Róisín Shortall (Dublin North West, Independent)
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I thank the Minister of State for coming to the House to address this topic. Apart from housing, the loss of medical cards for those over 70 years is the main issue that I am dealing with in my office at the moment. I imagine this is probably the case for most other Deputies as well. I need not remind the Minister of State that following the elections in May the loss of medical cards was identified as the number one reason why the Government took a trouncing. All of the attention seemed to be focused on the loss of discretionary medical cards and a decision was taken to restore them. However, what was not highlighted at the time and what is one of the biggest problems relating to medical cards is that the income limit for those over 70 years has been cut so drastically.

The Minister of State will recall that for a number of years up to 2008 everybody aged over 70 was entitled to a medical card. When the then Minister for Health, Ms Mary Harney, announced she would introduce an income limit, there were huge protests. The leaders of the main Opposition parties at the time, Deputies Enda Kenny and Eamon Gilmore, were on the platform at a protest on Molesworth Street supporting the pensioners and they decried the fact that income limits were being introduced. However, they were introduced and they worked reasonably well in so far as they were set at a level that enabled the vast majority of the over 70s to retain their cards. Approximately 5% of medical card holders lost theirs as a result of that decision.

That was fine until last year when the Taoiseach and the then Tánaiste, Deputy Gilmore, supported a proposal in the budget to cut the income limits for those aged 70 again to €1,200 per week for a couple and €600 for a single person. That was bad enough, given it kicked in in April 2013, but a second cut was announced in last October's budget, which meant that in less than a year the income limits were cut twice. That resulted in a cut of €500 per week for couples and this has had a drastic impact on access to medical card cover. Members are dealing with this every day. The major difference in the income limits for those aged over 70 and those aged under 70 is gross income is used for the over 70s and no consideration is given to the medical or other expenses they incur. They are inclined to have significant medical conditions because of their age.

A great many of those in their late 70s, 80s or 90s are put through the mill in medical card reviews. They receive calls to provide information on their financial circumstances with many of them told they have exceeded the income limit and they will lose their medical card and, instead, be awarded a GP visit card. That is a poor consolation for an elderly person who needs access to community services because the medical card is the passport to such services, including public health nurses, physiotherapy in the case of somebody who has had a stroke, speech and language therapy, which is also important for older people, and home helps. These are key services in enabling people to remain in their homes and out of nursing homes.

What is going on makes no sense whatsoever. It is wrong that the Minister of State is doing this to elderly people, many of whom are extremely ill. It also makes no sense from a financial point of view. The system needs to be changed.

Kathleen Lynch (Cork North Central, Labour)
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I am glad the Deputy has raised the issue because she understands it well given she was centrally involved in the review system and what we were going to do with primary care. I will not use the official script because she understands the issue so well.

The income limits involved are €500 per week for a single person and €900 for a couple. Nine out of ten people aged over 70 have either a GP only card or a medical card. I am glad the Deputy raised the question of access to other services and the passport into other services. We are examining how to separate access to community services, which the Deputy was involved in at the time. This is where we need to go to develop a proper community-based primary care system that does not require someone to have that passport in order that if someone needs access to a community service, it should be available or if he or she needs medical aids or appliances, they are available. Access to physiotherapy, including intensive rehabilitation, and so on should not be dependent on having a medical card.

Nine out of every ten people aged over 70 has access to a GP free of charge and their drugs bill is only €33 a week. The Deputy is correct that at this stage in life, people will more than likely have a chronic condition, even though people are living longer and are healthier, but they can still apply for a discretionary medical card where all the circumstances she outlined are taken into account and they will be treated in the same way. If one's needs are such that one cannot provide for oneself in respect of medical bills, one will be looked on favourably for a discretionary card. In reforming the system, we need to take a serious look at how people access the services they need because it is not always about access to a GP or drugs, it is also about access to community care services. That is what we need to build up and that is what we are doing now.

I thank the Deputy for raising the issue and I am glad it is her who did because she understands it perfectly.

Róisín Shortall (Dublin North West, Independent)
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Even in the worst days of the recession, we managed to retain the existing income limits in 2011 and 2012 and it is difficult to understand how three Ministers in the Department could allow two substantial cuts to take place. That was disgraceful at a time they were talking about improving access to medical services, especially for people with medical needs.

The Minister of State referred to the GP visit card. It is not of much use to those aged over 70 because they still face substantial drugs costs and the issue is ensuring access to community services. She said nothing in her reply that indicates that work is being done in this regard. If work is ongoing, people should at least be permitted to retain their medical card until an alternative system is put in place.

Proper access for people needs to be ensured. The Minister of State said that if somebody loses a medical card, he or she can apply on discretionary grounds. Over the past few weeks, I have dealt with several people who have serious medical conditions. I am dealing with one couple in their 80s. The husband is in hospital and the wife is dealing with her own medical conditions. They are expected to find supporting evidence for a new application. They have been told to apply using the under 70s income limits. Rather than people in those circumstances being put through the mill and expected to produce all this documentation while their cover has been removed, the Minister of State should at least introduce a system, if she is not going to ensure net income is used, whereby the medical expenses of those aged over 70 are taken into consideration. That is the key issue. If a person has substantial medical expenses, there should be a way to take them into account while considering their application using the over 70s income limits.

The application of income limits currently is too rigid. They are applied on a gross basis and there is no room to consider medical expenses. The Minister of State is causing huge hardship to people at a time they feel vulnerable and have serious medical conditions. It is wrong that she is putting so many elderly people through the mill like this. I ask her to give this issue her urgent attention.

Kathleen Lynch (Cork North Central, Labour)
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This is getting not just urgent but ongoing consideration and it is being worked on. There is a great deal of work to be done but we are working on this continuously and it is considered an urgent issue.

Despite the fact that we have been in the teeth of a recession, more people hold medical cards than ever before.

Róisín Shortall (Dublin North West, Independent)
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Not in the over 70s age group.

Kathleen Lynch (Cork North Central, Labour)
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Let me tell the Deputy about those aged over 70 years. As of 1 September 2014, the number of people aged over 70 holding a medical card stood at 332,872, of whom 5,078 held discretionary medical cards. Some 23,542 people aged over 70 years had a general practitioner visit card on 1 September, of whom 628 held discretionary medical cards. It is not the case that the system is not working, although I accept that it needs more tweaking. We are working on the system.

The number of people with a medical card is higher than ever owing to the recession, unemployment and increased life expectancy. For this reason, we had to spread the resources available to us more thinly. People have the option of applying for a discretionary medical card and all the issues raised by the Deputy can be taken into account in the application process. Welfare officers have been instructed to help people who are applying for discretionary medical cards.