Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

It is hard to believe that this Government has actually promised in its programme to provide free GP care for all. Its actions have all been in the opposite direction. It has increased the cost of primary care for people on medical cards by increasing prescription fees and for non-medical card holders by raising the drug payment scheme threshold. As this motion points out, it has reduced the number of discretionary medical cards issued, which is an indisputable fact.

The Government repeatedly points out that the overall number of medical cards, issued on the basis of income, has increased. The Minister has just made that point. That is correct but it is not an indicator of the Government’s commitment to primary care. It is, rather, an indicator of the dismal economic failure of this and the previous Government in driving masses of people down to the low levels of income which qualify for a full medical card or a GP visit-only card.

I have repeatedly raised the issue of medical card restrictions with the Minister, Deputy Reilly, and his Ministers of State, Deputy White and Deputy Kathleen Lynch, both in this Chamber and in committee. I have also met and lobbied the central medical card administration in Finglas.

It speaks volumes about the lack of real planning and real substance in the Government’s plans for universal health care based on the private insurance model that they fell at the very first hurdle with regard to GP care. The proposal to begin the roll-out of free GP care for all people in the long-term illness scheme has been abandoned. Why was it proposed to proceed in that way in the first place? Why was false hope given to people on that scheme?

Let us be clear. Sinn Féin has long advocated GP care free at the point of delivery for all, funded by fair and reformed general taxation - the funding basis for the truly reformed universal health service that we advocate. We have long advocated also commencing free GP care for children. It now seems that the Government may be considering extending free GP care to children under five. We included that proposal in our alternative budget proposals published today and we hope the Government does indeed proceed in that way, as a first step. I take this opportunity to advise the Minister that Sinn Féin will fully support such an initiative or an even more inclusive measure, if that is to be presented in the coming week as a first step. We must at least agree that a start needs to be made.

The specific focus of this motion is the discretionary medical card. We asked the Minister for Health about this matter recently and urged him to ensure that all children diagnosed with cancer are granted, or allowed to retain, medical cards. This matter arose because it was reported to us, and, I am sure, to other Deputies, that whereas previously the granting of discretionary medical cards to children with cancer had been virtually automatic, in recent times some parents were experiencing refusal or delay. This was contrary to previous experience and legitimate expectation.

Last July, when I questioned him on this issue at the Committee on Health and Children, the Minister admitted that discretionary cards are no longer being granted to cancer patients in the same way as previously. The record shows this. I pointed to the irony that the Government is promising to extend free GP care to all while at the same time cutting medical cards for some of those who need them most.

Medical card assessments need to be carried out with appropriate discretion and compassion, and not simply on the basis of the very low income threshold for qualification. This is clearly a requirement where applicants have life-limiting conditions, including cancer. The HSE has claimed that there has been no change in criteria for discretionary medical cards but has also admitted that the number of people on discretionary medical cards has indeed decreased, as the figures cited in the motion demonstrate. It does not take much imagination to see the great distress all this causes to already traumatised parents of children with cancer.

That distress for parents will be compounded by a reading of the Minister’s reply to our recent Dáil question urging him to ensure that all children with cancer get medical cards. He pointed out that other than on the grounds of income and “undue hardship” there is no provision for the automatic granting of discretionary medical cards to children with cancer, unless they are terminally ill. That is a most cruel position. It is also illogical and medically highly questionable. In very many cases no one can tell whether a cancer will prove terminal or not. It depends on a number of critical factors, including how the patient responds to treatment. What parent wants to provide medical evidence that their child’s cancer is terminal, in order to qualify for a discretionary medical card that is valid for six months?

This only goes to show the inequities and in some cases the cruelties that arise when the principle of universal care on the basis of medical need and medical need alone is not adhered to. The reality is that the Minister - like the previous Minister, Mary Harney - is shredding our public health services with his regime of cuts and patients are suffering as a result. That is the real situation.

A budget over-run on health spending is predicted again this year. That is no surprise. We have had successive years of health cutbacks since 2007 with our public health system unable to cope. Cuts of €781 million in health were imposed by the Minister for the current year. When Fine Gael and Labour cut over €750 million out of health for 2012, on top of the €1 billion cut in 2011, we said it was unsustainable and would cause huge damage to the health services. These are cuts, not reforms of health service funding. They then cut a further €130 million in August 2012. At the end of 2012, the Minister had to ask the Dáil for an additional €360 million supplementary Estimate to prevent services collapsing before the end of the year. That is no way to fund and run our public health services.

As we made clear at our alternative budget launch today, we would discontinue the futile austerity policy. We would address the deficit by redistributing the burden away from those on low and middle incomes and taking a greater contribution from the highest earners and from wealth. This is the only approach that can prevent further cuts to health and other public services.

Look at what has happened to health over the summer. In July, we saw further restrictions on discretionary medical cards, the focus of this motion. We found out during the summer that hundreds of young people with severe disabilities, who have finished school, are to be denied the day services they need due to coalition Government cutbacks. Cutting the allocation from almost €10 million in 2012 to €4 million in 2013 can only be described as callous in the extreme. The Minister of State, Deputy Kathleen Lynch, signalled that the Government intends to bring in means testing for home care and other services for older people and people with disabilities. This was denied subsequently but in the language of the reply to me from the Minister, there is clearly wriggle room for means testing to be sneaked in by the back door.

We had the cuts to services for people with disabilities at Stewart’s Hospital in Palmerstown. We had the decision to close the 22-bed mental health unit at St. Brigid’s in Ballinasloe. We have had the cuts to services provided by St. Michael’s House, one of the largest providers of services to people with disabilities. Over 2,000 service users are dependent on St. Michael's House.

In a Dáil reply to me, the Minister stated that in 2012, some 121 HSE executives earned in excess of €100,000. Between them, total remuneration, including allowances and arrears, amounted to €14.6 million. He said that a high-level analysis of annualised payroll data from May 2013 indicates that at that time, the number of executives on annual remuneration in excess of €100,000 had risen to 129.

This is scandalous, particularly in light of the cuts imposed on health services, the impact of which is having a devastating affect on the lives of many thousands of vulnerable citizens on a daily basis. Front-line services, acute and community care, medical cards, disability and mental health services have all been cut while those at the top of the HSE are rewarded time and again.

The Minister, Deputy Reilly, has failed to deliver the level of savings possible from the State’s drugs bill. We estimate that an additional saving of more than €300 million is achievable in 2014. This is based on figures provided and confirmed by the Minister's Department. The Minister and his predecessors, back to Deputy Martin, have failed to address the recurring junior hospital doctors crisis resulting in the industrial action which took place at hospitals across the State today. This action was inevitable given the lengthy failure to implement the working time directive. It is long past time to implement the directive in full and to bring in the root and branch reform of hospital medical staffing and training that is required.

I support the motion as presented by Deputy Kelleher.

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