately to that particular area to ensure the continued independence of people with disabilities. There are approximately 200 families in Wexford who will be affected if nothing happens at the end of the four months. I am hopeful that the Minister for Health and his Ministers of State will have enough sense and concern to make sure that people with disabilities have their mobility allowance restored.

I have written to the Minister a number of times about a practice which the Minister himself has said should not be happening but which is continuing to happen, namely, doctors charging medical card patients for blood tests. Charges range from €10 to €20. The Minister has told me that this is not allowable under the GMS rules but I know of doctors who are charging their patients. Doctors should be brought to heel in this regard. If they are not entitled to charge for blood tests for medical card patients, they should not be allowed to do so. The practice is widespread in my own county and it is important that it is dealt with forthwith.

I am concerned that the Bill gives the Minister for Health the power to further decrease the income thresholds for medical card eligibility without Dáil approval. In the past, the Minister for Health had to have Dáil approval for changes to income limits and could only increase, rather than decrease, the income limits. This Bill puts the Minister in a very powerful position whereby he or she can reduce the income limits for medical cards whenever he or she feels like it. If the Exchequer is not meeting its budgetary targets for 2014, will the Minister just decide, with the stroke of a pen, to further decrease the income limits for medical card eligibility?

Another area of concern is the data exchange agreement between the HSE, the Department of Social Protection and the Revenue Commissioners. The Revenue Commissioners are becoming the most powerful body in the State. They cause havoc for people in the area of revenue and have recently been given responsibility for the collection of the property tax. Revenue will now also be providing information to the Department of Health on people's incomes. I ask the Minister to explain how this will work and how any data protection concerns will be addressed. What discussions, for example, have taken place between the Department and the Data Protection Commissioner? I am concerned that so much information will be shared and exchanged and I believe that, at the end of the day, older people will suffer as a result.

I am opposed to this Bill in principle but recognise that it will be passed whether I like it or not, because the Government has a majority. However, I would like to see the moneys saved being spent on the areas I have referred to and, in particular, on elderly people. If older people are going to suffer cuts in one area, I would like to see them benefit in other areas. They have already felt the effects of the trebling of prescription charges, the sharp reduction in the income thresholds for the over-70s medical card and the reductions in the value of their household budget packages, all of which is having a serious impact.

I could read out all the things the Minister for Health said in 2008 when he was in opposition, when thousands of people were on the streets protesting about the reduction in the income thresholds for medical cards for those over 70. I will not do it because it might embarrass Deputy Reilly, although he is not easily embarrassed. He did a lot of jumping up and down and that stage, saying the then Government was callous, uncaring, a disgrace and so forth.

The Minister has made great play of the fact that generic drugs will become much cheaper but the cost of such drugs in Ireland is a scandal.

I got a prescription recently that was filled with a generic drug but when I compared prices, the saving in purchasing the generic drug over the branded drug was €1.20. The Minister of State should take that on board and tackle the companies providing generic drugs in this country. The cost of these drugs is way above the cost in England, Spain and other European countries, and we should consider why that is so.

People with disabilities who were in receipt of the mobility allowance should be the priority for the Minister of State, Deputy White. The Government must restore their funding within the four-month timeline set out by the Minister.

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