Frances Fitzgerald (Fine Gael)

I thank the Minister for coming to the House and for the willingness she shows to debate the topics of the day. It is appreciated.

The Government made a political choice to deprive the over 70s of a medical card. There were many options on the table, but for some reason that was the decision the Minister made. We have seen the response of the people, who certainly do not agree with it. Given the statistics provided by the Minister today, she has effectively told us that she has made these changes to the medical card for a saving of €20 million. I think I am right in saying that the other changes could have been brought about anyway. For example, the change in capitation for GPs was negotiated by the former Minister for Health and Children, Deputy Micheál Martin, who has stayed very quiet on all this. What stopped the Government from changing that deal in the past few years and saving the amounts to which she referred this morning? I could ask a similar question about drug charges.

I appreciate that the proportion of the population that is elderly is increasing and that the Minister is looking at projected ongoing costs. I find it strange that since the Government has made four or five changes on entitlement, the savings figure still remains the same at €100 million. It seems that those savings are being made in areas where change could have been brought about anyway.

It is regrettable that the Minister had to come to the House today to debate this issue because the Government insisted that the priority was to protect the vulnerable and the elderly. Providing a right just before the general election in 2001 and withdrawing it as soon as times get tough does not sit well with me or with the Fine Gael Party. I think the Minister has seen that it does not sit well with the public. We have seen mass meetings in churches, radio station phone lines have been jammed with concerned callers and 15,000 people protested outside the gates of Leinster House. We have seen an extraordinary reaction from the public to the decision that was made. There have been apologies from the Government and I am sure the Minister will admit that the decision caused incredible confusion, upset and distress. It really was a new low for this older group. The Government obviously made a number of changes since then.

I want to raise a number of questions regarding the shift away from universality because I do not think the Minister had any political mandate to move from universality on this benefit. In the general debate, there has been a striking lack of discussion on the philosophy behind universality and the benefits it brings not just to those who access health services but to society as a whole. Does the Minister agree that the means testing system can prove both inefficient and burdensome? What will the cost be of means testing the 20,000 or so compared to the entire group? One of the Minister's goals is to reduce bureaucracy in the HSE. She wants to reduce administration and move to frontline services. How many people will have to be employed on the administrative side to police this system? Who will administer it and how many extra officials will be dealing with it? What is the timeframe for sending out these forms?

I want to discuss preventative medical care. The Minister commented on elderly people attending a GP four or five times a year, but that refers to healthy people over 70. In the course of this debate there has been strong evidence based on research in this area, which is a cornerstone of the Minister's work, that if one improves community care services, thus keeping people in their own homes, it lessens the burden on hospitals and nursing homes. We have all seen this happening in our families. The medical card represented a door to those services for many people. It made the difference between allowing people to remain at home instead of availing of expensive accident and emergency or other hospital services. That research became evident during the course of this debate.

What will the cost be of the extra numbers of people who end up using accident and emergency units because they did not call to their GP for an antibiotic for a bad cough which developed into pneumonia? We know that money is tight for many older people so what will the cost be of such accident and emergency attendances or inpatient admissions?

The Minister said she will bring out a simplified medical card means testing form for the over 70s. Will she give the House more details on this? What will appear on this form and what will be omitted? How will these forms differ from those for the under 70s? The Minister said there will be a simplified form, but can it be simplified for everyone? At this stage, it is not clear what she is planning in this regard.

The Minister says she will introduce legislation, but the measures are not in the Social Welfare Bill. Will she clarify when that legislation will be introduced and what it will contain? I assume that the three-year automatic entitlement will end. Will that be in the legislation?

Will the Minister clarify where the savings will be made? At the beginning, she said the scheme covers approximately 140,000 over 70s who are medical card holders. It was estimated at the beginning that 15,000 people would change their cards, 85,000 would lose the full entitlement but would have a doctor-only medical card, 25,000 would lose all entitlements but would be in receipt of a €400 grant and 15,000 would lose all entitlements. That would enable the Government to save €85 million by recouping the cost from GPs, but will the Minister explain how she will end up with €100 million even though the dynamics of the scheme have changed as a result of the pressure that has been brought to bear on it? Why could the savings from GPs not have been achieved to begin with, rather than targeting older people?

A number of people have attacked Deputy James Reilly for his role in negotiating the contract for the over 70s, but I consider this to be a complete red herring. The reality is that the then Minister for Health and Children, Deputy Martin, negotiated the deal with the doctors. The Government signed up to it without ensuring that the public and the Exchequer got the best possible deal. It should be acknowledged that this was the Government's error, not Dr. Reilly's.

On many occasions, the Minister has said that people such as herself and retired judges should not receive a medical card when they reach 70, but that ignores the debate on the benefits of universality. She says she thinks the majority of people agree with her, but questions have been asked as to whether people with substantial means apply for medical cards anyway. There is a question mark over that point. Does the Minister have statistics on that issue and do we know the costs involved? It would be interesting to know the answers.

Age Action Ireland and the Senior Citizens Parliament do not agree with the changes the Minister made. In discussing that 5% we need to debate the impact of universality. The Minister may have seen an article in The Irish Times entitled "Should there be universal access to State benefits?" One of the points made in that article about universality was that the debate is not merely about hard statistics, cost take-up and outcomes. Given the amount of waste there has been following a range of Government decisions, one must ask again whether this money could have been saved elsewhere. The article went on to state that it is about investing in social capital. It made the point that the economies of countries, particularly the Nordic ones, that have invested in social capital are extremely good. Universality gives middle and higher income groups a sense of tangible benefit from the taxes they pay.

International research shows that means tests reinforce a sense of exclusion, stigmatisation and intrusiveness. Although it may not be an issue regarding the medical card scheme, very often when means testing is introduced the people who should be getting this service do not get it because they are excluded. There is a sense that services for poor people become poor services. The response on the street was a call for universality for the over 70s.