Alex White (Dublin South, Labour) | Oireachtas source

Currently, 360,000 medical cards are issued to people over 70. Therefore, medical card coverage of the over 70s population is approximately 97%. In comparison, the medical card coverage of the under 70s population is approximately 35%. As I outlined yesterday to Deputies, it is estimated that approximately 20,000 people will have their medical card replaced with a GP visit card. That is the factual position.

I wish to correct one or two issues so we are clear on what precisely is in the Bill rather than a particular take on it that Members might have unwittingly picked up. Deputies Kelleher and Browne referred to section 7(5) which states:

The Minister shall, on 1 September of every year, review the most recent information on the consumer price index made available by the Central Statistics Office, and may, with the consent of the Minister for Public Expenditure and Reform, by regulations to take effect on 1 January next following that review, increase or decrease the gross income limits specified for the purposes of this section to reflect any increase or decrease in that index.

It is clear from the provision that the power given to the Minister to increase or decrease the limits by regulation is predicated entirely on the most recent information on the consumer price index, CPI, in any given year. There is no right residing in the Minister, or any Minister from this side or the other side, on the basis of the legislation to introduce such change in a whimsical way or on some basis other than the CPI to change the income limits and eligibility. That is a misreading of what the section says. It is important that is placed on the record and that people are clear on precisely what is proposed.

A number of Deputies referred to the savings that will arise from the changes. One or more colleagues described it as nit-picking that €12 million would be saved in this year and €24 million in a full year. I find such an argument difficult to understand. Most of the individual savings that must be achieved across the board are relatively small amounts compared to the €780 million. In other words, one is talking about €24 million, €30 million, €50 million, €10 million or €5 million. It does not serve the House for us to say that because the saving is “only” €12 million in a year or “only” €24 million in a full year that it is nit-picking and that it can be set aside. We cannot operate on that basis because the same argument could be made about every single element of the savings that, regrettably, have to be made. There is not much point in dwelling on that argument because if that were the case then we would not be able to make any savings at all in the budget we must address.

I agree with much of what has been said in the course of the debate. Many of the issues Deputies raised do not directly relate to the provisions of the Bill. Deputies made observations on the cost of drugs. The point is well made and well taken that those issues must be addressed. They are in fact being addressed by the Government in a number of different ways.

There was much discussion about the general primary care reimbursement service, PCRS, approach to applications for medical cards, in particular discretionary medical cards. Deputies asked me to address the issue. Points were made about what happened historically. The fact is that under our system medical cards are not awarded to any particular group of patients on the basis of a specific disease or condition. That is not the position. The Act of 1970, which is the legislation under which we have been operating since, including during Deputy Kelleher’s time, is the one which governs eligibility. As everyone is aware, eligibility for health services in this country is based primarily on residency and in particular on means. That is the basis upon which medical cards are granted. The exception to that is a provision for discretion to grant a card in cases of undue hardship where the income guidelines are exceeded. It is necessary that we have a system in place for that to be assessed, where a person comes forward in good faith who has a particular illness or condition and he or she wishes to make an application for a discretionary medical card. We must have in place a transparent system we can all understand and that is properly administered by the PCRS. That is what we have done. In addition, we recently set up a clinical panel to assist in the processing of those applications. Deputies have raised issues about particular cases with which they have had to deal. I am aware of such cases myself. However, I am satisfied that the system is being administered in a sensitive, transparent and objective way. If Deputies have any reason to believe that it is not the case I ask them, through you, a Cheann Comhairle, to bring it to my attention. I refer for example to cases where appropriate sensitivity was not shown or where applications have in some way been improperly or unfairly examined. That is something I would not wish to see happen.

In addition to the discretionary medical card system there is also an emergency medical card process whereby if a person has become terminally ill a card can be issued within 24 hours in circumstances where someone is faced with such a tragic situation in his or her life. That does happen and will continue to happen. Currently, more than 62,000 discretionary medical cards are in operation in the State.

I disagree flatly with the point made by Deputy Healy-Rae. I have not disagreed as strongly with any other observations made. He said he regrets the removal of the processing of medical cards from local offices to the PCRS.

I respectfully suggest that this has been a very important, successful and progressive move. We previously had 100 local offices across the country processing applications for medical cards. What we now have is a centralised system that provides enhanced service delivery to clients and ensures a consistent and equitable national assessment process that everybody can rely on. Surely that is what we all want. We want a system that is consistent, effective, efficient and transparent, and that is what we have now. Ninety-five percent of medical card applications are now processed within 15 working days, which is a major achievement. Deputies might say that should always have been the case, and I would not disagree, but at least we have achieved that in a relatively short period of time. Before we centralised the medical card applications system, it was impossible to say how long it would take for an application to be processed. Now we have both transparency and efficiency and we should welcome that.

On the issue of community welfare officers and the local input to which Deputy Healy Rae referred, it is true that CWOs no longer have a role in the medical card application process. However, it is important to emphasise the fact that staff in local health offices continue to provide information and assistance to individuals in connection with their medical card applications.

We have had a very good Second Stage debate on this Bill and the contribution of Deputy Twomey, in particular, was excellent. I agree with what he said about the need for a serious debate about issues such as universality and how we fund our health services. I am strong believer, as is Deputy Ó Caoláin, in the principle of universality in the provision of health services. However, we sometimes throw around these words and phrases like slogans in this House and spend most of the debate talking about who said what on the back of which truck during the general election campaign. I often think that we should set aside one day in here during which I would commit to not criticising Deputy Ó Caoláin's party for its inconsistencies vis-à-visthe North and the South and, in turn, Deputy Ó Caoláinwould not say anything to me about what my party said in the general election campaign. I would not criticise Fianna Fáil for wrecking the economy and making it so difficult for us to put it back-----

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