Frances Fitzgerald (Fine Gael)

I welcome the Minister of State to the House. I regret that we must discuss this ill thought-out legislation because of the Government's failure to see the error of its ways. This Bill more than anything else has taken away the peace of mind of our elderly citizens, who contributed hugely to this society and who hoped to have the peace of mind that the medical card offered. The Minister of State acknowledged that increasing age often brings increased ill health and reliance on medical services.

There is no doubt that the decision by the Government to introduce the medical card for everyone over the age of 70 was a poorly thought-out political stroke. It was badly negotiated by the Government on behalf of the taxpayer, with the result that it was expensive. However, it turned out to be a significant support for our elderly population. It gave peace of mind to people who were on the verge of entering nursing homes and provided critical support in terms of access to services such as physiotherapists and GPs and to necessary medicines. It helped people to stay in their own homes. There is increasing evidence to indicate that withdrawing it at this stage will tilt the balance towards institutional care rather than care in the community.

Faced with increased costs, elderly people will decide against visiting their doctors or reviewing their medication. They will be cautious about putting their health first because they will have less money. The elderly person with bronchitis or a bad cough, who will not attend a GP to be prescribed antibiotic treatment, may end up being admitted to an accident and emergency department.

The Bill defeats certain aims of Government policy, such as the supposed focus on community care and keeping people out of nursing homes. In regard to the cost implications, I have no doubt that the Government would save money by leaving the medical card in place. Additional costs will be created through nursing home fees and the greater expense of institutional care and hospital beds. This is a short-sighted measure, therefore.

It is ironic that the Minister of State stated that almost everybody will retain their medical card. Where are the savings if that is the case? Savings could instead be made in drug schemes and through negotiations with GPs. Eamon Timmins of Age Action Ireland expressed his extreme disappointment at seeing the Bill being pushed through the Dáil yesterday by Fianna Fáil, the Green Party and the Progressive Democrats. He stated:

I find it hard to believe that politicians can ignore what was an unprecedented show of force by older people against the withdrawal of automatic entitlement. All the arguments are against the measure — the economic argument, the public health argument, and the weight of public opinion.

That is the view of an organisation which is in close contact with the elderly.

I spoke previously in this House about universal benefits. This is not about benefiting the wealthy, it is about making sure that people's needs are met by the State's services and that the Exchequer makes up in other ways the shortfalls in funding. Those who have the greatest needs are guaranteed services. Fine Gael supports universal health care because it is better at meeting the needs of our citizens than any other system.

When this proposal was made in the budget, there was widespread panic and confusion among older people, their families and their carers. The subsequent U-turns which introduced a variety of medical eligibility criteria only added to their concern. What is the Minister of State's estimate of the savings that will be made by taking the medical card from this group of people? Has the broader issue of institutional care been considered? Where will this attack on universality end? This year, it is the medical card for older people, but what will be next, given that the principle has changed?

The generation who will be hit by this Bill comprises people who contributed constructively to Irish society. A savings exemption is being introduced, but a couple who took out insurance policies may breach the exemption if one partner dies, even if the insurance money was intended to pay for nursing care. As long as such people remain in their homes, they will lose their medical cards because they have set aside money for nursing home care. It is short-sighted to catch out the people who have tried to make independent provision.

I have set out the reasons my party opposes the effort to remove the medical card from older people. Issues also arise in respect of the bureaucracy that will be needed to administer the new arrangements. It is difficult to know the Minister of State's precise intention for the new means test for older people who have to reapply for cards. What exactly will they be asked to do? Will they have to write a letter outlining their position or complete a simple form, and how does that differ from the current means test? There is much concern and anxiety about this and people are very worried about losing the card.

I spoke to people who have expenses for GPs, medication, incontinence pads, occupational therapy, physiotherapy and outpatient visits. These people, who may be retired teachers or public servants, may be just over the limits as set out. The costs they will have to face, as outlined earlier, may well be a deterrent to getting the kind of care they need, and they will be put in a much more vulnerable position. Will the Minister of State clarify what exactly the people will be required to do and the type of form they will be required to complete in the new year?

I will comment on how the legislation is being dealt with. It was rammed through the Dáil yesterday and guillotined. It is very unsatisfactory that we have had so little time to consider the debate in the Dáil yesterday and the various points that were made. A number of constitutional points were made about the changes to the legislation and the impact of taking the card away, for example, from a widow or widower after three years. That is the Minister's attempt to ensure people are not left in a dreadful plight when one partner dies.

If this legislation was dealt with normally, there would be time for the Minister to go to the Attorney General, look at this issue and come back to inform the Seanad of the findings. I assume the Minister of State does not have any more legal advice in this regard. If she has more information on the issues raised yesterday, she might share it with the House. As it is not in the script, I assume there is no new legal information.

Serious points were made yesterday in the Dáil about the declaratory principle, which, as I understand it, was brought in for the first time. Neither my colleagues nor I had heard of the declaratory principle being used as a reason to exclude a Minister from having to report to a House about developments in legislation. I assume it was used yesterday by the Ceann Comhairle under legal advice and the Bill was then guillotined. We are in the same position today as the legislation is on Second Stage in the Seanad. There will be a half hour break to put down Committee Stage amendments and then it will be rushed through again.

I can understand why the Government would want to rush the legislation.