Róisín Shortall (Dublin North West, Independent) | Oireachtas source

I very much share the concerns that have been expressed by earlier speakers about this measure. It is one of a number of measures which will result in the health service going into free fall. The programme for Government sets out a clear plan for transition to universal health insurance but, unfortunately, we are now at a point two and a half years down the road where little or no progress has been made on implementing the programme for Government. We were promised a White Paper which would set out all of the issues concerned in the moved towards universal health insurance. Two and a half years later, there is no sign of that White Paper and I would have to ask does anybody in Government know what is happening in Health. Does anybody in government realise that, as a result of the inaction, and also some of the austerity cuts, over recent times, coupled with a number of provisions in today's budget, we will find ourselves soon in a situation where the health service is in free fall?

We are supposed to be moving towards a situation where health services are more accessible, more affordable and more equitable, and the result of these measures today, and actions that have been taken over recent budgets, is that health services will become less accessible, less equitable and more expensive for everybody. On this measures today, whereas we are supposed to be moving towards a situation where more citizens can afford health insurance according to the model set out, already, because of austerity and because they have so little money in their pockets, they are leaving health insurance in their droves, and this will accelerate that process.

I very much object to the presentation of this by the Minister, Deputy Noonan, earlier on where he claimed this was merely about "gold-plated" health cover. This is about hitting those who are struggling to maintain basic cover plans with VHI or one of the other health insurance companies. This measure, which makes health insurance less affordable, will result in increasing numbers giving up their health insurance altogether.

Other budget measures will see 35,000 people over the age of 70 years lose their medical cards. The new income limits and all income limits applying to the over 70s are gross income limits. For example, a joint income of €900 a week for a couple may be regarded as comfortable enough, but it must be borne in mind that when applied for medical card purposes, it is regarded as gross income and there are no offsets for expenses, irrespective of the level a couple in such circumstances may be faced with. No expenses can be written off. It must be remembered that the medical card not only allows a person to access GP services but critically for older people it is also the only way of gaining access to a public health nurse, the local home help service and physiotherapy service from the local clinic. One must have a full medical card to access these services.

The Government is making health care far less accessible to 35,000 people over the age of 70 years. In addition, the other provision in the Budget Statement is to make savings of €113 million from those aged under 70 years by withdrawing a significant number of medical cards - in the region of 150,000 will be withdrawn in the coming year. The medical card income limits have not changed or increased for donkey's years. The limits are actually below the standard rate of social welfare benefit. I am very concerned that we are moving towards a situation where many more people will be squeezed out of cover, whether that is cover they are struggling to provide for themselves by way of health insurance or having a medical card. Sometime in the middle of next year the health service will be in freefall because the centre will not hold within it. There are too many pressures on it and there has been no reform. There will be cuts of €660 million on an already overstretched health service and none of the reforms and changes to the model of care has taken place. A total of 55,000 people with long-term and chronic illnesses expected to have free GP care because the Government had told them they would be included in the first phase of the programme. They are also being squeezed out and denied the essential care they require. Of course, it would have made good sense if the Government had gone with that proposal - the argument about legal advice is entirely spurious - to give medical cards to that cohort of people with chronic diseases. It would have allowed a change in the model of care in order that the chronic disease management programmes could have been introduced which successive Ministers for Health have been promising in the past ten or 12 years.

I share the concerns expressed by other speakers. We are facing a really difficult period in health due to inaction, the lack of joined-up thinking and any plan under consideration by the Government. There is a plan in the programme for Government, but, unfortunately, it has been entirely ignored. We are facing a most horrendous situation where more and more people will be denied basic health care. More and more doctors and nurses are leaving the service and its centre will not be able to hold.

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