Sandra McLellan (Cork East, Sinn Fein) | Oireachtas source

I will speak to the specifics of the Bill shortly but, first, I wish to comment on the Government's supposed vision for health care. The Minister will know that we had our reservations to begin with, to put it mildly. We never truly believed that reliance on the private insurance sector, itself enfeebled and in many respects subsidised by the public system, could ever truly deliver the type of care that citizens should be entitled to as of right.

However, even if we were to take the Government at its word, we now seem to be a long way from the programme for Government which was published in 2011. The programme for Government states:

This Government is the first in the history of the State that is committed to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income. By reforming our model of delivering health care so that more care is delivered in the community, and by reforming how we pay for health care through universal health insurance, we can reduce the cost of achieving the best health outcomes for our citizens and end the unfair, unequal and inefficient two-tier health system.

Realising a vision is not easy. I accept that it requires preparation, planning, co-operation, compromise and time. We are more than two and a half years into the life of this Government - closer to the next election than the last - yet we are as far as ever from this vision. For every step forward, such as free GP care for under fives, we see two steps back, removing so-called discretionary medical cards from so many who desperately need them and, for the second time, making a raid on medical cards for the elderly.

Many of the Government's original commitments have seen no progress whatsoever. The programme for Government says that universal primary care will remove fees for GP care and will be introduced within this Government's term of office. We were told that access to primary care without fees will be extended in the first year to claimants of free drugs under the long-term illness scheme at a cost of €17 million. We were led to believe that access to primary care without fees would be extended in the second year to claimants of free drugs under the high-tech drugs scheme at a cost of €15 million, and that access to subsidised care would be extended to all in the next phase. The final phase would see everyone having access to free primary care.

The Government's rhetoric on primary care is good. Primary care is an area where we have lagged behind other parts of Europe and there is a need for investment now, which will accrue savings in the long run. The delivery of some primary care centres is a positive move, but it is far from being enough. As regards the extension of actual primary care, we have not made any real progress as regards these policies whatsoever.

At this rate, it is hard to imagine the goal of universal health care, with an end to the two-tier system, being delivered in the life-time of this Government. It is hard not to wonder whether the next 12 months will not in fact see a deterioration in our health care system and the quality of health care delivered.

At the time of the budget, as with every year, we saw Government TDs briefly and furiously spinning the budget as one which protected the most vulnerable in our society. For the most part, remarkably, many of them seemed to believe it. However, even the most enthusiastic Government TDs appeared overcome with reticence and doubt when the €666 million in health cuts was brought up. The sum of €666 million is an ominous and enormous number. The big question is what these cuts will amount to. Anyone can recognise that such a huge sum can hardly be removed without doing some damage.

We have begun to see what it will mean and this legislation is part of that. For the second time in 12 months, the Government is going for the elderly and removing cards from approximately 35,000 people in that age category. Gross weekly income limits will drop from €600 to €500 for a single person and from €1,200 to €900 per couple, which is a substantial drop.

My colleague, Deputy Ó Caoláin, has ably demonstrated how the Minister has jumped from one position to the next on income limits. In particular, the Minister will recall his own comments at the time of the Fianna Fáil changes to income limits, when he said that "tinkering with income limits is nowhere near good enough" and that the cutbacks were "a vicious assault on the elderly". It appears as though his opinions on such matters, far from being guided by any commitment to a vision, are guided by what position or office he holds.

We are talking about a category of people who are far more statistically likely to need their medical cards than others are. This is not only a false economy, it is grossly unfair and yet another attack on the elderly who were already badly hit in the budget. I note in particular the cynical abolition of the phone allowance.

The Minister has sought savings of some €149 million to the medical card scheme. It is a precise figure coming under the heading of medical card probity, which is a mysterious and vague heading. Probity seems to infer some form of wrong-doing or deception on the part of those who have medical cards that the Department has decided no longer need them, and that there is a lack of probity on the part of those in possession of such cards.

We are seeing people with disabilities, with life-limiting diseases and the elderly, all losing cards. I have referenced examples in this house, as have others, of people with life-limiting diseases and serious chronic diseases, being denied medical cards when quite clearly they need them. The Minister's demanded savings will obviously result in suffering, hardship and pain. People who need medical cards will lose them and of that there is no doubt.

We will also likely be looking at seriously curtailed service plans in the new year, as CEOs and hospital management around the country are faced with budgets they simply cannot manage with. We have already had a glimpse of what that might mean in a letter from the CEOs of Crumlin, the Mater, St. James's and Tallaght hospitals, claiming that cuts to their budgets in recent years have led to delays for the treatment of cancer patients.

One of the leading oncologists in Our Lady's Children's Hospital in Crumlin said that delays experienced by children being treated for cancer are "unacceptable". I fear that this is only the tip of the iceberg and that we will see further delays in treatments, as well as cutbacks and reductions in services. There is no way such a sum can come from our hospitals and for them not to suffer. The reality is that our hospitals are underfunded. The Minister will point to the free GP cards for under fives, which are welcome indeed. However, in terms of what is being taken away, it does not go anywhere near to making up for it.

Sinn Féin produced a pre-budget submission which included free GP cards for children under five without undermining the quality of care for other citizens. While some children get free GP cards, and that is welcome, their seriously ill siblings or their grandparents might be losing them at the same time. What part of this resembles universal health care and how can this possibly be in accord with the Minister's vision?

Under the Minister's proposals and policies, many in desperate need of care are having their ability to access it reduced. This is a long way from what the programme for Government promised, which was universal care based on need, not the ability to pay. On the one hand, it asserts the importance of universality. On the other hand, however, with legislation like this, it attacks what were universal entitlements in the form of these medical cards. The Minister has lost direction and this Government's supposed vision for health care reform is a long way from being delivered.

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