Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister of State and join my colleague in wishing him well during the next seven days. It is important to place on record the figures relating to medical cards. I have consistently stated - I will continue to say it - that since we entered office in 2011, the number of medical cards in circulation has increased by over 217,000, from 1.73 million to 1.951 million. The Bill before the House deals with a particular group of individuals, namely, those under six years of age. Many members of the medical profession have stated that they do not understand why people who have very good incomes should receive free GP services for their children. However, there are many individuals who are caught in the middle in this regard. I refer to those who are working, who do not earn large incomes and who do not have the benefit of a medical card. People with two, three, four or five children are caught within the tax net while not receiving the support they require. I have encountered families that have had a bad run of luck whereby two or three of their children may have become ill at the same time, and that has proven to be expensive for them.

It is in this case that the legislation will be of benefit, which is important. It is also important to realise we have worked out the net cost of this provision. There are already quite a few children under six who benefit from medical cards in any case. Approximately 60% of children do not have free medical services provided to them. We are talking about including them in the equation to ensure they will have access to adequate health care.
I am not disagreeing in any way with the Bill but believe we have changed slightly in respect of prescriptions through the imposition of a nominal charge. We did so because there was a problem with people getting a lot of medication and not necessarily using it. I wonder whether we shall be asking in the House in a few years whether there should be a nominal charge for going to the general practitioner.
We reviewed a large number of medical card holders and the outcome was that four in 100 were to be removed from the scheme because they did not fulfil all the criteria. The other 96% still had to go through the process. The big problem general practitioners have raised with me at a number of meetings, both as groups and individuals, concerns the amount of administration and paperwork they are now doing. It is consuming a considerable amount of time. The time general practitioners have to devote to examining health issues has been greatly reduced as a result. I am concerned that there could be circumstances in which people will go to their general practitioner with the slightest cough. I was talking to an individual recently who overheard a medical card holder in a shop stating she had taken her child to a general practitioner and got a prescription and medication. She was asked how the medication worked but she replied that her child was fine and that she did not bother giving it to him. However, this required a general petitioner visit, the issuing of a prescription and the collection of that prescription, thus incurring a huge cost. The lady went through the process for reassurance rather than anything else but it was interesting to note how the cost arose. It is in this context that I am making my point.
Overall, I welcome the Bill. It represents a good move. There will be a benefit for working, taxpaying families on a very tight budget. If they have a bad run of luck, they will have difficulty in gaining access to the medical services they require. That is what this Bill is addressing. I welcome the decision by the Minister to bring forward this legislation.
Let me touch on section 6. I have been considering this issue in a different context, namely in regard to the transfer of assets under the nursing home scheme. As the Minister knows, I have been very involved in this matter for over ten years. I have been examining the matter from a legal perspective over the past six months. It relates to the qualifying criteria that apply when somebody has assets. Strangely, if somebody becomes unwell, different criteria apply. I am open to correction and am not asking the Minister for an answer today. I will probably be reverting to him on it. There is a cut-off point of three years in regard to the contribution to nursing home care. If one has a gradually worsening illness, such as MS, and ends up in a nursing home because one needs a full-time carer, there is no upper limit on the number of years for which one must contribute. The problem this is causing for a family on my books is that, on the basis of an income assessment, the contribution will have to be made ad infinitum until the patient passes away. This is causing great difficulty for the family because the income now being generated from their asset, a farm, is not sufficient to support the family who have taken over the running of it. This is unfair. I have a question over the constitutionality of it.
We are now amending the section. I see where the Department is coming from. It is a technical amendment requiring the transfer of assets afterwards. However, it is the current legislation that I am concerned about. There is a discrepancy causing difficulties. A very small number of families are affected but extreme difficulty is caused for them. There is a cost to the State because nursing home costs are working out at roughly €50,000 per annum per patient. Where there is income, there has to be an appropriate contribution, obviously, but in some cases the contribution required is excessive and makes it difficult for families who are trying to run and generate an income from the family business or farm. This is just one of the problems that has arisen.
Overall, I welcome the Bill. I hope general practitioners will be brought on board in regard to the implementation of this service. We need to be conscious of the amount of administrative work, however.
Let me touch on what was said by Senator MacSharry, who has raised some important points. I do not agree with the report in The Irish Timesand the comments of the OECD on the consultant issue. There is a strange set of circumstances regarding the interpretation of consultants' salaries here.