Dara Calleary (Mayo, Fianna Fail) | Oireachtas source

There is no doubt that this Bill will be passed, given the Government's majority. What should be noted about this debate is the complete lack of speakers on the Government side of the House over the course of the debate. They will press the buttons and support the Bill but there has been a paucity of speakers and most of the contributions have been from this side of the House.

This is the second occasion this year that the House has considered legislation to do with eligibility for medical cards. The Taoiseach and the Tánaiste revved up the crowds in 2008 but this is contrasted with the manner in which they now deal with medical card eligibility.

I ask the Minister of State to consider some aspects of the Bill in advance of Report Stage. Like other speakers I am concerned at the manner in which the figure has been arrived at. Couples living together are being discriminated against because their weekly income threshold is being reduced by €100. This is a significant departure from previous Bills amending eligibility for medical cards which gave couples double the allowance of individuals. I agree with Deputy Terence Flanagan that if the Department is using a new formula for assessing eligibility this should be explained to people. Will this formula be used for all eligibility applications? It marks a significant departure from current practice.

This is the second time that the Government has reduced the eligibility for a medical card for the over 70s. Will there be subsequent reductions? The Government is also making health insurance more unaffordable, in particular for this cohort of people. The Taoiseach spoke this morning at Leaders' Questions about older people needing more expensive policies. I agree that is the case but these are the people whom the Minister for Finance, Deputy Noonan, on budget day described as having expensive gold-plated policies. He announced the cut in the tax credit by stating that it would only affect those with gold-plated policies. However, for most older people, their policies are more expensive and they use them, but they are not gold-plated by any means. These policies provide the security of being able to obtain a bed in a ward or having timely access to services. There is nothing gold-plated about that but because of their age or condition, some people will have to pay more.

I am aware of a constituent who suffers from chronic pain syndrome at the age of 39. I spoke to her on budget night and I have referred to her case previously in the House. She has a requirement to travel from Mayo to the national pain centre at St. Vincent's hospital every six weeks to have her condition treated. Her VHI policy - which she still pays - will rocket in price because of this taxation decision. She does not have a gold-plated policy; it is a policy directly relevant to her condition. The issue of discretionary medical cards is broader than this legislation. My constituent will now be forced to defend her right to have a discretionary card because it is specific to her condition and it was given on discretion.

Even the use of the term "discretionary" is wrong. I agree with Deputy Terence Flanagan that communications about the long-term illness scheme are appalling. People do not understand it. I would not like to compare the medical card staff in the office in Finglas with the Revenue Commissioners.

They are doing a hell of a good job currently and they are trying to deal with people. While I disagree with the reviews, the forms are clear and the staff in Finglas are trying their level best. There were hiccups in the beginning, but they have got everything together and they are good to deal with, in my experience. The reality is that discretionary cards are being withdrawn from people who have cancer or children who have disabilities who require them to be in care. The notion of giving free GP care to under-fives while not being in position to give a guarantee to a child if he or she has a serious illness that the or she will have a medical card when he or she is six is wrong. We all aspire to free GP care for under-fives, but when children with serious or terminal illnesses cannot get that guarantee, we need to examine our priorities.

The Taoiseach referred to cancer patients and said this diagnosis no longer strikes the fear into people that it used to. He is correct but he is able to say that while looking on from a distance. When people are given that diagnosis, no matter how good the prognosis is, it strikes fear into them and their families in the days and weeks afterwards. People will have to battle and go through the process of applying for a card and that will not assist them to deal with the fear. The health services need to liaise with the Irish Cancer Society and cancer specialists regarding a fast-track system for people with serious illnesses. Motor neurone disease is another example. It is incredible that given the prognosis for sufferers and the care they need, there is no system to fast-track applications for specific conditions. That needs to be implemented.

On budget day, the Taoiseach stated that only 3% of those aged over 70 would be affected by this change. He again gave the impression, as the Government tends to do in its communications, that people should not worry because only rich, gold-plated individuals will be hit by this and everybody else will be fine. To achieve the savings target, however, 35,000 medical cards will have to be withdrawn and, therefore, either the Taoiseach is wrong or the savings target is wrong. The amount the Bill proposes to save needs to be clarified.

Probity measures are also an issue. The notion of probity suggests something is wrong with people who have a card and that they should not have it. They comprise a small cohort and some were given discretionary cards because of local knowledge and input.

It is frustrating that medical decisions are taken on the basis of a form without engaging with the applicant. Either the Minister of State or the Minister for Social Protection committed to increasing the number of doctors assessing medical card applications but it is one thing to read a form and look at a range of conditions. It is another to sit down face to face with a patient and make a call. If the Government wishes to emphasise decisions made by doctors, they must meet the people on whose applications they are deciding. One cannot diagnose a person's medical condition on the basis of a form.

The notion of a card being discretionary suggests people can do without one. I received an e-mail from a constituent a few minutes before I came into the Chamber. His mother has a serious medical condition and her discretionary medical card has been withdrawn. The husband has a small business and is struggling like all small business people and he is trying to keep his family going. The card was reviewed a few weeks ago and it was withdrawn. This is a serious condition and I have asked for the details, which I will pursue, but this person is going through incredible distress, as are many thousands of others who are getting these letters. The worst element of this is that people are attending doctors only to find out that their medical card, which might have an expiry date in 2014 or even 2015, has been withdrawn from the list. This is the first they have heard about there even being a question over the card or that it is subject to a review. Their doctor has been told that the person no longer has a card. Communications issues need to be addressed because this is wrong.

We are saying to older people that they are expendable. The statements and rabble rousing engaged in by the Taoiseach and the Tánaiste in 2008 on this issue stands in stark contrast to this legislation which will pass Second Stage later. The loudness of the silence on the Government benches has been noticeable throughout the day.

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