Alex White (Dublin South, Labour) | Oireachtas source

That happened more quickly than I expected. I thank Senators who contributed to this important and interesting debate.

Senator Cullinane of Sinn Féin and the Fianna Fáil Senators are opposing the Bill for the reasons they explained. Those are reasons on which we all have views, one way or the other. However, no one actually made a strong case against the alterations to the eligibility limits. That fact is striking. Senators are perfectly entitled to oppose the Bill for whatever reasons they see fit. I have no objection to that because it is the system within which we work. It is worthy of note that no one, including Senator Cullinane, addressed the core issue with which the Bill deals, namely, the reduction in eligibility limits, nor has anyone, either expressly or specifically, opposed that reduction.

I repeat what I said at the outset that 90% of those who are over 70 will not be affected by the proposals contained in the Bill. When Senator Cullinane was making his contribution, I offered a point of clarification and I take this opportunity to repeat what I said. Certain colleagues are seeking to convey an impression that the Bill in some way undermines - a number went so far as to suggest that it reverses - the Government's approach to universal free GP care. It does nothing of the kind. That argument simply cannot be sustained. Nobody will lose access to free GP care as a consequence of the enactment of this legislation. Anyone who loses his or her medical card on foot of the legislation will be given a free GP card. It flies in the face of both reality and the truth to suggest that the Bill will somehow give rise to a reversal. I understand the other arguments that have been put forward and I will deal with them in a moment. However, I must stress that what is involved here is not a reversal in the context of universal access to free GP care. This legislative provision is neither a reversal nor an undermining of that Government commitment. It remains an absolute commitment on the Government's part that it will extend free GP care to everyone in the community by the end of its term in office.

A number of other issues were raised by different Senators as the debate progressed. Senator MacSharry raised an issue to which reference was made in the Lower House. I know the Senator is aware that it was raised there because he made mention of that fact. The point in question is not a good one because it is not really based on fact and it does a disservice to the debate. I admire Senator MacSharry very much and I value his contribution but it is simply not true to say that the Minister for Health is being given power under this Bill to unilaterally alter the general eligibility limits relating to medical cards without having recourse to the Oireachtas. That is simply not happening. In order to clarify the position for the benefit of the House, I wish to read into the record the provision contained in section 7(5), which states:

The Minister shall, on 1 September of every year, review the most recent information on the consumer price index made available by the Central Statistics Office, and may, with the consent of the Minister for Public Expenditure and Reform, by regulations to take effect on 1 January next following that review, increase or decrease the gross income limits specified for the purposes of this section to reflect any increase or decrease in that index.

This is a very circumscribed power that will be bestowed upon the Minister and it will be based on upward or downward changes in the consumer price index. It is designed to maintain the real value of the eligibility limits. That is all it will do. It will not extend to the Minister a unilateral power to increase or reduce eligibility limits generally. The Oireachtas has the power in that regard, which is quite right. In the case of the Bill before the House, the Oireachtas is being asked to reduce the eligibility limits. That is a power which rests with the Houses of the Oireachtas in the context of primary legislation and it will not be disturbed by anything which is being done in the Bill.

As Senator Gilroy stated, no one - least of all me or anyone else in government - takes pleasure in introducing a measure which takes away entitlements from citizens. We are endeavouring to protect the most vulnerable and to engage in the fairest possible distribution of scarce resources. Those resources are, of course, particularly scarce at present. I understand and appreciate that some Senators object to the Bill and may wish to oppose it. However, it should be opposed on the basis of what it actually says rather than on the basis of what people suggest it says.

A number of Senators referred to the cost of medicines. I completely agree with the emphasis that has been placed on this issue. It is important that it should be addressed. I stated in my initial contribution that it is being addressed and that the legislation on reference pricing and generic substitution, which began life in this House, has passed Committee Stage in the Lower House. The Report and Final Stages of said legislation will be taken in the Dáil in early course. The legislation is extremely important and it was long called for and long spoken about. It has now been introduced by the Government and is undergoing its passage through the Oireachtas.

It meets Senator Crown's point, namely, that the default approach should be generic substitution, but there should be exceptions, for example, where a doctor indicates that substitution is not appropriate in a particular case.

We have introduced responsible prescribing initiatives, in which respect we are working with general practitioners, GPs, and consultants to ensure a more careful and focused approach to prescribing. Professionals in the field will co-operate with these initiatives.

We saw progress in our agreements with the drugs companies last year. They have had and will continue to have an effect. However, a problem remains and must be addressed. One element has seen us commission the ESRI to conduct a comparative study of the price of drugs in Ireland and among our comparators. I hope that the results of this expert study will become available to the Government in the coming weeks. People want the problem rectified, as do I. As a minimum, I want an explanation. This is a matter of considerable public interest and concern. I compliment the journalistic work done in this regard, including that of the Sunday Business Post. Debating the information openly is in the public interest.

On the opposite side of the argument, it has been suggested to me that one is sometimes not comparing apples with oranges. Other countries have different circumstances and do not permit proper comparisons. These may be legitimate arguments, but I want to put my finger on the truth. For this reason, the study will be of benefit to us in seeking to address this issue. I agree with colleagues, in that it should be addressed. It will be.

Senator Barrett referred to the opening up of the General Medical Services, GMS, scheme. He fairly acknowledged the legislation that we passed last year, relatively early in the Government's lifetime. The legislation affords more doctors the opportunity to enter the scheme. The number of participating doctors has increased as a result.

In respect of GPs' earnings, and as they would point out to the Senator, they have already been subjected to a number of reductions in fees under the Financial Emergency Measures in the Public Interest, FEMPI, Acts. My colleague, the Minister for Health, is undertaking a FEMPI process to assess whether it is appropriate to apply further reductions to primary care fees. Certain targets were set in the Estimates process, the outcome of which we need to await. Due process is necessary in the assessment. This issue will also be addressed in early course.

I take the Senator's point on what he described in his usual, reasonably benign fashion as legacy issues in the Department and across the health service, for example, excess costs. I am aware of Mr. O'Connor's recent analysis, to which the Senator referred. Considerable progress has been made on the financial restructuring and reform of the way in which business is done and finances are managed across the system. Given what I know about the changes to practices, I am confident that we will see many results from this process.

In Senator Burke's interesting contribution, he discussed the basis upon which income was to be defined or assessed for eligibility limits. He raised an interesting question on whether the property tax would come into play. The provision on income from property in section 7(7) is meant to prevent an elderly person from being penalised simply because he or she owns a family home or other property, even where no rental income accrues. Where there is rental income, the costs associated with renting out the property are to be taken into account. I will not express an opinion on whether the property tax is such a cost, but there might be a question mark over whether it can be considered a cost necessarily incurred and associated with the rental of the property.