Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister of State to the House and thank her for bringing forward this Bill to introduce GP cards for the over-70s who are beneath a certain income level, which is €36,400 per annum. That is substantial income and the threshold for a couple would be €72,000. Some 36,000 people will benefit from the introduction of this Bill. The scheme will also be rolled out for the under-sixes and the number of people with GP cards will increase from 164,000 to over 412,000, which is a substantial increase meaning that over 46% of the population will have either medical cards or GP cards. We gave a commitment to try to introduce a universal health care system and this is only part of the process because we cannot do it all overnight. The argument has been made, particularly in respect of the under-sixes, that there should be a means assessment but that would have an administrative cost. We are removing administrative costs to a large extent in the way we are rolling this out.

As the Minister said, when the scheme is up and running it will benefit over 800,000 people who are either under six or over 70. There is a cost to this and while we would love to roll out free GP care for everyone, it is not financially possible and we have to use the budget of the Department of Health with care, as the Minister of State and the Minister, Deputy Leo Varadkar, do. We have given a commitment to roll it out for everyone in the long term but it will depend on income and on the taxation coming into Revenue. It is also important that the number of discretionary cards has increased quite substantially. I understand that the total figure is now over 126,000 between GP cards and medical cards, which is a substantial number. In fairness to the Department and the HSE, each case in which a person is over the income limits is being examined and discretion is being applied in a careful manner. While I accept that not all cases which one would expect to go through do so, if a strong case is presented, all of the issues are taken on board. I like it when people raise a medical services issue with me and ask, "Why can we not do this?" It is all about having the finance available. We are spending over €13.2 billion in the health budget, which is a huge budget providing a huge level of services.

The one major challenge we will face over the next 10 or 15 years is the increase in the number of people over 65. At present we have over 585,000 people over 65, which I understand will increase by about 20,000 per annum so that, by 2030, we will have 990,000 people over 65. It is not only about medical care, it is also about pensions and a whole lot of issues we will need to keep in mind in forward planning. Whatever parties are in government - I hope it will be Fine Gael and Labour the next time around - we will have to be mindful of planning expenditure. An additional 20,000 people over 65 means that, by the time the next Government finishes its term in 2021, there will be an extra 100,000 pensions to be paid out. There will also be a certain percentage of people who will need additional support, for example home care, nursing home care or medical care.

While I am talking about elderly care, it is appropriate to bring up the issue of home care and the need to further develop that service. While we have put additional money into nursing home care over the last six months - a welcome development in respect of freeing up hospital beds - in the long term, we also need to plan carefully home care for those who do not want to go into a nursing home. The overall cost in real terms is less than one third of the cost of nursing home care. We must make sure not only that we have an adequate number of people available to provide home care, but also that adequate facilities and training are available. We need to start focusing on this issue and to develop it over the next two to three years. The figure of 580,000 to 650,000 people will not be long growing. In the last six years, I understand that the number of people over 85 has gone up by 20%, which is a significant increase in a very short period. We currently have an average of 3.5 people working for every retired person. If we want to have the same ratio in 2030, we will need to have 2.7 million people working. That is a huge challenge for which we need to start planning.

I thank the Minister of State for bringing forward the Bill, which I fully support.