Billy Timmins (Wicklow, Independent) | Oireachtas source

Aside from the legislation itself, one point has struck me as being extraordinary in the Chamber today. I am surprised by it because while this legislation on the surface appears to be draconian in many respects, certain aspects of the medical card regime have improved over recent years. I refer to the lack of Government speakers on the issue. While Members on this side are always arguing that they cannot get time, there appears to be no difficulty in so doing today. I am sure the Minister of State, Deputy White, must be a little perplexed that he cannot get his colleagues to come into the Chamber to speak in favour of the legislation. I am unsure whether any Government Member has spoken in favour of it. Nevertheless, I certainly am happy to go along with certain aspects of the legislation.

In the first instance, however, I note this legislation is on foot of the budgetary measure changing the eligibility for medical cards for people over the age of 70. Following the budget, a view has formed among elderly people, who Members should recall are those who worked during an era in which they were obliged to pay more than 60% in tax and when mortgage rates were between 10% to 20%. The rates hovered around 20% for many years in the late 1970s and early 1980s. There is a certain sense that such people were perceived to be easy pickings in respect of the prescription charges, the telephone allowance or the medical card. I do not necessarily agree with this and do not believe that was the Government's intention but it certainly was the message that came across. Again, it shows the weakness in Ireland's budgetary system because it would be to the Government's advantage to come into this Chamber in the months ahead of a budget to outline the amount of funding it has available to it and its proposed allocation thereof and then to ask Members whether they could come up with a better proposal. In this context, it is easy to lament the cutbacks and is easy to lament the reduction in services or the increase in taxes. However, Ireland still is spending beyond its means and this must be addressed further. The economy will not get back into shape until the finances are back in order. This is the reason I am surprised that Government Members have not come into the Chamber to speak.

I have a number of points to make and while I am not a spokesperson for the Government, it is important to point out that notwithstanding the increase in the number of people on the live register, the numbers of medical cards issued have risen dramatically. In 2004, there were 1.14 million cards while in August 2013, there were 1.863 million cards. Notwithstanding the increase in the numbers on the live register, this constitutes a dramatic increase. Moreover, the number of medical cards in circulation has increased by 62% between 2004 and August 2013. Second, the coverage of the population for health services through medical cards has increased steadily since 2004 to reach almost 41% of the population by August 2013. When GP-visit cards are included, that figure increases to 43%. I reiterate the caveat about the economy but these basically are good news stories and I am surprised that Government Members are not in the Chamber to push them.

On the other side, in my dealings with the HSE, in general I have found its staff to be fine. Mistakes of course will be made and Members are familiar with the high-profile cases that end up on the chat shows or whatever and which are not possible to defend. Errors will happen and this is where I believe the HSE and the health services have faltered. I will cite a statistic that does not show the health service in a good light. In 2009, approximately one in 18 medical cards issued were discretionary while in 2012, the comparable ratio was 1:33. I believe medical cards should be issued for medical reasons and not as financial assistance cards. This is the reason it is really important to have consultations. The system has changed in that it is now managed centrally and, consequently, what is now missing is input from the community welfare officer, the public health nurse, the local politician, the local health board member or whoever. Previously, such people had an input into the granting of medical cards but this practice has now ceased. As society becomes more technologically advanced, lots of shortcomings emerge and in this case, the interface with people is one such shortcoming. I would be happy to support the broad principle of this legislation, were a commitment given about the discretionary card for those who are actually in need. The Government has a policy in which money follows the patient, whatever that might mean, as I am not quite sure. However, a policy in which money follows the patient and need would make a lot more sense. It is the same in respect of providing the medical card for everyone aged from zero to five.

There are many children aged six, seven and eight in dire need of a medical card whose the family's earnings are over the income threshold for eligibility but, due to the special needs of the child, they are in difficulty. They will get a medical card for the child on most occasions, but not always. It would be preferable if that cohort of people were to get a medical card than to have universal provision. I do not believe in the principle of universality because it does not address the need.

There is an anomaly in the legislation with regard to the income threshold applying to a married couple. The income threshold has been reduced to €500 per week for an individual and €900 per week for a couple. I tabled a parliamentary question on this issue, the reply to which stated that it is easier for a couple to cope with the cost of living and, to bring it down to simplistic terms, only one light bulb is needed for two people. The same argument can be applied to a sister and brother or two individuals over the age of 70 who share a house. The income threshold qualification for those individuals is €500 per week and this is the first time in legislation on this area that there is discrimination against married couples. Unfortunately, I am not a member of a committee but I will certainly consider tabling an amendment on Report Stage to restore equalisation in the legislation. This anomaly sends out a message of discrimination against married couples.

Approximately 2 million people have a medical or GP visit card and 43% of the population are in the medical card system. I would like to know what percentage of that 43% have private health insurance. In theory, there should not be any of those in that system and, if there are, it is a clear indication that there is a lack of confidence in the health service. The chief executive officers of four hospitals wrote to us recently expressing concern about the services being provided. I represent a constituency in which there is no general hospital. It is probably unique in that respect. It has not had a general hospital since the foundation of the State and prior to that. Perhaps Leitrim is the only other county in a similar boat. I am not sure if there was a general hospital in Carrick-on-Shannon but Wicklow does not have one. I have encountered a few cases involving people who have passed on where I would be almost certain - whether it was due to lack of resources or other reasons - that should not have been the case. I definitely believe there was misadventure or neglect at the heart of it, for whatever reason I do not know but it is to be hoped that, in time, it will be established.

I want to deal with the issue of the prescription charge. I was an advocate of it from the perspective that it was a quantity control measure. One would find on visiting houses that there would be lockers filled with unused medicines. The charge was to be a quantity control measure, not a revenue collecting measure. Unfortunately, the Government has developed it as a revenue collecting measure. There is a maximum charge of €25 per month, but that is a good deal of money for an elderly person. I ask the Government to reconsider the impact of that charge on elderly people in particular. The charge is €2.50 per prescription item.

I am a believer in the concept that no one should get something for nothing, notwithstanding that there are people in difficulties. I believe most elderly people would support an idea with regard to the medical card. In the case of the free travel pass, I have met several active retirement groups who expressed the view that they would not mind paying a €1 or €2 per journey, once it was not used as a revenue collecting measure. It could be a quantity control measure or a means of monitoring the position. I would not be adverse to a charge of €1 per visit for a medical card holder provided that next year the charge would not be €5 and €10 the year after that. I do not believe people by and large would have a difficulty with a small charge. While some sections of the media might hammer the Government initially for bringing in such a charge, it could explain the advantages of it and that it would put a certain status on the card. People are very fair and reasonable.

I want make a few basic points. With regard to the discretionary medical card, it is important that the interface with and knowledge of the local person is taken into consideration. It is fine then to reduce the other sections provided the discretionary card follows the need.

We have a community first responder scheme in Wicklow. I have often raised this issue with the Minister, Deputy Reilly. The issues of concern to people who are isolated medically are meningitis in the case of a young child and cardiac arrest. The community first responders in Wicklow have 400 or 500 people trained in a voluntary capacity. When an ambulance is called out, a mobile telephone number is concurrently dialled and the local person who has been trained - there are volunteers on duty in almost 30 locations - makes their way with a defibrillator and the oxygen to the individual concerned. They get good assistance from the ambulance service. When a former Minster, Mary Harney, was in office, she launched a report on it around 2006. The scheme has not been extended nationally. It is a fantastic scheme that no one knows about other than the people who avail of it. I heard a presentation on it when the Minister, Deputy Reilly, was in opposition and I would like him to read it because, for very limited resources, it provides a fantastic facility.

See this speech in context