Frank Feighan (Fine Gael)

I welcome the Minister of State to the House. I wish the Tánaiste well in her new role as Minister for Health and Children. She faces a very difficult task. In light of what has gone on in recent years, the confidence of the general public and the health boards in the health system, while not at an all-time low, is very low. Without playing politics, the Opposition hopes that something can be done to instil a new confidence and that health will not be such a serious issue when we meet people on the doorsteps or in clinics.

Politicians should not have to involve themselves in such cases. Health care professionals and managers are paid enormous amounts of money and it is sad when people find the health system has let them down despite the billions that have been invested. They have to come to my constituency office to ask me to make representations regarding medical cards or waiting lists, which is wrong. As politicians, the sooner we can divorce ourselves from this system the better. Unfortunately, the health system is the way it is.

I have always found the Tánaiste very honest in her approach. While I have not always agreed with her, I have always found her to be very honest and pragmatic. She tells it as it is and I respect that in a Minister. However, she will find it very difficult to measure up to the promises made in 2002. As politicians we should not make rash promises. A rash promise was made to increase the number of medical card holders by 200,000. I know people have mentioned this again. It is quite obvious that the number of medical card holders has reduced by 46,000. This is driving constituents crazy because they simply do not have medical cover.

The income ceiling for eligibility for medical cards has increased by a mere 8% since May 2002. While we welcome the 46% increase in the drugs refund scheme, unfortunately, charges for accident and emergency treatment have increased by 42% and the nightly cost for a public bed has increased by 36%. I am single, I get a nice salary as a Senator and would not consider myself to be on the breadline. While I regard myself as being quite measured and am not a devil may care person, I would put off a visit to a doctor if I had a cold as it costs €30 to €45. There is also the increased costs for prescription drugs. Sometimes it can cost up to €80. If I were a father with two or three children earning just over the ceiling for medical card eligibility, I would end up putting my children at risk as some people do because they cannot afford doctors' fees. This situation is seriously wrong.

The percentage of the population covered by the scheme has fallen from 31.24% in January 2002 to 29.43% in January 2004. It has been mentioned that the CEOs of the health boards have discretion in allocating medical cards in cases of hardship and medical need. Their discretion is limited by the budget of the health board for which they work. The CEOs of health boards often act as if they own the health boards. Although I have never served on a health board, I do not doubt that officials in the health system are sometimes almost as powerful as those who are elected to represent the various constituencies. When politicians make representations to CEOs — those who make the decisions — they may be told that funding is or is not available. If one has served on a health board and one's relationship with the CEO is okay — if one knows him well — one will get a much more favourable audience than that given to others, such as Senators and Deputies from Opposition parties and county councillors.

Allowing the relevant Minister to have a say is also part of the system. Politicians should be divorced from the health system but — this is where the contradiction comes in — the system is run by politicians, unfortunately. It is operated by people who have not delivered and are primarily interested in covering their own jobs. I wonder if the changes in the health board structures will help to change the current jobs for the boys system. That is another day's work, however.

Children under the age of four should receive medical cards automatically. I do not think there should be a limit on funds in such cases. Similarly, cancer patients should receive medical cards as a matter of course. Some cancer patients who have called to my office have told me about their fight to get a medical card. A person who is going to hospital for cancer treatment, such as radiation, should receive a medical card automatically. Given that most cancer patients go through a traumatic time, the Government and the health boards should ensure they are given medical cards.

We are all in it together. This is a serious situation. I wish the Minister for Health and Children, Deputy Harney, well in trying to get through the morass she faces. Any success she will have in her new Department, which has been referred to as Angola, will be a fair achievement.