Tom Fleming (Kerry South, Independent) | Oireachtas source

I welcome the proposed Bill. Senior citizens have taken a significant hit, first, in the Health (Alteration of Criteria for Eligibility) Bill 2013 in respect of medical cards. It is estimated that as a result of the enactment of that legislation, up to €12 million per annum has been saved at the expense of the most vulnerable section of our society. Statistics show that older people make more use of their medical card than the general population. The statistics also demonstrate that more older people are being admitted through emergency departments. New figures from the HSE show that there were almost 7% more emergency admissions of persons aged 65 years and over compared to January last year. The performance overview for January shows that there were considerably more older patients with complex medical needs who required longer stays in hospital. At the end of January, there were 729 delayed discharges of patients who had finished their acute care treatment but required alternative care.

Figures also indicate that 94% of people over the age of 70 years visit their GP on a regular basis. They have a high intake of drugs to help them to cope with their above average rates of illness and disability. Some are on four to five medications of various type for complex problems at any one time. They are further burdened with several overheads such as water charges and property tax, while there has been a lessening of reliefs in terms of household bills and fuel allowances. These issues are also resulting in a certain deterioration of their living standards.

There is huge concern about the current review of the fair deal scheme. There are indications of the Government's intention to pass on additional nursing home costs by imposing a charge after the death of a vulnerable older person for any community-based service that he or she needed. These disturbing proposals were recently broadcast on an RTE "Prime Time" programme. Part of the unpublished review of the nursing home support scheme prepared by the Department of Health and the HSE was quoted on the programme. The options included increased State investment in the scheme or an increased contribution by those resident in nursing homes. This has caused great alarm and huge stress for people concerned about their future. It seems the options for an increased contribution by nursing home residents include reducing the income disregard threshold in means testing; increasing the annual charge on a person's asset from 7.5% to 10%; increasing the number of years over which a person would pay a percentage of the value of their home, currently 7.5% per annum for three years; and increasing the percentage payable of a person's disposable income, currently 80%, to be contributed by those with income above the amount of the State pension. The report also recommends that consideration be given to charging for community-based care, with the charge to be imposed on a person's estate after his or her death.

The way in which the nursing homes support scheme charges the sickest of older people for essential care is fundamentally unfair. No other section of society is required to pay from their disposable income, additional assets and a portion of the value of their home towards their care. This is very draconian and the feedback I am getting indicates that it will be vigorously opposed in its current format. I ask the Minister of State at the Department of Health, Deputy Lynch, who is a very fair and sympathetic person, to have considerable input into the proposals that are currently in the public domain. We are getting some information on it by way of leaks at the moment but what has come out publicly on RTE on the issue is very disturbing for people. The rumour machine is revved up now, making a bad situation even worse. Will the Minister of State give us some clarification regarding the scheme tonight?

The existing charging structure is already causing hardship for older people. For example, the older person whose only income is the State pension is left with €46 per week after the fair deal charges are deducted. The so-called fair deal only covers basic bed and board and does not cover any other costs such as therapies, including physiotherapy or chiropody, specialised wheelchairs or other equipment, haircuts, shampoo, etcetera. While the entitlement to a public bed exists in other parts of the health system, the introduction of the nursing homes support scheme in 2009 extinguished the right to a public bed in a nursing home, so that older people who need around the clock nursing care are left with a choice of either signing up for the fair deal or paying the full fee privately. Although the scheme has only been in existence for six years the charges have already been increased. The range of increased charges proposed in the Department of Health's document suggests a lack of understanding of the basic inequity of the scheme. There is a belief that this inequity can be increased even further to the disadvantage of that cohort of people who are most seriously affected. These people are sick and frail. We all know that there are many sensitive situations out there and it is unacceptable that these people's means can be tapped into once more.

I received correspondence recently from a concerned person which I want to put on the record of the House. The letter of appeal reads as follows:

My wife, who is sixty seven years of age, suffers from Alzheimer's and has been a resident of a nursing home for the past five years. For that length of time I have been contributing to her upkeep under the fair deal system. My monthly contributions amount to approximately €2,200 per month, after which I am left with barely enough to survive on myself. This is after working for forty six years in an industrial factory and at a time when, after retiring, I had hoped I could look forward to some independence and self respect in my old age. Now, in recent days, there are reports that we may have to pay more. In God's name, what type of heartless, uncaring people come up with these ideas? Do these people realise the worry that this causes to the elderly people who are already struggling to make existing payments? Where are we going to find the money? Are we going to be stripped of the last vestiges of self respect in our old age, having to pay more and arriving at a situation where we have nothing left to give? What will happen to us and our partners then? We have free public hospital care for all, yet our elderly are stripped to the bone. It is not fair and it is not just. I know I am not alone in this and there are many others in the same situation as myself. I am certain that they would really appreciate your support on this issue and any efforts that can be made to ensure that the people with the power to make a decision understand what is happening in the real world.

That is an appeal from the heart from a person who is really feeling the brunt and who has fears of worse to come. There are many more people in that category and I ask that the Minister of State, Deputy Lynch, the Government, the Department of Health and the HSE give very serious consideration to the plight of people who are vulnerable and who have given their lives to this country and to their communities. I ask that they be given due consideration and that there would be a complete rethink of the proposals revealed by RTE recently.

Today general practitioners held a protest in Molesworth Street to highlight the fact that the GP sector is in crisis. It is evident that we need high quality GP services and general practitioners are doing their utmost in difficult circumstances. The elderly people of whom I have been speaking, who are faced with sensitive health problems and who are facing the prospect of going into a nursing home or are already resident in one, need high quality medical care. From the day they are born until the day they face eternal rest, people need the comfort and care of a GP. However, the GP sector is under severe pressure, as illustrated by the document circulated to the media and public representatives today. The annual GP training scheme has only 157 places but a recent survey has shown that only 25% of current GP trainees are planning to stay in Ireland after graduation. A full 50% of the trainees said they were "unsure" if they will stay, while 12% said that they would definitely emigrate. It is estimated that overall, 47% of Irish GPs do not work in Ireland which is the highest figure among OECD countries and compares with a figure of 6% in the UK. In a recent survey of 1,055 GPs, 50% said that they had considered emigrating in the past 12 months, with 35% saying that Australia would be their country of choice. These highly qualified people are a very valuable resource. They received their education and training at a very high cost to the State, their families and themselves. It is very disturbing to read such statistics in that context. It is obvious that this category of doctor is under severe pressure.

The National Association of General Practitioners, NAGP, argues that the Government continues to alienate GPs by failing to ensure the maintenance of a safe and effective GP service with a coherent strategy for growth. The plan for free GP care to selected groups - those under six and over 70 years of age - will remove more private income that has, up to now, provided an essential GP practice support. It will lead to a threefold increase in consultations, resulting in shorter consultation times. This in turn will lead to a three to five fold increase in admissions to secondary care, that is, emergency departments and acute hospitals, as GPs will not have the time available to investigate properly and manage patient problems.

I am of the view that those in question are justified in their petition.

I ask the Minister of State, Deputy Kathleen Lynch, to take the various matters to which I have referred into account. The Bill will cause a huge increase in the number of those over 70 years of age who will have doctor visit cards. The latter is going to become the norm and it and other matters will have to be taken into account in the future.

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