Máire Hoctor (Tipperary North, Fianna Fail)

I have listened with interest to the contributions of Senators and I thank them for their participation in the debate. As I indicated at the outset, with the enactment of the Bill, persons aged 70 and over will have three gateways to a medical card. First, under the new gross income limits, we expect 95% of persons aged over 70 will qualify because their income will be below the new, high limits of €700 a week for a single person, or €1,400 for a couple. Second, persons whose gross income is above the limit may still apply for a medical card using the standard net income means test that applies for persons aged under 70. That takes account of personal circumstances such as high outgoings on nursing home fees. Third, under the discretionary medical card arrangements, a person may still apply for and be granted a medical card if his or her health circumstances cause undue hardship. Many persons with a terminal illness, for example, are granted medical cards, even if they do not qualify under the means test.

As has been pointed out during the course of the debate, the objective of the General Medical Services, GMS, scheme is to ensure the medical card benefit is available to those who are unable, without undue hardship, to meet the costs of health services for themselves and their dependants. In the current difficult economic climate, the Government has decided that continuing to provide automatic entitlement to a medical card for all persons aged 70 years and over, irrespective of means, is not sustainable. The new arrangements proposed in the Bill will deliver on the Government's dual objective of prioritising the provision of medical cards to those most in need while at the same time achieving a more financially sustainable scheme for persons aged 70 and over. The Bill will help to ensure 19 out of every 20 persons over 70 will continue to hold a medical card.

Persons who had attained 70 years on 31 December 2008 and had full eligibility on age grounds will continue to have full eligibility as long as their gross income does not exceed the specified limits. Those limits are €700 gross per week in the case of a single person, excluding any income from savings or similar investments whose principal value is €36,000 or less, and €1,400 gross per week in the case of a couple, excluding any income from savings or similar investments whose principal value is €72,000 or less. Persons in this cohort will be required to self-assess and, where they conclude that their gross income is in excess of the specified income limits must, by 2 March 2009, make a declaration to the Health Service Executive, HSE, to that effect. That answers the question asked by some speakers about the procedure for persons whose income is in excess of the threshold. I understand letters will go out early in the new year to that effect. All persons in this cohort can continue to use their medical card as normal during the two-month period up to 2 March.

In the case of persons who attain the age of 70 on or after 1 January 2009, they will have to make an application to the Health Service Executive and provided they meet the income, age and ordinary residence criteria, they will receive confirmation from the HSE that they have full eligibility and will continue to have full eligibility as long as their gross income does not exceed the limit. In line with the Government's commitment, income will not be imputed from property and only the net rental income, calculated as gross income less any costs necessarily associated with the rental of the property, will be included for the purposes of the Bill.

I wish to deal with specific points raised by Senators in the debate. Senator Fitzgerald was the first to speak on the issue and she referred to Government policy. She was correct to do so as it is our intention to support persons to remain at home for as long as possible. We cannot but recognise that fact. Since the introduction of the free medical card in 2001, many supports were put in place to provide care in the home for persons in need. A total of 11,000 persons benefit from home care packages. Some 53,000 persons avail of home help.

We must recognise the fee structure for general practitioners had to be changed. Speakers failed to refer to the fact that the population has increased and that the cohort aged over 70 will increase dramatically in the coming years. For example, within two years we will have 13,000 additional persons over 70. According to the figures on which we have based the legislation, 95% of them will avail of the over 70s medical card free of charge. A fee of €640 for GPs was not sustainable. In fairness to GPs, they recognised that. They said to me personally that the situation could not continue.

Senator Fitzgerald inquired what would go next in regard to universal entitlement. Assurances have been given by the Government that the universal benefit such as the household benefits package will remain intact for those who continue to avail of it under the social welfare scheme. That commitment will hold for as long as Fianna Fáil is in Government. We will stand by it.

Senator Fitzgerald inquired also about the savings that would accrue following the enactment of the legislation. Senators on the other side of the House questioned the Government's ability to deliver on the savings originally outlined in the budget and sought clarification, which I am happy to give. As outlined previously, under the new arrangements it is expected that 95%, or 19 out of 20, persons aged over 70 will continue to have medical cards. It is estimated that this will result in a saving of approximately €20 million in 2009, taking account of GP capitation fees, drug costs and superannuation.

With regard to the single GP capitation rate, the Government appointed Mr. Eddie Sullivan to make recommendations on a new single annual capitation fee, to be paid to general practitioners in respect of medical card holders aged 70 and over. Mr. Sullivan recommended the single capitation fee of €290, which will come into effect subject to the making of the proposed legislative changes from 1 January 2009. Mr. Sullivan's recommendations were accepted by the Government on 29 October 2008. Mr. Sullivan estimated this would generate savings in the order of €16 million in 2009.

I disagree with my colleague Senator Callely who suggested there was an erosion of these figures. I must state emphatically that there was no erosion of the figures announced originally. The Government believes there is potential for significant savings of at least €64 million in drug costs without compromising on patient care. Accordingly, it has decided to establish a process under the chairmanship of Dr. Michael Barry to develop recommendations for good practice which will secure safe and effective prescribing for patients while maximising the potential for economy in the use of public funds. The initial report from Dr. Barry has been received by the Department and is being considered.

Senator Prendergast referred to callousness and suggested the Government was creating hardship for older people. I remind her, as a fellow Tipperary woman, that the HSE in south Tipperary rightly takes great pride in the fact that it has the highest number of home helpers per capita in the country, particularly among those over 70. I laud the HSE for this because it has operated a very good home help system. Home help staff seem to be much more available in south Tipperary than in most other places, where it is sometimes difficult to get people to provide a home help service regularly.

I remind Senator Prendergast of a remark by her Labour Party colleague, Deputy Liz McManus, who, in November 2004, stated, "If any millionaire, whether tax paying or not, is over 70 years of age, they automatically qualify for the medical card. This is an obscenity when compared to the experience of ordinary hard-working families."