Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

When one reads the Bill, there is little with which one would have major concerns regarding the aspiration to make free GP care available to children under six and the broadening out of that over a period of time to ensure that there is universal access to primary care over the next number of years. That is the stated purpose of the Government. As most people acknowledge, all the various reports suggest that unhindered access to primary care advances the health of the nation. International standards and comparisons highlight that. There are other fundamental issues at stake, however. The Minister talks about universality, which is something we welcome. The issue with it is that it must be funded and sustainable.

We ration health in this country every day of the week because we have a defined amount of money with which to provide health services. Decisions are made day in, day out in the rationing of health. Universality funded by resources that were not taken from elsewhere would be fine but, whether the Minister of State accepts it or not, when one has a defined envelope of money for health service provision and wants to roll out universality of primary care access for under sixes, the money must come from somewhere else. After analysing the accounts, the HSE service plan and last year's budget, the only possible conclusion is that the money is coming from those who need medical care immediately. These are people whose lives have been afflicted by grave illness, physical and intellectual disability and aging. The decision of the Government to launch a vicious attack on those who most need the support of the State in their time of difficulty is almost morally bankrupt. I mean that. It is not just Deputy Ó Caoláin or me saying that; it has been said on all sides of the House over the last number of months. It was said emphatically last Friday at polling stations throughout the country. People want fairness in our health system. When one is rationing health services on foot of the limited amount of money one has to spend and making decisions on who gets services, what one is doing is taking from one to give to the other. That is what is happening here.

To say the under-six provision does not impact on the budget available for discretionary medical cards is not credible. It was stated in last year's Budget Statement that there would be a probity exercise in relation to medical cards to assess the eligibility or otherwise of recipients. That was a coded, polite way of describing the withdrawal of medical cards. It was stated in the HSE service plans for the previous year that there would be a reduction in the number of discretionary medical cards. It is a stated policy of the Government that it will reduce the number of discretionary medical cards. Efforts have been made in the House consistently by the Minister of State and his ministerial colleagues in the Department of Health as well as by the Tánaiste and Taoiseach to assert that there has been no change when it has been stated categorically that there will be a reduction in discretionary medical cards, about which the Minister of State said there was "no such entity". That is as clear as anything.

What is clearest of all is that the Irish people last Friday expressed many views on the Government's policies. The thing they were crystal clear about was their desire for fairness. They want those who need a medical card - those who are dying, have a lifelong, life-limiting illness, are battling cancer or are children with profound challenges - to be looked after first. That is what they said to me. I am sure the Minister of State picked it up also. There is something inherently fair in the Irish people. To announce a grand plan of universality for under-sixes does not camouflage what is happening to those over six. Medical cards are being taken from people at the end of their lives, people with cancer, children with Down's syndrome, men with motor neuron disease, people with multiple sclerosis. That is what has happened here. We have said it time and again, while the Minister of State has asked time and again what my view is on universality. I have said time and again that while I have no difficulty with the concept of universality, it cannot be put before those who most need the support of the State. That is what is happening as we speak today.

A very interesting figure was published with regard to discretionary medical cards, which was that almost 800 were granted in April 2014.

I welcome the allocation of every discretionary medical card. Every one was deserved and, most importantly, was needed. It is interesting that the elections were in May.

We were told there was no change in policy. I welcome the fact that the office of the Minister of State often helped me in pursuing a discretionary medical card, an application, a review or an appeal but the point is that we were told there is no interference. All of a sudden, a plethora of cards were granted in the month of April. I find it interesting to say the least. There were 800 such cards. There was a change in policy and then there was an acceptance that the policy was causing grave anxiety. I am not sure whether the concern was the anxiety of the people or of the candidates meeting people. One way or another, there was an acceptance by this Government, the Taoiseach, the Tánaiste and others that what was happening for the past two years was wrong and unfair.

We are waiting for the Minister of State to come forward with proposals to address the issue. The discretionary system was working fairly well. People say there was disparities between various counties. That is the case and we can argue some counties were overly generous or that some counties were not understanding enough in granting medical cards. I am not sure which it is but discretion is critically important. Over the past number of months, the Minister of State has said that discretion is a grey area and that there are difficulties with it. Discretion is used every day of the week by agents of the State. Children are assessed for special needs assistants and for the number of hours they need. It is discretion when a professional makes a judgment that a child needs two hours, four hours or six hours per week. A public health nurse uses her valued public professional judgment and her discretion that someone needs four, six or seven hours of home help. We do not need a legislative blade that cuts off people from something when they need it most. We need humanity and fairness in the system.

The Minister of State said that granting medical cards on the grounds of illness is a difficulty but I must remind him that it was the stated policy of the Government to grant medical cards on grounds of illness. The first tranche of free GP care was to be for those on the long-term illness scheme. It was a stated policy and I do not see anything wrong with that. I would welcome the Government reversing from where it is, until the nation's finances improve, to grant medical cards to those who need them most first, and as time goes on and as we can expand the economy, we can fund a broader roll-out. Putting it the other way around is morally bankrupt and something I have grave concerns about. These concerns have been expressed in this Chamber and through many organisations that have consistently been saying, for the past two years or more, that a particular issue was causing great concern.

I raised the issue of the withdrawal of discretionary medical cards in January 2013 in the Chamber during Leaders' Questions. A woman who has had a double mastectomy had her discretionary medical card withdrawn. It has been appealed and reviewed but, unfortunately, the woman does not have the medical card. We have raised the issue of children with the most challenging disabilities whose medical cards have been taken from them. All of the families with these major challenges in their lives do not want anything else for themselves. They just want this for their children and are willing to pay for GP care for themselves and for other children. They are quite happy to do so but they want medical cards for their children.

Deputies in this House are on reasonably good salaries and I suspect every Member can afford to pay a GP. However, if something tragic hits a family, we would like to think the State would come in to give some support. Every family thinks the same way. That is why free GP care for children under six years being put ahead of addressing the problem of discretionary medical cards for those who need them most must be addressed quickly. Between now and the debate on Committee Stage, there should be some way of addressing this through the legislative process. Otherwise, the Minister of State should announce the considerations of the Government with regard to addressing the shortcomings exposed over the past two years because of the change in how discretionary medical cards are awarded. That should be done quickly not to satisfy me, but to address the misery and the hardship it causes in our communities.

It affects people but it does not affect all people. It was an issue raised at every second door I went to. There is inherently and innately something fair in the Irish people. If they think they are getting a free GP care cards for themselves or for children under six years when they can afford to go to a GP while a neighbour's child is being denied a medical card, they find it distasteful. Week in, week out, every community is involved in fund-raising efforts at community level, parish level or school level to help a child. That is happening in our communities throughout the country and it is beautiful to watch. People get together and rally around to help someone who needs help. At the very least, the State should be willing to do the same. In that context, will the Minister of State revisit and reverse the policy quickly? It should be done in the context of this legislation.

Reference has been made by the Minister of State and others to the fact that the provisions in the Bill date to the 1970s or the 1950s. The Minister of State says that we must change legislation but that is the purpose of this Chamber. It is within our gift to change legislation and it is within the gift of the Minister of State to propose to the Government to change legislation. The Government can then present it to this House. It is not a major obstacle to change the legislation. In fact, that is the purpose of the debate today. The idea that the Health Act 1970 is a statute that cannot be changed is not the case.

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