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

We will be supporting the Bill. We thank the Minister for bringing it to the House in a reasonably timely fashion on foot of the commitments that were made in the programme for Government and the negotiations in that context. This measure was contained in most parties' manifestos in the run up to last year's general election. However, that is as far as I can go in welcoming it.

This issue must be viewed against the background of what has been the policy on medical cards generally in recent years. The Minister spoke about new politics but often this can mask the fact that people may still be entrenched in their views as to what is right and what is wrong with regard to ensuring people, particularly those who most need it, have accessibility to medical care. Whatever way we decide to fund health services and whatever we decide on universality, we must ensure in the meantime in getting to that point that those who most need health care and the support of the State for access to health care get it first. I have instanced the issues of people who are sick and children with serious illnesses and rolling provision out from that level. The concept in this respect that has been pursued for the past few years has beggared belief. While we still have limited resources, there has been an increase in the overall budget, but we are still rationing health care in the State every day of the week. Somebody has to do without because somebody else gets what they need. Until such time that we get to the stage where everybody can get what they need, we have to make decisions and choices on who gets health care and support from the State in accessing health care, who does and does not qualify for a medical card and who qualifies for general practitioner, GP, services. In that context, when we reflect on an analyse the previous five years, it tells a fairly harrowing story. I point to that because it is important if we are framing policy and trying to get to a stage where there is universality, that we do it in a humane way that is fair and primarily fair to and supportive of those who need it most.

People often talk about equality and fairness but there is a big difference between something being equal and it being fair. We must be honest with ourselves about that and until such time as we get to a stage where everybody can be treated equally we must be fair. We have not been fair to many thousands of people in recent years in terms of access to medical cards. To take the example of the discretionary medical card, eventually a compassionate scheme was put in place but it was beaten out of the last Government. It was incredible to think that week after week following harrowing story after harrowing story, there was an absolute denial that there had been a change in policy. There had to have been a change in policy because the number of discretionary medical cards decreased to 49,000 and the number of them is now more than 100,000 and yet we were told for a long time that there was no change in policy. Children with cancer were unable to access a medical card. Women who were dying of cancer were told that they could not get a medical card. People requiring end of life palliative care could not get a medical card.

We raised these issues in the Dáil time and again. I am not reminding the Minister of this to get at him because he is only in office ten months and I will not hold him culpable, but when we are trying to get to a place of equality let us be fair in the meantime and being fair is ensuring that those who need support most get it first until such time as we have enough resources to give it to the others. That is something I believe was missing in health policy development in recent years with regard to medical cards. The discretionary element was, to say the least, distasteful in how a system, be it a Government or an administration, could preside over something that was heartless and without feeling.

We simply said "No" to people who were dying. Week in, week out, Deputies all across this House, including those on the Government side, raised the issue, yet the whole Administration, the whole system, said there had been no change. Ministers told me there was not even such a thing as a discretionary medical card, that it did not exist, as quoted in the Dáil by the Minister of State with responsibility for primary care.

While we wait for the Committee on the Future of Healthcare to publish its report, while we wait perhaps for a health policy from the Government and while we wait for policies from the various Opposition parties, I ask the Minister to put at the heart of our policy the issue of fairness. If universality is our aspiration or our goal, in the meantime, the pathway must be fair. To decide to target one age cohort over another is equal but not necessarily fair. I have had representations from children and families who are still under huge pressure. They get the exact same as families who can well afford these costs. We must think clearly about this. It is welcome that the legislation to make the domiciliary care allowance available is to come before the House. The targeting of this at children with disabilities is the right concept because it is fair. However, is it fair to give it to everybody else and not to children with disabilities, or to give them the exact same as everybody else? I do not think so.

Regarding decisions to come from the Government, if there are to be any - I do not mean that in a dismissive way - let us be honest that there are no policies from the Government on health. There was a general election last year, there were manifestos and negotiations and there is a programme for Government. However, there are some statements in the programme for Government but no clear, defined policy or vision on health. We do not know whether the HSE is to be dismantled or retained. We do not know whether we are moving to hospital trusts or hospital groups or whether they are all being scrapped. We have no concept of a Government view on health, which is worrying in view of the fact that many people depend on a public health system underpinned by a policy that can in turn be supported by financial means and choices in respect of taxation and funding. We have none of that. Nothing has come from the Government in the past year. Even before last year, policy was chaotic, from universal health insurance to no universal health insurance; from no prescription charges to prescription charges of €2.50; and from marchers on the street saying we will never take medical cards off our over-70s to reducing the threshold from a very high point down to €900 and €500. All these things did happen and they were all opposite to the stated view at the time and the commitments made. At least in this area, the commitment made has thankfully been honoured. This might restore some element of confidence in what one says and what one does, and the public might buy into the concept that we live up to our word in this House.

Regarding the broader issue of prescription charges, there is no doubt that €2.50, to some people, is not a lot, but to the people paying the €2.50 who are on medical cards, it is a huge sum. It adds up at the end of the month to €25, which is a substantial amount of money being one tenth of the old age pension for a week. This is the kind of money we are talking about. We must therefore put things in context. When people are drafting or drawing lines on how much we will charge individuals, they should at least take into account their ability to pay, a very simple, basic concept. However, I am definite that whoever decided to change the charge from 50 cent to €2.50 was not on an old-age pension or a medical card. If he or she was, there is no way he or she would have asked a person on an old age pension to pay €25 per month for prescription charges to avail of medication. The concept is simply not that those who have the most pay the most in the context of fairness as opposed to equity.

When this legislation passes, 33,000 people with disabilities will be on medical cards. I know that the Minister will consistently say the Government is waiting for the report of the Committee on the Future of Healthcare but I wish to raise two issues with him because I want to give my colleagues plenty of time to consider them. The first concerns the long-term illness scheme. We have been up and down on this issue but at some stage we will have to consider an imaginative way of addressing it. I will make proposals as to how this might be done but, in the meantime, the discretionary element will have to be revisited in a more meaningful, compassionate way. I accept there have been major improvements, for which I give the Minister credit, but there is an issue of long-term illness and people with very serious conditions being unable to access medical cards, even conditions which 30 years ago were unknown or at least in respect of which the research was not as readily available.

Negotiations between the IMO and the Minister's Department are ongoing, wherever they are going. I have heard that the National Association of General Practitioners was previously outside the window but is now even further from the window; it cannot even look in now. The reason I raise this issue is that I am of the firm view - perhaps the Minister should go back and check this with his Department - that his Department officials have no interest in negotiating a major new contract, despite the pretence continuing there. They are tinkering around the edges with the old contract.

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