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

I am glad to have the opportunity to speak in this debate. It is notable that the Government is not offering any speakers at this point. Apart from a handful of Members who had the courage to show up at the start of the debate, it appears no other Government Members are offering to speak. That speaks volumes about this Government's position and all the promises that were made over recent years. When it comes to a decision on this issue, nobody has the courage to show up here today and provide any type of defence for this legislation. It is no surprise, because it is indefensible legislation. The Government Deputies in their offices might be running scared but the electorate knows who is responsible for these vicious cuts.

Given the fact that there are three Ministers in the Department of Health, it is also disappointing that they are unable to attend this debate today. Other Ministers and Ministers of State are being sent into the Chamber to cover for them. The least they could do is come into the House and defend the cuts contained in this legislation.

What we have seen as a result of the budget is an utter lack of coherence in the Government's health policy. It is now in total disarray. The provisions of the programme for Government set out a clear plan for fundamental reform of the health service by switching the focus away from hospitals to primary care, through opening up access to GP care and enhancing primary care services to make them fit for purpose so they can genuinely meet 90% of people's health needs, which we were told was the intention. It is clear that policy is in disarray. There is no commitment to the type of fundamental reforms that are required. What we are seeing now is merely an attempt to chase the recurring deficit in the health area. Nobody has got on top of the financial situation in the Department of Health. Nobody has reined in expenditure and dealt with the underlying cost drivers in the Department, such as the ridiculous pharmaceutical bill and other huge costs that must be tackled. We are not seeing reform and matters can only go from bad to worse at this stage, given the financial circumstances and the lack of reform in the early years of the Government's term of office.

We were promised wider access to primary care, but we are getting the opposite. In the budget, a great deal of attention is focused on the initiative which is due to be implemented at some point later next year to provide free GP care for children aged five years and under. The Government is making €37 million available next year for that initiative, but it is giving with one hand and taking with the other because, on the other hand, it is targeting savings of €149 million from the medical card scheme. The impact of that will be extremely severe on tens of thousands of people. One category of people that will be severely impacted by this savings target is the category under consideration in this legislation. The legislation seeks to further restrict access to medical cards for people over 70 years old. This has caused a great deal of concern among older people.

Other speakers have quoted comments by the Minister for Health when he was in opposition. The actions he is taking now are clearly a direct contradiction of all the claims he made in earlier times. Some 35,000 people over 70 years of age will lose their medical cards as a result of this legislation. There are three very distinct aspects to that. The first aspect we must bear in mind is that in the case of people over 70 years old we are talking about gross income.

It is not possible to have disregards, irrespective of one's medical or living expenses. The type of disregards that are allowed for people aged under 70 years are not allowed for those aged over 70 years. We are discussing gross income, which changes the picture significantly.

My second point is probably of most concern to older people. Not only does a medical card provide access to general practitioner, GP, services, but also to other essential community primary care services, for example, home help, public health nursing and physiotherapy, that older people need. The withdrawal of the medical card in respect of those 35,000 people will see them losing that access. As people move into their 70s and 80s, the need for these services becomes all the greater. In many areas, it is not possible to access them. Leaving aside financial considerations, such services are not available privately. A more nuanced approach was necessary. Even a system of co-payments would have been preferable in order that people might retain access to essential primary care services.

My third point is on the distinction in treatment between two people living together as siblings or friends and two people who are married. We are moving away from individualisation, in that the allowance for a couple is less than the allowance for two siblings living together. There can be no justification for this. There are grounds for a case to be taken against the distinction.

This is only one way in which medical cards will be restricted. A second matter of concern, one that has received little attention since the budget, is the targeted savings of €11 million as regards people who have recently returned to work. We all know the difficulties posed by the disincentives to taking up employment, but a measure that assisted people in moving from long-term unemployment into employment was the ability to retain their medical cards. This measure is to be removed. We have heard a great deal of bleating from Fine Gael backbenchers, complaining to the Minister for Social Protection, Deputy Burton, about people not being incentivised to return to work. This measure allowed people to return to work, as they could retain their medical cards for three years. Under this budget, however, that concession has been withdrawn. It is a slap in the face for people who recently took up work, as the withdrawal does not apply to new entrants alone. We have been told through replies to parliamentary questions that people who are still in the three year phase after returning to work will have their medical cards removed and will be means tested. This is a particularly mean measure. There are also tax implications for people in such circumstances, as holding a medical card allowed one further concessions.

The main issue is the targeting of €113 million in savings from medical cards. It is all very well for Ministers to react to this move and to try to reassure people that no one with an entitlement will lose a medical card, but if the budget has targeted savings of €113 million, either large numbers of people will lose their cards through a tightening up of the assessment of means and other conditions or the savings target will not be met. Either way, it is a dire situation for people who are dependent on the public health service. Next year, tens of thousands of people will lose their medical cards or savings will not be made, leaving a hole in the budget that will need to be filled by achieving savings in front-line services. It is a poor look out for people who depend on the health service. It is clear that Government health policy is in disarray.

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