Fergal Browne (Fine Gael)

I welcome the Minister to the House and congratulate him on his appointment as Minister of State at the Department of Health and Children. His appointment was welcomed in Kildare although it is a point of contention that we in Carlow-Kilkenny got no Minister. However, it is the new Minister's moment of glory and I wish him well in his new job. I hope he will not forget about Carlow.

This motion is very appropriate. I am glad the Government parties are not querying the need to do something in this area. It should be borne in mind that people on the minimum wage will not qualify for a medical card. That is the bottom line. I accept the point Senator Glynn makes regarding people being back at work. However, we all see people in our clinics who are barely outside the eligibility criteria for medical cards and we also fight cases for them. Most are subsequently granted a medical card. Unfortunately, some are not. Many people are put off and do not bother applying because they do not realise they can apply for one based on medical condition if their income is in excess of the strict financial limit.

A married couple with an income of €206.50 a week who are under the age of 66 cannot qualify for a medical card. If someone on an income of €206.50 a week needs to go to a doctor — the going rate in Carlow is at least €45 — then to a pharmacy where the cost of drugs will be at least €40, and make a return visit to the doctor at €45, the total expenditure is at least €120, more than half their income. That is the real issue.

As a public representative it annoys me when people who have had a medical card for years are cut off for some reason and must go through the whole process of applying for a new medical card, arguing their case, invariably on medical grounds. They are then granted a card, but months will have elapsed and in the meantime they will have amassed huge medical bills and have wasted the health board's time because the staff in the health board must deal with an issue they should not have to deal with. I ask the Minister to ensure that if somebody with an ongoing medical condition has a medical card it is renewed automatically. It would save everyone time and effort and ensure people do not run up expensive bills.

I had a case in Carlow recently of a constituent who has severe medical problems, whose daughter has only one kidney and also suffers major medical problems, failing to qualify for a medical card. I was successful in arguing a case for them, but they endured months during which they did not have a medical card and ran up huge bills in the meantime. That should not be allowed to happen. One message I hope the Minister will take away from this debate is that people with an ongoing medical condition which has been proven and who have a medical card should not be forced to apply for a medical card every year. It is unnecessary.

The Government's record on health is atrocious. I welcome the appointment of Deputy Harney as Minister for Health and Children. The previous Minister, Deputy Martin, did not do his job. He fudged every issue he could. He commissioned report after report but did not enact many of their provisions. All he did was write further reports on the reports. I hope that when the new Minister gets up to speed in the Department she will take decisions and implement them. Her predecessor did not do so and we are suffering as a result. I hope the Minister will not commission any more reports. We have plenty of reports. I am sure the Minister of State must have shelves of reports in his office which he will never read. I hope that all the reports that have been written will be implemented.

In 1997 and in 2002, a clear promise was given by the Government to increase the number of medical card holders by 200,000. It is appalling there are now almost 100,000 fewer card holders. That is even more remarkable when one considers that in the meantime all people over 70 years automatically qualified. There is no doubt that many of those people deserve to have a medical card. However, there are many people over the age of 70 years who could afford private medical care and do not need a medical card. That is a big difficulty.

I urge the Government to give careful consideration to giving medical cards in respect of children under four years of age. Based on my experience with my nephews and niece the difficult period for children seems to be between birth and four years of age. After the age of four years, children tend not to get sick as much. When they are older they might fall out of a tree and break a leg but that is an occasional mishap. Invariably if there are three or four children in a family and one gets sick there is almost a guarantee that the other two or three will also get sick. It puts a huge strain on families if they have to go to the doctor with three or four children, to the pharmacy for drugs and then to the doctor for a repeat visit. The Government should, therefore, consider giving those under four years of age a medical card and prioritising medical cards for the elderly who have an ongoing medical condition. Those who need medical cards most should be targeted. I am terrified of a free-for-all system. With respect to Dr. Michael Smurfit, as he is over 70 years of age, he would be entitled to a medical card. All Members will agree that he does not need it as much as a woman with a family on the minimum wage. Anomalies in the system need to be addressed.

The national health strategy, published in 2001, promised an investment of over €1 billion in primary care yet three years after its publication only €16 million has been spent. The Department only refers to ten pilot projects when 600 primary care centres were promised by 2012. Badly needed funding for primary care is being withheld until 2007. This morning my local radio station held a discussion on medical cards where the point was made that last year income levels were not increased. Another disastrous decision that the Minister must take into account is that of former Minister for Finance, Deputy McCreevy, who raised the threshold level for the drug refund scheme. While the medical card threshold has remained the same, accident and emergency charges and the drug refund scheme threshold have increased, a double slap in the face.

Yesterday's ESRI report on health provides food for thought. It claimed medical card holders only attend their GPs 6.6 times a year, validating Senator Ryan's point about the misconception that they go to the doctor every day of the week. People in private care attend 3.5 times a year. This indicates that the cut-off level is wrong. People are harming themselves by not going to the doctor because they cannot afford to do so. This has a knock-on effect on absenteeism from work which IBEC recently highlighted. I urge the Minister to increase the threshold level for medical cards and consider giving cards to all under four year olds. Those on the minimum wage must qualify for medical cards. Those who already hold medical cards, and whose medical circumstances have not changed, should not be forced to renew their applications. It is unnecessary and time consuming for everyone involved.