Finian McGrath (Dublin North Central, Independent) | Oireachtas source

I am thankful for the opportunity to speak to this new legislation, the Health (Alteration of Criteria for Eligibility) Bill 2013. The medical card issue and the health of our senior citizens is important and should be part of a broader debate on health service efficiency and proper care for those over 70. We allow senior citizens a great debt, particularly those who paid taxes through their noses in the 1970s and 1980s. I remember very well the famous PAYE marches from years ago, and these people paid taxes and made a contribution to the State. They deserve care and respect for that work. We discovered later that many people from that time did not pay taxes, and I welcome the fact that the Revenue Commissioners have brought in more money because of efficiencies.

Overall, nearly 43% of the national population has free access to GP services under the General Medical Services scheme. As 1 February 2013, there are 1,855,797 medical cards, equating to over 40% of the national population. There are 130,301 GP visit cards, representing nearly 3% of the population. Expected activity in 2013 for medical cards and GP visit cards reflects the Government's approach to the issue, with the total number of medical cards expected at the end of 2013 at 1.921 million and the total number of GP visit cards expected to be 265,257 at the end of 2013. This is the scale of people affected by the medical card eligibility rules.

In the 2013 budget, two interrelated changes to the over 70s medical card eligibility arrangements were announced. The income limit for an over 70s medical card is to be reduced to €600 per week, or approximately €31,000 per year for a single person, and €1,200 per week, equivalent to gross income of about €62,000 per year, for a couple. For those whose income is between €600 and €700 for single people and between €1,200 and €1,400 for couples, they will receive GP visit cards. They will also continue to have the cost of their GP services covered, with the HSE meeting the prescription drug costs in excess of the drugs payment scheme threshold of €144 per month. There are approximately 370,000 people over 70 in the State, with approximately 360,000 medical cards issued to people over 70, leaving coverage of that population at approximately 97%. I welcome that. The medical card coverage for those under 70 is approximately 35%. The policy change will leave approximately 92% of those over 70 unaffected, with approximately 20,000 medical card holders over 70 - the wealthiest 5% - continuing to receive free GP services instead of the medical card.

I listened very carefully to Deputy Durkan's points. I do not know if he was listening to the previous debate on disabilities but a number a of Independent Deputies have always dealt in reality and put forward positive proposals. Our proposal for the mobility allowance issue was in the region of €12.6 million. People are angry because this Government broke promises when it was elected. We knew of the crisis at that time, and when I was banging on doors, I remember being told that people should try to do their best in here. Nevertheless, people did not want to listen to false promises, which is why many people are grieving so greatly, as Deputy Durkan indicated.

The Deputy stated that we all caused the problem, but certain people - including some politicians, Ministers, developers and senior bankers - caused it. We must not label everybody when we are apportioning blame for the economic downturn and the crisis. Some people were greedy, cocked up and did not do their job efficiently, and they should get the blame. I endorse Deputy Durkan's comments to the effect that some of those people who wrecked the country should be charged. I do not wish to interfere with the judicial system but I hope to see some prosecutions in the end.

A transitional arrangement will apply to current medical card holders over 70. Those who qualified for medical cards before 1 April 2013 will automatically retain those cards until 31 May 2013. Between 1 April and 31 May 2013, medical card holders over 70 who qualify for a GP visit card - where gross income is more than €600 but less than €700 for single persons or more than €1,200 but less than €1,400 for couples - will be required to notify the HSE accordingly. Under the legislation it is proposed to make a change in the manner in which those over 70 who have obtained judicial separation are assessed. With the proposals, separated people over 70, although still legally married, will be assessed as single persons, which is welcome. Their assessment will take into account obligatory maintenance payments.

This proposed approach is similar to that used by State bodies such as the Revenue Commissions. These are the details in the legislation.

Going back to the higher GP usage by older people, there are some interesting statistics. Older people use the health services more often than young people. The CSO survey shows that in 2009-10, older people were more likely than the general population to visit their doctor in that year; 74% of the general population visited a GP at least once in a year while 94% of those over 70 visited a GP at least once a year. The same study shows the average number of GP consultations increases with age, with 18 to 24 year olds averaging 2.4 visits per year and the figure rising to 5.4 consultations per year for those 70 and over.

I know the Minister of State is interested in the broader debate and his heart is in the right place. We must look at a sensible, fair and equitable health service for the entire population, with sensible funding proposals based on the general taxation system. I strongly advocate universal health services similar to those in other countries. I would pick the models that are most efficient and work best to emulate. Currently, many people covered in the private health insurance sector face huge costs. I know many people who would rather give few bob extra in tax so they did not have to go to private companies for health needs. The Government has a fair and equitable health service on its agenda and if it comes up with the right proposals, many people on the Opposition benches will support them. Health must be prioritised but it is about more than just spend, spend, spend, as Deputy Durkan pointed out. There must be clear funding and stability, along with efficiency.

I have seen some tremendous examples of good practice in the disability sector in the last six months. The sector has taken a financial hit while continuing to deliver quality services, particularly those working in the intellectual disability sector. Fresh, new people are working in the sector, young adults between 20 and 35 who are working with those with intellectual disabilities. They are doing amazing work and it is important we mention that in this debate. Just because they are examples of good practice does not mean we must penalise them by cutting their budgets. We should reward them instead. The 500 respite and residential care places per year for four years between 2012 and 2016 recommended by service providers can be achieved and would make a major dent in this issue.

The new income limits for medical card eligibility for persons over 70 were announced in the budget for 2013 and this Bill introduces that change. It is anticipated the measure will generate €12 million in savings during the second half of 2013 and €24 million in the full year. We all know this is a difficult time for the Government and the Department of Health. This saving is part of the €781 million in savings the budget set out to achieve in health spending, including an overall reduction in the cost of primary care schemes of €323 million. That is the bigger picture but I urge the Ministers that while looking at waste and efficiency, they must also be conscious that front line services or services to senior citizens or those with a disability must be given special exemptions from any cuts. The vision of the health service can be observed through how it treats the weakest and most vulnerable.

That €781 million in savings in 2013 must not be achieved by slashing and burning. There are many examples of good practice in the health service. There are problems in certain areas but we should reward and develop good practice and efficiency. I commend the staff working in the health services, the doctors, nurses, carers and porters, who all do an excellent job.

The new income limits are that a single person over 70 with a gross income of €600 per week will qualify for a medical card, while a single person over 70 with a gross income of between €600 and €700 will qualify for a GP visit card. We should encourage preventative measures for senior citizens. We have many good senior citizen groups and we should encourage them to be more proactive in encouraging physical exercise for older people. This would reduce the need for many GP visits and visits to accident and emergency departments.

I was recently in the accident and emergency department of Beaumont Hospital with a minor complaint. I was on a chair for 17 hours, then I got an armchair before eventually getting a trolley. While there, I met many senior citizens and it was very upsetting to see how they had to wait. The Minister of State should keep fighting on this, we must do something about it. It is easy to score political points but the bottom line is that anyone who has the chance to be in government for five years must make some sort of impact.

The purpose of the Bill is to amend the Health Act 1970, as amended, to change the eligibility rules for medical cards for persons aged 70 years and over. The date the changes come into effect will be by order made by the Minister. Section 7(4) makes provision for the HSE to provide support to anyone who seeks help in making an application due to any incapacity. That is a good section because, as most back bench Deputies know, there are many problems for senior citizens and those with a disability when dealing with bureaucracy and HSE application forms. Many of them come to our clinics, which is part of our job. I hope section 7(4) is implemented in a professional and caring manner. Section 7(10) defines the meaning of "civil partner" as that in the Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010. This is a progressive subsection that acknowledges the reality of modern Ireland.

I welcome the debate on this legislation. I urge the Minister of State to introduce radical new reforms in the health service. If we are to help the over 70s we must tackle the other problems and get involved in health promotion campaigns. There is a great deal of potential to make sensible savings without directly affecting senior citizens.

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