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

In the few minutes I have available to me, I want to make a small number of points. First, it is wrong that Members of this House who are not in parties or the Technical Group should have to fight for time. I very much recognise the fact that the Ceann Comhairle recognises that our group, the others, should have entitlements. I wish this principle were recognised by the Government Whips.

This morning we are debating proposed amendments by the Minister and an instruction to the committee. As a Member of this House, I have not been provided with any documentation relating to the procedure under way. There is a serious problem with that. It is believed everything is done through the Whips but it is not. My colleagues in the “others” group and I should be entitled to the same notice and documentation on proposed business in the House as everyone else.

I have no difficulty with the amendments being proposed and I am happy to support them. However, there has been and continues to be overemphasis on nursing home care. Many patients who are in nursing homes, at considerable expense to the State, should not be in them because their level of dependency does not warrant full-time nursing home care. This should not be happening. More important, we know the vast majority of older people want to stay in their own homes and do not want to be in institutional care. They want to be in their own surroundings and that is what we should be trying to facilitate because it is in their best interest from both health and welfare perspectives. Of course, the difficulty is that there is not adequate financial support available to older people who want to stay in their own homes. Equally, there are insufficient services. This is where primary care is required. We should have a sufficient number of public health nurses. There are large numbers of vacancies in the public health nursing services at present. We also need the allied health professionals, including physiotherapists, occupational therapists and speech and language therapists, who help older people to make a recovery after an incident, return to the best state of health possible and continue to live as independently as possible. This should be the focus of health policy in this regard. I am concerned that we depend too much on nursing homes.

With regard to medical cards, it is regrettable that the amendment to section 6 that Deputy Naughten and I tabled was ruled out of order. I question that decision and wonder where the impetus for it came from. It was ruled out of order on the grounds that it constituted a potential charge on the Exchequer. There may have been a potential charge on the Exchequer but there would only be an actual charge if the Government in power decided to make it a charge. The charge is not something that the Opposition is proposing, therefore, nor is it something it or this Dáil would have any control over. There would be a charge on the Exchequer only if the Government decided to avail itself of the opportunity. The point of the amendment is to facilitate the Minister in extending access to general practitioner care as he or she sees fit. It was a mistake not to do what we propose. It indicates the absence of an overall plan. Despite the Government's statement that it intends to extend general practitioner care across the population within its term of office, there is clearly no phased plan to do so. If there were, the Government would welcome this opportunity to extend access by ministerial order rather than having to return with primary legislation on each occasion it wanted to extend care.

It is very odd that the Government is opposed to that.

I would like clarity from the Minister in regard to what is happening to the proposed initiative for under-sixes. What happens when children who are now, say, five and a half reach their sixth birthday? They will be getting their birthday cards but will they be getting their GP visit card removed when they get to their sixth birthday? It is not entirely clear from the legislation. Is it the intention that, when a child gets to six, this entitlement will be removed? How exactly is it proposed to do that? It seems extraordinary that when somebody happens to reach the arbitrary age of six, he or she will no longer be entitled to free GP care. This needs to be clarified.

There are a couple of serious outstanding questions that need to be answered. I would also appreciate clarification on the decision by Government to reverse the withdrawal of discretionary medical cards. Why exactly does the initiative only go back to 1 July 2011? I would like an explanation of that because it is not clear why that date was selected. What about those who are in need of discretionary medical cards at this point, and from now until whatever date in the future that this or some future Government decides to introduce entitlement to a medical card based on medical condition? It would seem that the same kind of unfair treatment that was meted out to people in recent years in terms of the withdrawal of their discretionary medical card is now going to be meted out to people who will be seeking discretionary cards in the coming 12 months or more. It strikes me that it is not legally sound to treat people who are in similar circumstances in a different manner by virtue of the fact of an arbitrary date, before or after that date. There are many questions still outstanding in this regard.

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