Phil Prendergast (Labour)

I too welcome the Minister, Deputy Harney, to the Seanad. I will not repeat many of the points that have been made, but there is major concern in certain areas. I too was in the church on the day of the protest and I was struck by how upset people were. I know many other people were too. I join others in saying I was rather horrified at the way in which the Minister of State, Deputy John Moloney, for whom I have high personal regard, having got to know him in his capacity as Chairman of the Joint Committee on Health and Children, was not allowed to put forward his viewpoint. I did not agree with that. People have a right to be heard.

As Labour Party spokesperson on older people, I maintain that the elderly should not be treated as an expense to be contained. We can make trite remarks and comments, but older people, generally speaking, are a lovely group of people. With the automatic entitlement to a medical card, they did not have to worry too much about going to hospital. I will speak a little about hospitals because of my past experience. Hospitalisation for older people is associated with a major cost factor. I am sure that if an analysis was done on the first three days of a hospital stay and then every ten days after that it would be found there is significant cost involved. When somebody is admitted to hospital, as well as all the issues of prescribing and changing medication, he or she is analysed and subjected to sometimes unnecessary interventions such as blood work. This must add considerably to the expense of putting that person in hospital. If the cost of each blood test is added up it will be found that this aspect contributes significantly to the cost of a hospital stay. Sometimes blood work is done in routine fashion although it may not always be necessary. This is an area that should be considered with the aim of achieving cost savings.

Senator Boyle wondered how we might do things. Working in the health service for so long I saw many areas in which there is scope for savings, which would not affect positive initiatives such as cervical screening. This has been shelved recently, to my regret. The extension of the medical cards entitlement to everybody over 70 was a very positive and forward-thinking development. It had a significant positive effect on the health of older people because it allowed them to be monitored and treated for their ailments at home or by the doctor.

My mother-in-law, a lovely woman of 84, was in hospital recently. When she came home she said it was very cold and that she felt the cold much more badly after coming from hospital. She felt her need for heat was increased when she came out of hospital, which was an additional expense. Bord Gáis is looking for a 3.9% increase in the price of gas, while the ESB is flagging a 5.6% increase. The cost of gas has already increased by 20% and that of electricity by 17.5%, while inflation is at 4%. People who worry about heat or are prone to colds find that their confidence has been damaged, whether because they no longer feel they have the safety net of the medical card or because they have a genuine fear that they are not keeping control of their health to the same extent. They are getting sick and being admitted to hospital. This results in a major increase in costs to the Exchequer as well as the follow-on negative aspects of being in hospital. When their confidence is gone it may not return for quite a while, if ever. I hate to say the word but we must consider the danger of being put in hospital. Older people are being put in a place which is frequently over-crowded and in which they may be prone to being infected with MRSA or other conditions they did not intend to get when they went into hospital. This results, again, in significant additional costs. Thus the automatic entitlement to a medical card was very positive. It allowed people to be at home and to retain their input into their health. It was lauded everywhere as being the right thing to do.

Based on the figures released by the Government, the medical card entitlement for the over 70s had a positive impact on health and took pressure off the acute hospital and nursing home sectors. It was felt that it did not make sense, from an economic or public health point of view, to press ahead with the abolition of the automatic right. That was also the view of Age Action Ireland, which went on to say it challenged the Government to reveal whether it has factored into the estimated savings the increased number of older people who will need to be hospitalised or to go into full-time nursing care as a result of the curtailment of the medical card scheme. Age Action Ireland also made the point that this measure, which has made a major contribution to people's health, was being abolished for the sake of saving less than €20 million. It felt the Government should have considered doctors' fees, the cost of prescriptions and the possibility of using generic drugs.

There is major scope within the health service to consult the people who are at the coalface. We should consult nurses, care assistants and doctors who treat people at the coalface. There is not much point in asking administrators or people who do not know what it is like. Sometimes when a person comes to a doctor or a practice nurse, all he or she wants is a little bit of time. They might not need treatment. Confidence is a major issue for older people. They do not like to have the rug pulled from under their feet in any sense. The removal of the entitlement to a medical card was a retrograde step. The automatic entitlement should remain. I am sorry that has happened.

I admire the fact that the Minister has come into the House. Given that I worked in a hospital for so long, when I met my former colleagues they wanted to know what it was like up here. I was amazed at the frequency with which I had met the Minister through this House and that is to be welcomed. I hope she will listen to some of what is being said. There could be an opportunity sometime to engage positively with people on the ground. I recall the Minister's visit to South Tipperary General Hospital. It was a lovely occasion and it was to celebrate the expansion of the services, even though they were being reduced. It would have been nice for the Minister to sit around the table for a cup of tea or coffee with the staff and ask them how they would run their departments if they had the budget and how they would make sure quality is maintained. The Minister would find that the service would be managed very efficiently. Staff who administer care would allow for the unexpected and we would have a very efficient health service.