Michael Healy-Rae (Kerry South, Independent) | Oireachtas source

I thank the Technical Group for sharing its time and allowing me to speak on this Bill. This legislation provides us with an opportunity to discuss generally the administration of medical cards and what has been happening in this regard over the past 24 months in particular. Owing to the downturn in the economy, people who never before envisaged needing a medical card have found themselves reliant upon having one. Medical cards for the over 70s are vital given the raft of additional charges they now have to pay. While some of these people have paid off their mortgages, many are living on modest pensions from which they must meet the cost of the household and water charges and fuel costs, which have increased dramatically over the past three years. The average home heating oil bill has increased by 60% to 75% over the past three years, which is an enormous increase in terms of the income on which people on modest pensions are living.

I do not like speaking about a person who has left the House. However, I cannot tie anyone to the Chamber. Deputy Nash referred in his contribution to people on this side of the House being engaged in vote grabbing. It is a little rich for a member of the Labour Party to be speaking about vote grabbing given the signed pledges broken by that party on taking up office. Yesterday and today, there were protests outside this House by people who believed the promises made to them by the Labour Party and Fine Gael. While I am critical of the contribution made by Deputy Nash, I welcome the positive and sincere contribution made by Deputy Tom Hayes in regard to people suffering from cancer. The Minister of State, Deputy White, has been involved in politics for a long time and may recall that in the past a person with a consultant diagnosis of cancer was, regardless of means, entitled to a medical card, which was right and proper. A person who has cancer has enough to deal with and should not have to be concerned with the cost of medical care. I would like a return to the situation of the past whereby a person diagnosed with any form of cancer, regardless of means, was automatically entitled to a medical card. This should be reintroduced and should continue.

During a briefing two weeks ago I discussed with officials from the Department, who deal with applications for carer's and disability allowances, invalidity pensions, illness benefit and so on, the issue of eligibility in general for medical cards. When it comes to assessment of people under any scheme, the goalposts have been moved dramatically, in particular over the past three years. Previously, applications for a medical card accompanied by a general practitioner's report on a person's illness, be it cancer or another illness, was sufficient. Currently, people are being refused a medical card on the basis that their medical evidence is not sufficient. What this means - the officials will not put this in writing; they never do - is that the evidence required should be from a consultant rather than general practitioner. I tried hard to drive home that point with the officials during the briefing two weeks ago. Every politician, including the Acting Chairman, Deputy McConalogue, will be aware that medical evidence from general practitioners is not now being accepted. An application supported by anything other than a consultant's report will be refused. That is a fact. I challenge anybody to tell me or prove that I am wrong in that regard.

It is particularly mean that Department officials, when following up on applications for medical cards or under any other scheme, are requesting that the person provide more evidence from their doctor. People are taking this to mean that they require stronger evidence from their doctor. While the doctor has given the best medical evidence available, he or she is not a consultant. The officials need to be straight with the people and tell them that they will not qualify for a medical card or illness benefit without evidence of diagnosis from a consultant. While in the first instance I would rather that the doctor's evidence be sufficient, if that cannot be accepted, the officials should tell the people the truth. The Minister of State will be aware that this process is resulting in additional financial burden for people. While in many cases consultants do not charge for updated reports, a consultant who has not seen a patient for a period will be unable to provide an updated report without first seeing him or her, which incurs a considerable cost. Consultants must and do charge, which puts a further financial burden on people.

The gist of this legislation is amendment of the eligibility rules in respect of the over 70s medical card. As stated, under the GMS scheme, almost 43% of the national population has free access to general practitioner services. I am concerned that given the number of people who have GP only cards and do not have the financial wherewithal to take care of their health, what is proposed in this Bill will result in more cost to the State. I would not like to see a situation whereby people will opt to wait to see if they get better rather than go to the doctor. If this happens, they may end up critically or dangerously ill and need to be hospitalised.

We all know what happens when people are hospitalised; they take up acute beds which incurs considerable expense. The earlier people are assisted, the better, and if having a medical card entices them to go to their local GP in time, it is sensible, prudent and the right way to go. Since 1 February 2013, some 1.8 million medical cards are in circulation, which equates to 40% of the national population. This reflects what I stated earlier, that people are under a financial pressure they never were before.

I appreciate that the reduction in income limits is being introduced to reduce spending on medical cards for those aged over 70, and it is forecast this measure will generate €12 million in savings during the second half of 2013 and €24 million in a full year. This sounds like an almighty amount of money, but if it results in people taking up acute beds when they should not be, we might spend a lot more. We must be very careful that we do not throw out the baby with the bath water.

The changes proposed in the Bill are in the context of broader health service reforms. These include the phased introduction of free GP care for all and the introduction of a universal health insurance plan for 2016 which will effectively end the two-tier health service we have at present. On a daily basis people are dropping their VHI or full health cover because they cannot afford it. A headline in one of the national newspapers today states people in negotiations with banks on debts and mortgages in crisis will be told to get rid of a car or private health insurance. This is not sensible because it is awful to think of anyone with private health insurance not being able to pay for it and having no proper medical cover. This is not right and it is not a good way for people to finish up. It is certainly not a good way for those aged over 70 to finish up.

The Bill being published so close to being initiated in the Oireachtas means stakeholders and interested people have had little opportunity to make statements. I want to highlight the views of Age Action Ireland, a group about which I know a considerable amount and I support the work it does. Following the budget announcement in December 2012, Age Action Ireland criticised the reduction in income limits for those aged over 70. It stated the sharp reduction in the income threshold for medical cards for those aged over 70 will cause hardship and further undermine the ability of older people who will lose their cards as a result to meet their health care costs. Age Action Ireland was also concerned about this reduction in the context of a number of other charges facing older people, as I already stated, as a result of budget 2013, such as the increase in the prescription charge for medical card holders from 50 cent to €1.50, the increase in the threshold for the drug payment scheme, the decrease in the amount available for the household benefit package, the introduction of a carbon tax on solid fuel and the introduction of a property tax. This is a major issue and I ask the Minister of State to take on board the views of an association such as Age Action Ireland because it does invaluable work in representing elderly people.

Nobody should ever underestimate the importance or value of heat when it comes to elderly couples and people aged over 70. There is nothing worse than visiting an elderly person - not that I would consider a person over 70 to be elderly now because thankfully people live longer than they did in the past - and finding the person in a room without adequate heat. It is most distressing. This in turn leads to bad health. Today is a cold day and many people in the city, and in towns, villages and the rural countryside, do not have adequate heat in their houses. I feel tremendously bad about this. The Government should address this in a more concise and workmanlike way. An elderly person not having heat automatically leads to medical problems. The simplest cold can progress to a flu and then to pneumonia which, in a very short time, could kill a person. This is happening on an hourly basis.

I am sure of my facts because I know of many instances of elderly people who stay at home and do not have adequate heat to keep them warm during the day or at night. This is a crisis which should be tackled. The introduction of a carbon tax on solid fuel was a horribly mean measure. It was also mean to young families. The country must ensure older people are warm in their homes at night, otherwise it will have a knock-on effect on their health, and it is an awful thing to do to these people who have worked so hard all their lives. It is awful to think they find themselves in a position of not being warm when they sit down and take their ease, which they are perfectly entitled to do after a lifetime of work and perhaps rearing families. I would like to hear the comments of the Minister of State on this.

When it comes to processing medical cards, one of the biggest debacles we have witnessed in the history of the State was when people thought it was a good idea to take the processing of medical cards away from county level. We had a great system whereby those processing medical cards worked in conjunction with community welfare officers and knew everybody. A network was in place. Local and national public representatives were able to make direct representations to those dealing with the processing of cards. Additional information may have been required and it could be streamlined or handed in. It was a great system. People thought the right thing to do was break up this system. The excellent local knowledge has been taken away. Local community welfare officers no longer have direct input to impart their knowledge to those processing cards. This was a shocking thing to do. We have all seen the disaster which ensued. People are waiting for their medical card applications to be processed which in turn means people are not able to take care of their health needs or avail of other benefits which go along with having a medical card, such as sending young lads to school. The extraordinary waiting period has deprived people of medical cards. It was an extremely poor decision. I have spoken to many people involved in the old system, such as community welfare officers or those dealing with the cards, and they all say it was a shameful thing to do which certainly did not benefit those applying for medical cards. The same happened with regard to student grants but I do not want to speak about this because I want to stick to the subject at hand.

I am opposed to changing the criteria for medical cards for those aged over 70.

Nowadays, people find it hard enough to qualify for a medical card or a GP visit only card, be they over 70 or not. This is a penny wise and pound foolish endeavour. The Minister of State may claim that we are going to save €24 million but I do not think we will save one cent. I remain to be convinced otherwise. In the longer term, I think it will actually cost the State money.

Local GPs, who work with their patients daily, were previously able to contact the local processing centres when a medical card was applied for. They could thus have an input but all of that has virtually gone now. That personal connectivity has gone to Dublin where everything else has gone also. There are so many Government Ministers and Deputies in or around the capital that they think the whole world stops at the Red Cow roundabout and we do not exist at all. This is one of the most anti-rural governments we have had since the foundation of the State and that will be proven in time. The Government is anti-rural; it is all about centralisation and grabbing everything for Dublin but time will prove this policy to be wrong.

I thank the Acting Chairman for his indulgence. I also thank the Technical Group for the time its Members have afforded me. I am grateful for the opportunity to contribute to this debate.

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