Tim O'Malley (Limerick East, Progressive Democrats)

I thank the Senators for their contributions to this debate. Regarding the 80% charge mentioned by one or two speakers, this is a maximum of the old age non-contributory pension that can be deducted. There is flexibility in this regard.

Senator Henry raised a point about flexibility regarding the doctor-only card and expressed concern over whether patients would have a choice of doctors. Patients will have a choice; the arrangements will be the same as those for the medical card scheme. I am not pleased to see some politicians placing advertisements in the newspapers advising people to go to clinics for this matter. This practice politicises the issue and does not help the situation. I was unaware of these advertisements until I came into the Seanad this evening.

I agree with Senator Mooney that the Government is trying to respond in a humane manner to a problem that has been before successive Governments for 29 years. This extremely important legislation represents a symbolic gesture to the over 70s and we must get it right.

Senator Henry referred to a recent newspaper report about psychiatrists who are appointed and left for months or years before getting a team or accommodation. This is the first time the matter has been brought to my attention but it worries me. It is a waste of expensive resources if the consultants' management fails to put in place working facilities and registrars for them. Senator Henry gave an example of someone who did not have an office or secretarial staff for several months after being appointed. It is extremely disappointing that this could happen in this day and age, especially when Comhairle, the Government and the HSE appointed these people.

The Government has introduced this Bill to establish a sound legal basis for the policy of requiring some contribution towards the shelter and maintenance of people with full eligibility in long-stay institutions. The issue has been put beyond legal doubt after nearly 29 years as the Supreme Court has confirmed that it is constitutionally sound for the Oireachtas to legislate for this policy. The other matter addressed in the Bill, the introduction of a doctor-visit medical card, is a major step in ensuring that people of low incomes will have access to GP services and advice. Senator Mooney referred to the evidence that many people, particularly mothers of young children, are just above the limit for a medical card and have problems if there are illnesses in their families necessitating several visits to doctors in the space of a month.

It is important that the Government has taken this decision to allocate GP-only medical cards. The general public and the future recipients of these cards welcome them as they will be a consolation for many families, especially those with young children. It has always been a problem that children are struck by illness most often. A mother may unexpectedly be at home with two or three sick children, which can cause undue hardship for families. I do not view this as a generic or yellow pack card, as some have called it. It will be extremely significant in helping many people and families.

The HSE was established to administer the health services on a national basis and will be in a position to commence the introduction of these cards as soon as the Bill has been enacted. It is a long-standing feature of our system under various Governments over 30 years that most people in publicly-funded long-term care should make some contribution to the cost of their care. Quality care is expensive and the bulk of the cost must be borne by the Exchequer alongside these contributions. The quality of care provided in many public nursing homes and what were formerly called workhouses, now public institutions, is far superior to many of the most expensive nursing homes. It is wonderful that successive Governments have raised the standards and it is a tribute to the care and diligence of the nurses and doctors involved. I am sure Senators agree with me.

The income foregone by the HSE for as long as these charges cannot be raised is estimated to be in the region of €2 million per week. Even if one does a quick sum and agrees with Senator O'Toole on reducing that figure by 10% to 20%, the amount lost to the State will be sizeable. However, there is flexibility in the scheme and the HSE will have the right to waive charges.

A statutory framework that puts the long-standing policy on a sound legal footing and safeguards the income generated from this source is vital. The provisions of the Health (Amendment) Bill 2005 will secure this source of income, which has been an essential element to the funding of our health services in the past and must remain so. The introduction of a doctor-visit medical card is the most efficient way to help a significantly increased number of people to access primary care. It is in line with the commitment contained in the health strategy to ensure that the allocation of medical cards is on the basis of prioritising the groups most in need and is intended to benefit approximately 200,000 people. Those who speak about the percentage of people on medical cards are missing the point. If those who use the services most are prioritised, it is right that the Government proceeds with this and gives GP-only cards to young families, as they will benefit the most.

I will respond to some of the points made by a number of speakers during this debate. Concerns have been raised that the percentage of the population covered by the medical card has declined in recent years. It must be recognised that this is attributable in large measure to the economic success Ireland has enjoyed, which has reduced the need of many people for State support to meet health care and other living costs. The Government's objective is to ensure that the people most in need have a medical card rather than simply achieving coverage of a certain percentage of the population or issuing a specific number of medical cards. In order to give effect to this targeted approach, changes to the income guidelines expected to result in the issuance of an extra 30,000 medical cards in 2005 have recently been introduced by the HSE at the request of the Tánaiste. This is in addition to the doctor-visit cards, which will be introduced subsequent to the passage of this Bill.

The Department will ask the HSE to keep the medical card's revised income guidelines under close review to ensure that the Government's policy decision on the extra 30,000 cards is delivered upon. I emphasise that there is no question of the Government seeking overtime to reduce the number of standard medical cards in favour of issuing increased numbers of doctor-visit cards. This initiative is intended to complement the existing arrangements that have been in force for many years. Several Members of both Houses were under the impression that the Government has taken the decision to change the former full medical card into the doctor-only card. The Government has taken a conscious decision to make this an add-on.

The Department of Health and Children has recently written to the interim CEO of the HSE to formally indicate that the Government's objective in introducing this initiative was to enable in the region of 200,000 medical cards to be issued in respect of general practitioner services. The Tánaiste wishes to have the necessary administrative arrangements in place to enable the new cards to be issued from April onwards.

The HSE has been requested to have the necessary preparatory steps taken and operational guidelines developed, such as will enable applications for doctor-visit medical cards to be accepted as soon as possible after the enactment of the relevant legislation, and the cards subsequently issued to persons who meet the relevant criteria. It is important to emphasise that with the establishment of the HSE, the administrative arrangements for this card will be operated on a standardised basis across the country.

The Department has written to the Irish Medical Organisation to notify it formally of the Government's decision regarding doctor-visit medical cards and of the provisions of this Bill. It has also indicated that the HSE has full operational responsibility for the delivery and funding of all health services and that it is the appropriate body with which the IMO should deal with regard to the introduction of these cards.

I wish to reiterate that while the HSE intends initially to set the income threshold for the doctor-visit cards at 25% higher than applies for the standard medical card, this threshold will, if necessary, be reviewed in the light of experience so as to ensure that the desired number of cards are issued to those intended to benefit under the initiative.

The Bill will bring clarity to the issue of charges for long-stay care where it is clear there has not been a sound basis for the practice going back almost 30 years. The legislation will also ensure that the income flow from charges imposed to date will remain secure and continue to support and continue to support the provision of quality services to those in long-term care. I am pleased that none of the major parties have registered any difficulty with the principle involved here.

The introduction of doctor-visit medical cards is a supplementary initiative which will enable some 200,000 additional people from lower income households to attend a doctor free of charge. This will help to overcome barriers to assessing general practitioner services for many individuals and families who are above the standard medical card income guidelines. I thank all the Senators for their contributions.