Éamon Ó Cuív (Galway West, Fianna Fail) | Oireachtas source

Tá áthas orm deis a bheith agam labhairt ar an rún tábhachtach seo. Tá go leor le plé.

The first decision we must make collectively is whether we want a proper health service and then we must decide if we are willing to fund it. Choices are made and sometimes the choice is to reduce taxes. At other times, the choice is made to improve services. We must be conscious as money inevitably becomes available that rather than promise next year's tax cuts, as is already happening, we should have a rational, adult debate as to what we need to do. I am not talking about people on €38,000 to €40,000. If one reduces the top tax rate by 1%, it helps a person on €1 million a year a lot more.

Before we start doing top-of-the-head budgets, we must decide if we require more money to provide a health service. I am sure that the Minister of State and her Department are convinced in their hearts and souls that they can require efficiencies in services. Given that there are human being running the health service, however, it will never be fully efficient. We must recognise that while we must make things as efficient as humans can make them, a flawless service where everyone turns up every day and is motivated will never exist. Therefore, the Department must plan how to get the best service given the real human beings who run it with all their differences and the issues that arise and then ask if it has enough money on that basis to run it.

It is becoming clear that we have not put enough money into health. There is no cheap way of doing health. Every country in the world is facing a challenge in regard to people's expectations of health services versus the budgetary requirements. I am not saying there should be an infinite budget, but we must have a rational and reasonable debate about this as a society. I believe we can make different choices to those we are making. I remember saying many times when we were in government that no matter how much money one had, one would find a good way to spend it. No matter how much one is given, one's budget is finite. As every budget is finite, one must make choices no matter what state one lives in.

One issue that is a question of choice involves the nursing home subvention scheme. Currently, there is a 16-week waiting list from the time one gets approval to the time one goes into payment. One can take it that there will have been a lapse of eight weeks from the time a person went into the nursing home to the time he or she obtained the approval. Very few people get the approval to go into a nursing home before they go there. In many cases, something happens which means a person must enter a nursing home suddenly. That can mean a total wait of 24 weeks as I saw in a recent case. Every few weeks, one is notified of a case involving the wait for nursing home subvention. Nursing home care can cost up to €1,000 per week. Even if a person has a pension of €200, €700 must be found in cash. Over a 20-week period, that amounts to €14,000. Over a 24 week period, it is €16,800, which is a great deal of money. It is serious money to pay while waiting. This scheme is unique in a particular respect. Social welfare payments are backdated to the date of application but nursing home subvention is not even backdated to the date of approval.

The Minister of State might ask where I would get the money to do away with the waiting list. If there was a finite waiting list of a couple of weeks, while people would not be happy, at least it would be controllable. I would get the money by suspending the provision of GP cards to every person aged over 70 years. I would leave the limits which have been set in place. How much can GP services cost a person who has a €100,000 pension in one year? Even if one went once a week, which would be a lot of visits to make, it would only amount to approximately €3,600 at €50 to €60 a visit. That is not a great deal of money by comparison with the kind of bill I am talking about, which can run to €24,000 or €25,000 gross. Even if one set one's whole pension against the nursing home fee, it would still run to €16,000 to €18,000. Very few people visit the doctor every week. If one were that ill, one would probably get a medical card on health grounds.

The other scheme I would suspend is the proposal to give GP cards without means testing to everybody under six years old. I have grandchildren in that age group and am aware of what children need. A normal healthy child who does not have a disability or underlying health issue may visit a GP five or six times a year. If he or she has a disability or health issue, he or she should be given a card on medical grounds, but we are talking about a universal giving away irrespective of income. If a child visited the doctor four or five times a year, it would amount to €240. While parents are currently feeling pressure, it is nothing like the €16,000 to €25,000 pressure we are currently imposing on older people. By definition, all of these older people are means tested in respect of the nursing home subvention scheme and, as such, have been determined to need the support. Therefore, they are digging into something to try to come up with the money.

It would take a little courage to do one of the things that can be done. I note that according to the Department's own projections, there will be a little extra funding due to the diversion of €25 million from getting people out of hospitals earlier. That will have a €10 million effect and will cut the list in the short but not the long term. I share the Minister of State's concern about the following and acknowledge that it is unlikely she will be allowed to stand up and give her real thoughts on the issue. Whereas I welcome the €20 million for disability, I note the effect of demographic pressures and cumulative cutbacks. There was a point at the beginning where savings were being made and services were being slimlined that needed to be. I accept that. However, there comes a point where there is no more flesh and the cut is being made right into the bone.

I note that €20 million is not enough. I have always felt that we have not recognised the challenges people face where a member of a family has a disability. Families make huge sacrifices and need very good support services. People with disabilities are not ill but rather require continuous support. They have a lifetime to live and it is very mean to impose cuts on their sector. It will be very important to determine how much money we need to provide adequate services taking demographics into account. I would like to know the true figure. We know we have more people with disabilities and, thanks be to God, that they live a lot longer due to medical improvements. Extra money is not in fact extra money. It is the cost of standing still. The provision of €20 million will not ensure that services remain at the same level. I would be very interested to hear the Minister of State's thoughts about that.

While it is not a matter directly under the remit of the Minister of State's Department, I note a proposal I have made previously which I would still like to see being implemented. I proposed at one stage the restructuring of domiciliary care allowance and disability allowance.

The savings achieved from this restructuring should be moved to the domiciliary care scheme. An allowance should be provided until the age of 18 years but no 16 year old should receive payments of the magnitude of disability benefit. I would use the savings to provide a top-up to the domiciliary care allowance in the two years before children commence school. This would allow parents to purchase additional services.

We refer repeatedly to early intervention. The savings to which I refer could be recycled to deliver early intervention. This creative and constructive change could be implemented over a period without having a budgetary effect. It would, however, put to better use the overall funding available for this type of care.

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