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

Now they further restrict medical card access as a so-called savings measure that will adversely affect the health of our older citizens. It is another smooth transition, make no mistake about it, from Fianna Fáil to Fine Gael. There is no other way to describe what is being presented here and I cannot leave the Labour Party out of that story. Despite the sham fight we witnessed between the Minister and Deputy Kelleher this morning which fools nobody any more, make no mistake about it, there is not a hair's breadth between them in terms of their policies and approach. We will be told that the difference now is that the Government has provided for universal free GP care for those aged five and under, and I have welcomed that. It was something I argued for in our prebudget submission. However, I must point out that I welcome it only as far as it goes. The Minister of State, Deputy Alex White, was quite correct this morning when he added the comment, which reflects my own caution and concern, that it is welcome only as a measure as part of a package that will lead to the universal roll out of access to free GP care for all. If it is not part of a clear programme of extension of free GP care for all with a limited timeframe, a plan like that which was outlined in the programme for Government in 2011, it will undermine the principle of universality and there will be no public confidence in it and no welcome for it.

My concern was borne out only this week when one mother - others must have noted her contribution on television - whose disabled child aged over five lost her medical card, said that she did not want the under fives card for her other child but wanted the restoration of the card to her child with particular challenges in life, her disabled child, as she was the one who needed it most. The disabled child lost the card as a result of the Government’s policy of restricting access to discretionary medical cards.

If this Government was genuinely pursuing a policy of universality and a single-tier health service with access based on medical need alone, the Minister would have my wholehearted support without hesitation. However, this is not the Minister's intention. There may be those in the Labour Party who delude themselves into believing they are pursuing such a path - some of them genuinely so - but it is far from the position of Fine Gael in this Government.

A total of €37 million is to be spent on GP cards for the under-fives but €149 million is to be taken out of the medical card budget - not just €113 million under the heading of probity. The total is €149 million. That will mean more people losing their medical cards, including those older people losing out as a result of this Bill. The extension of free GP care to children aged five and under, comes at the expense of taking medical cards from other sections of the population who need them. This is not universality; it can only be described as robbing Peter to pay Paul. I can think of no other way to refer to it.

In our alternative budget Sinn Féin provided for the extension of free GP care to all children aged five and under without depriving anyone else of their medical card entitlement. Nobody would have suffered on the basis of our approach to this issue as are now suffering as a result of this Bill. As we said at the time of the budget, the Government’s idea of universal health care is to give out GP-only cards with one hand and take back full medical cards with the other. This is a completely indefensible position. The medical card probity heading in the budget document is still as mysterious as it was when it was published. I have tried to elicit some further clarification in the course of questions to the Minister this morning at Question Time. Under this heading, the Minister, Deputy Reilly and the Minister of State, Deputy Alex White, have targeted a huge so-called saving of €113 million. The Ministers are still unable to account for this figure. It has never been explained. It is not as if it is a round figure of €60 million, €80 million or €100 million. Where did the figure of €113 million come from? How was it computed, calculated and arrived at? It seems clear now, as we said in response to the budget, that it was cooked up to provide a sizeable chunk of the at least €666 million signalled for reduction in the health budget in 2014. Similarly, it seems that the figure of €666 million –not a popular figure at any time - is not clear. It could be €1 billion, in the words of the director general of the HSE. This will have a significant impact on the preparation of the HSE national service plan which is currently deferred at the approval of the Minister. Perhaps it may be deferred once again before the end of this week, as the Minister has indicated earlier this morning.

I also spoke to the Minister this morning about the warning from the chief executive officers of the four major Dublin hospitals about the impact of such cuts in 2014. These are not just four Dublin hospitals; these are four national centres of excellence. All areas of this State depend on these centres. I acknowledge that savings need to be made and Sinn Féin's pre-budget submission has identified a number of savings that could be pursued. Therefore, I do not want my contribution to labelled as always being in opposition to measures being undertaken by the Government. I will oppose them on the basis of their merit or otherwise. I am equally conscious of the responsibility of elected office to outline where savings can be made and where more effective and efficient systems can be employed and which I have outlined, year on year and in even greater detail this year than at any time in the past.

Sinn Féin has identified savings on expenditure on medicines which are far in excess of the Government’s. We also addressed the issue this morning. However, this Government seems incapable of reaching even its own modest targets in this regard as we see that the HSE is still paying multiples of what the NHS is paying for commonly prescribed drugs. This morning I instanced the situation of generic substitution for Lipitor. The HSE is paying four and a half times the sum being paid for the same drug as against what is being paid North of the Border under the terms of the NHS. This is after the introduction of the reference pricing and generic substitution is taken into account. Instead, the Government prefers to make patients pay and in the case of this Bill, our older citizens are very much the target of the day of this Minister and this Government and many will lose their medical cards as a consequence. I wish to record my opposition to this Bill. The Minister's intent, what he seeks to introduce, is outrageous, insulting to older people and there is no explaining it away. I have seen the worry and the concern of people and I have met people who are immediately affected by the drops in the threshold for qualification. These are not people living in excessive comfort by any stretch of the imagination. This Bill is doing a great disservice to our older citizens. With all respect to the Minister, Deputy Reilly, and to his colleagues in Government, he is doing exactly the same as those he lambasted across this Chamber but a few short years ago. There is not a hair's breadth of difference between them.

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