Seanad debates
Wednesday, 9 March 2005
Health (Amendment) Bill 2005: Second Stage (Resumed).
7:00 pm
James Bannon (Fine Gael)
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The Tánaiste and Minister for Health and Children, Deputy Harney, is going around the country for photo opportunities which are worth nothing. The Minister would be better occupied in ensuring that help lines are fully manned. This matter has been raised by members of the public including the elderly who have complained in my clinics that help lines are mismanaged. Elderly people who dial a helpline number get confused because they must wait quite some time to receive guidance or obtain an appointment. It is extremely frustrating for them. The Minister should ensure that such services are properly constructed before establishing help lines.
The Minister has been pretending to open health services throughout the country. However, in the midlands in particular, there is evidence that facilities are promptly closed once she has left. Photo opportunities are only worthwhile if what has been promised is delivered upon. On this legislation and on other issues, I want to see action from the Minister, not false smiles. People want the Government to provide proper health services. Recent surveys have shown that health services have deteriorated since the Minister took office.
James Bannon (Fine Gael)
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The closures may suit the Minister and may go some way towards shoring up the mismanagement of health service finances but they do not suit the general public. I am referring in particular to the people of the midlands, as the Leader of the House is well aware.
Rory Kiely (Fianna Fail)
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The Senator will have to conclude because other Senators are offering.
James Bannon (Fine Gael)
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I did not think my two minutes had elapsed.
Rory Kiely (Fianna Fail)
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I have been very generous to the Senator who has spoken for more than two minutes. I call Senator Leyden who has ten minutes.
Terry Leyden (Fianna Fail)
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I may not avail of the full ten minutes, a Chathaoirligh, because so much has been said about this issue. Now is the time for action more than words.
Terry Leyden (Fianna Fail)
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Nevertheless, I welcome the Bill which is belated; part of the legislation has been overdue since 1976. I welcome the extension of doctor-only medical cards which is an innovative move by the Minister. It will allay the fears of many people who are deeply concerned about the cost of attending a general practitioner. Eligibility for the new card will be based on the current limit plus 25% or 30%, depending on the number of people coming into the system. Approximately 200,000 people would be eligible for this medical card, which is to be warmly welcomed, although most people would prefer the full general medical card, which has been of great benefit to so many families. I strongly recommend that the means test attached such medical cards is considerably increased because it has not kept pace with the cost of living. I have brought many such cases to the attention of the health boards over the years.
The Travers report which was published today will be debated tomorrow. Therefore, I do not intend to go into detail on it at this stage given that there are many aspects to it. However, in summary, the question posed was whether a person with a medical card had full or partial eligibility under the 1976 regulations. This was the crunch issue. I have been aware over the years that health boards withdrew medical cards from residents of welfare homes under their jurisdiction on the basis that they were being well cared for there both medically and physically.
Moreover, all the patients whom I visited in public welfare homes in the Western Health Board area when I was chairman of it were cared for in the most diligent manner by the staff of those institutions. The level of service was far higher than anything which could be provided in the private sector because of the staffing situation. A number of these patients feel aggrieved that demands for refunds might be made by relatives of theirs who might not have visited with them. Nevertheless, that is the law because the Supreme Court has made a decision in this regard.
The State must repay the money, particularly to the people concerned, with a heart and a half rather than half-heartedly. It should not pay the money grudgingly. Last week I was in contact with the Health Service Executive on a number of occasions, the telephone numbers for which, for the information of Senators Bannon and Finucane, are very easy on which to get through. I received an assurance that the application form would be redesigned, which point I raised last week with the Leader. The form which was provided referred to "a client" or "on behalf of" an applicant, whereas, quite a number of residents are eligible to apply themselves, a point they made clear to me when I met some of them at the weekend. They are applying directly to the executive for a refund of the money.
James Bannon (Fine Gael)
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This issue has been mismanaged and has caused a great deal of confusion to the public. Does the Senator agree with me?
Terry Leyden (Fianna Fail)
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The people concerned are themselves seeking refunds of payments taken over a number of years. The money will be placed in their accounts. We must bear in mind that dormant accounts are held by the health boards on behalf of thousands of patients whose estates had a question mark over them in respect of the identity of the rightful claimants. Much of this money will be paid into these estates because many of the patients will not be physically able to spend the money which is being returned to them.
When I was chairman of the Western Health Board, I made the point that there is not enough activity for patients of public nursing homes. A system should be put in place so that those who are active are allowed to have an annual holiday to get away from the institution. The health board has buildings on the west coast in Connemara and Clifden which could be made available for a two week period. It is simple to organise such a trip and one would not need too much money to pay for it. I hope that some of the money which is returned will assist these people in enjoying the remaining years of their lives in care.
There has been a cynical exploitation of this issue by certain lawyers advertising on radio, particularly on Shannonside Radio.
James Bannon (Fine Gael)
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The Senator should name and shame them.
Terry Leyden (Fianna Fail)
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I have heard two companies from Athlone which I have no difficulty in——
Rory Kiely (Fianna Fail)
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The Senator should not be provoked into naming anyone by Senator Bannon.
Terry Leyden (Fianna Fail)
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I know the Cathaoirleach would not permit me to play the tape recording from Shannonside Radio and I would not dream of doing so.
James Bannon (Fine Gael)
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The Senator is keeping us up to date with the local news.
Terry Leyden (Fianna Fail)
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However, the tape contains the name of two companies in Athlone which are asking people to come to them to apply for something for which they are eligible to apply for themselves — they do not need a lawyer. Furthermore, there has been exploitation by certain Fine Gael public representatives in Longford-Roscommon who have called a public information meeting on illegal charges on 21 March. An advertisement for the meeting in the local paper urges people to log their claim and promises details on the illegal charges imposed on persons in long-term nursing care between 1976 and 2004. All the details are published and this behaviour is exploitation of this issue. The public is entitled to apply through their public representatives.
Terry Leyden (Fianna Fail)
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It is not a question of competition between one Fine Gael Deputy or Senator and another.
Rory Kiely (Fianna Fail)
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Senator Leyden, without interruption.
James Bannon (Fine Gael)
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On a point of order, the Senator referred to one Senator in the constituency of Longford-Roscommon.
Terry Leyden (Fianna Fail)
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I did not refer to Longford-Roscommon at all.
Rory Kiely (Fianna Fail)
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That is not a procedural point. If memory serves me, the Senator did not mention any particular area. He mentioned a Senator. Senator Leyden without interruption.
Terry Leyden (Fianna Fail)
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Apparently this great meeting is taking place and, according to the newspaper, a "John Kerry" will appear, who I presume refers to Deputy Perry, the former chairman of the Committee of Public Accounts.
Rory Kiely (Fianna Fail)
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The Senator should not mention the names of persons outside the House.
Terry Leyden (Fianna Fail)
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There is a typographical error in the notice. It means to refer to Deputy John Perry not John Kerry.
Rory Kiely (Fianna Fail)
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Deputy Perry is not a Member of this House.
Rory Kiely (Fianna Fail)
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Members of this House cannot be referred to in their absence.
Terry Leyden (Fianna Fail)
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A young Deputy from Roscommon, Deputy Naughten of Fine Gael has——
Rory Kiely (Fianna Fail)
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I told the Senator not to refer to Members of the Lower House.
Terry Leyden (Fianna Fail)
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I was challenged by Senator Bannon.
Rory Kiely (Fianna Fail)
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It is I who will decide what is and what is not in order. I told Senator Bannon he was out of order.
Rory Kiely (Fianna Fail)
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I am telling Senator Leyden that he is out of order.
Terry Leyden (Fianna Fail)
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The Cathaoirleach will not allow me to play the tape either.
Throughout the country, Fine Gael Deputies and Senators and lawyers are abusing the unfortunate situation which has arisen. The Government will deal directly with the patients themselves. It will be in contact with them because it has the records, facts and figures. If there is a dispute in regard to these people's estates, there will be a question to answer about who is eligible to collect the money.
James Bannon (Fine Gael)
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I am glad the Senator is acknowledging that the Government is robbing the elderly of this country left, right and centre.
Rory Kiely (Fianna Fail)
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I call on Senator Bannon to allow Senator Leyden to continue with his contribution.
Terry Leyden (Fianna Fail)
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The Government will deal in an efficient and effective manner with its liability and responsibility with a heart and a half rather than half-heartedly.
James Bannon (Fine Gael)
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What has the Government done for the past seven years? Shame on it.
Mary O'RourkeTerry Leyden (Fianna Fail)
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We do not need Fine Gael Deputies and Senators around the country engaged in a sordid campaign of exploitation. The Government will honour its commitment. The same Deputies who are complaining seem to be those who are promoting all the good the Government has done in the constituencies in the form of a guide to people's entitlements for 2005. However, these people complain about what has been achieved by the Government, while exploiting what it has contributed.
I commend this detailed report and hope we can discuss it more fully tomorrow. Let us get on with the business. There will be a considerable cost to the State. Each case should be addressed on its merits. We must take responsibility on this issue. It is regrettable and will cost a considerable amount of money — possibly up to €2 billion — but we have a responsibility to those patients and we must honour it, open the vaults and provide the money.
Mary Henry (Independent)
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It was a wise move for the Cathaoirleach to call me. While I realise that the Department of Health and Children is very busy and complex, we have seen an example of the most extraordinary maladministration within the Department. If one could feel that this was the only area in which there was the problem, I would not be quite so concerned. One could consider that this was one specific topic which was not addressed well or examined carefully enough over a very long time. However, there seems to be a serious lack of diligence in the running of the affairs of the Department which costs Irish taxpayers a considerable amount. While I know of the concern of the Minister of State, Deputy Tim O'Malley, for people with mental illness, it frequently seems to affect such people or, as in this situation, elderly people.
Members may have read in yesterday's The Irish Times a report concerning Dr. Aisling Denihan, a consultant psychiatrist who carried out a survey of 89 recently appointed consultants in psychiatry to ascertain the status of the job. I heard her present the same information some months ago and I am glad it is now coming into the public arena, although I found it profoundly depressing. She consulted 89 of her colleagues and, according to the report:
. . . she was nine months waiting for an office and clerical support after she was appointed as a consultant psychiatrist for older people with the former North Eastern Health Board in January 2003. "It was a full nine months before I could start accepting referrals from GPs. I did what I could but it was an absolute waste of money. We are expensive personnel," she said.
Dr. Denihan brought some interesting facts to light. She stated she "was finally given a 'beautiful suite of offices' by her health board in Navan [but] it emerged that the building did not have planning permission to allow her to see any patients in it, so she has to see patients in their own homes".
This is utterly ridiculous when one considers that in general health boards have approximately five months knowledge of when a new consultant will be coming forward. The Department of Health and Children has all the knowledge because it must make sure the funding is available before Comhairle na nOspidéal can advise appointments. It is a terrible waste of money. Dr. Denihan found that three months after taking up their posts, 44% of her colleagues were in much the same situation as her, namely, they did not have an office, clerical support, a junior doctor or a community nurse. I would like to be able to say that when they got going, all was well. However, worse followed because the funding for the support services was not in place. When Dr. Denihan eventually got up and running, she found that the funding had gone. A manager told her it had gone "to the corporate good". What sort of waste of money does this represent? It is totally ridiculous.
In today's newspapers, we read that Dr. Oscar Breathnach, an oncologist at Cork University Hospital, has resigned stating he would be moving to Beaumont Hospital because after four years in Cork he still had not received the required back-up staff. There is no point appointing a person without appointing the team needed to work with that person. I have seen this repeatedly and I regret to say the problem is getting worse. I have frequently pleaded with colleagues who returned to Ireland from the United States or the United Kingdom not to leave jobs because they were so disillusioned after two years here. However, the Minister of State knows that some of them leave after deciding the promises made to them would not be realised. This is an appalling waste of their time and our money.
Something must be done to improve the administration of our health service. When the Health Service Executive legislation came through the House, I was the one Member on this side who voted in favour of it, although some other Members voted against it because it was guillotined. However, while I supported the Bill, I am afraid it was just re-branding. We will be certain of this in a year or two.
If the events concerning nursing homes had taken place in a major multinational company, I do not know what would have resulted from such an appalling level of communication. While I will not judge who is at fault, there is some political onus on those who passed through the Department because I am sure it must have been mentioned to them at some stage. However, the other part of the Bill provides for doctor-only medical cards for, we hope, some 200,000 people. I do not oppose the doctor-only medical cards; to have one is better than not having a medical card at all. Despite the involvement of the Minister of State in the pharmaceutical industry, I am sure, like me, he does not believe there is a pill for every ill. As the number of medical cards has fallen by approximately one third under this Government, I am sure much good can be achieved with the doctor-only card. However, I have concerns with the logistics of the process.
When the over 70s medical card was introduced, I welcomed it despite thinking others were more deserving at the time. However, I would not have welcomed it if I had known of the lack of logistics in regard to how it would be applied. For example, there were twice as many people over 70 than had been expected. I discovered later that this oversight was not the fault of any of those working in the Department of Health and Children because the decision was made shortly before the budget speech by the former Minister for Finance, Mr. McCreevy, in which it was announced.
What planning has gone into the production of these cards? Will all the cards come on stream on one day? Will there be a doctor-only card day? Will the primary health care service, which is sadly underfunded and has terrible problems in many areas, simply be told to cope? One of the most serious problems is that there are areas without general practitioners. Therefore, some people will receive cards to visit non-existent doctors. Moreover, we know that people use doctors more often when they have a medical card, probably because they need to and should visit their doctor. From the perspective of preventative medicine, I welcome this. Will there be any increase in the funding of primary health care so that doctors can employ more practice nurses or receptionists, for example? We have not been told if this will be the case.
The process seems not to have been thought out. I do not know how it will operate except as one great shambles in which people will turn up at the surgeries of general practitioners, who will be told to cope with the situation. Theirs is not to reason why, but to do and die or live on, if they can, and keep going. There should be more consultation with those working in primary care so people receive the treatment they deserve.
There appears to be considerable discretion in regard to the granting of the cards. I remember the bad old days when discretion was very important in acquiring medical cards. I hope this does not recur.
I have concerns with section 5(3), which states "Insofar as it is considered practicable by the Health Service Executive, a choice of medical practitioner shall be offered under the general practitioner medical and surgical service made available under this section." This suggests we could, if we are not careful, return to the days when there was no choice of general practitioner. This would be dreadful when we consider the great improvements made by allowing medical card holders to have the same choice private patients had.
Eamon Scanlon (Fianna Fail)
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I wish to share my time with Senator Mansergh.
Eamon Scanlon (Fianna Fail)
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I welcome the Minister of State to the House and congratulate the Tánaiste and her Department on bringing forward the Bill so speedily. Many elderly people are in or waiting to get into long-term care hospitals and there is much confusion in regard to the current situation. While this problem arose almost 30 years ago, the Bill will resolve it once and for all.
We can get into the blame game if we want but that will not solve the problems for the many people who need the service. Following the court ruling, whatever charges are introduced for elderly people and their care will be put on a sound footing by this Bill. It has also been pointed out that the contribution made heretofore is approximately 10% of the cost of the care provided and I do not know anyone in a nursing home or anyone wanting to get into one who is not prepared to or does not want to contribute in a small way to paying for the fine service provided and the excellent way in which people are looked after. This problem has gone on for a long time and I am glad it has come to a head. We must deal with it. The Minister and his Department have worked very quickly to ensure we address the problem.
Some Senators have belittled the 200,000 extra medical cards. There are many people who would be glad to get such cards. Many people who are working and earning what we think is good money find it difficult to attend a doctor and pay perhaps €60 or €70 if their children or they themselves are sick. To many people that is a substantial sum of money which they might not have. People will be very grateful when they get these medical cards.
The refund scheme has been discussed in the House earlier. I agree with Senator Bannon that the help line is a problem for elderly people who are often left waiting. One can be lucky. I know people who have got straight through and have had their problems dealt with. However, many people wait up to ten or 15 minutes. Nevertheless there is on-line access too and forms are available via e-mail. Most Senators and Deputies now have those forms. Many people are asking how they can apply or contact the relevant section but the problems will be resolved quickly.
Martin Mansergh (Fianna Fail)
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I welcome the Minister of State and his officials. I also welcome the Bill. The Minister of State will not take it amiss if I say that some issues progress by trial and error and this is probably one of them. One would hope to arrive at the right result in the end.
The Bill falls into two parts. There is first the question of legitimising the charging of patients for care and maintenance. There has been a good deal of debate on that over the past couple of months and in general most commentators and political parties accept the principle. It has not been fiercely attacked from any substantial source.
The Bill refers to a maximum take of 80% of the non-contributory pension. That strikes me as being rather on the high side. I have not done an exact calculation, but an old person left with a maximum of €30 or €40 a week might want to buy a couple of things for himself or herself or family members. This does not leave people with very much. I hope this section is interpreted as meaning a maximum rather than a norm. I would hope that the norm would be 10%, 15% or 20% below the maximum. I am realistic enough to know that with hard-pressed agencies that may not often be the case but in my view, 80% is a bit on the high side although I have no problem with it as a maximum.
The other part of the Bill is meant to provide a statutory footing to the new type of medical card. Despite the criticisms, the card is welcomed by the general population as far as it goes. It is also welcomed by most general practitioners. At least it means that if people are worried about their health and fall within the relevant category they can attend a doctor without having to pay a substantial charge. They do not have to sit about worrying. There are very definite limits as to what can be paid out in terms of medication per month or per year. The card is an improvement.
I have not been in the House for much of the debate but I heard the discretionary element being criticised. If we want humane legislation and humane public administration there must be some discretion. A rigid rule-based system allows no account of personal circumstances, of differing needs in what look on the face of it to be similar circumstances. No doubt the Senator who raised the point did not like the idea of political representations being made on behalf of deserving cases or perhaps undeserving cases. However, some discretion must be built into these types of rules.
There has also been some criticism about granting medical cards to the over 70s on the grounds that not all the implications were thought through. That brings me back to my original point about Government sometimes proceeding by trial and error. I am quite certain that when Donogh O'Malley announced free secondary education, all the implications were not thought through. It was a matter of making the announcement first and thinking through the implications afterwards.
Fergal Browne (Fine Gael)
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On a point of information, Garret FitzGerald had planned to move on that issue.
Martin Mansergh (Fianna Fail)
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Donogh O'Malley made the announcement——
Fergal Browne (Fine Gael)
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After he heard that Fine Gael was planning to do so.
Martin Mansergh (Fianna Fail)
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If we could revise history in that regard, Donogh O'Malley took the political responsibility and was backed by Seán Lemass. It is people who do things, not those who argue for things, who move on.
It is right that people over the age of 70 should have financial worries taken from them. That is a good reform. I have heard that the matter might be re-examined. I deprecate that because it is a good reform even if we have to work through its implications.
Paschal Mooney (Fianna Fail)
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I welcome the Minister of State, Deputy Tim O'Malley, to the House and note that once again he finds himself in the eye of a storm. When the storm broke over the constitutionality of charging elderly patients in long-stay care, I was reminded of a famous quote by a former Minister for Health, now the Minister for Finance, Deputy Cowen, who when asked to describe his situation in the Department of Health, replied it reminded him of Angola. The reference may have passed over people's heads. On one famous occasion the journalist Vincent Browne stated that he could not figure out its meaning. Sadly, at the time the former Minister made the reference, Angola was the country containing the greatest number of landmines in the world. It was pockmarked with them, leading the former Minister to draw the analogy. Vincent Browne should take note of the explanation.
The two issues dealt with in this Bill are very straightforward. As the Minister observed, the introduction of this Bill brings clarity to the issue of the constitutionality of charging patients for the maintenance element of inpatient service in publicly-funded long-term care residential units.
I do not wish to go back over ground covered by other Senators like a variation on a theme. Members on all sides of the House have alluded to the crisis that struck the Government in the immediate aftermath of the Supreme Court's decision on the constitutionality of the original Bill. Since then, the focus has been on the 29 years when the charges were charged illegally. However, the Minister is correct to emphasise that when the smoke clears, despite the drawbacks, the reality of the judgment is that the Supreme Court did not doubt that the Government is fully entitled to charge. The issue arose regarding its retrospective nature. I understand that a regulation was at fault rather than an actual law. To my mind, a regulation is in "division one" of the hierarchy of legislation. It was not passed at the relevant time to allow successive Governments to introduce this measure.
Inevitably, the Opposition will use the issue to score political points and if we were on the other side of the House we would do the same. The fact is that according to the court, the charge was levied illegally for 29 years and no-one spotted it or did anything about it. The Minister wishes to correct the legal anomaly and move on.
At the same time, she is taking the opportunity to introduce a second measure which will be welcomed by all who have concerns about the access by the more severely economically disadvantaged to local general medical services. It is a sad reflection on our society that despite our economic progress, a large cohort of people still exists for whom the cost of access to medical services is prohibitive. The Government should be applauded for taking this initiative along with the other legislative measure. It would reflect terribly on our society if parents living in economically-strained circumstances were discouraged from taking their children to see a GP for strictly financial reasons. In the Minister of State's former professional capacity as a pharmacist, he must have been exposed to many people with financial difficulties in his locality. Knowing him as I do, I am sure he did his best to alleviate their problems and he must be particularly proud to bring this legislation through the House.
There was some criticism of the catch-all nature of the Government's initiative to introduce medical cards for those aged over 70. If we are to be a caring society, what is wrong with taking an initiative of this nature? I use the word "society" rather than "government" to avoid having a political charge thrown at me. Those of us in a position to help others who are less fortunate should do so. While some people over the age of 70 are asset rich, despite the advent of the Celtic tiger they may not be cash rich. If God spares me until I reach 70 and beyond, I hope I will not be obliged to worry about the financial implications of my health but that the Government will acknowledge the contribution I made to the financial upkeep of the State and that it will repay me in my retirement. The acknowledgement is as much symbolic as it is financial.
Despite all their flaws, the Chinese have a wonderful philosophy in their approach to the elderly. The elderly are a respected part of Chinese society and of Asian society in general. We used to have such respect in our culture. Sadly, the all-embracing, consumer-oriented, fast-paced society in which we now live has eroded at the edges people's traditional affection, regard and respect for the elderly. I make the observation to rebut the criticisms levelled at the Government about the catch-all nature of the initiative for those over the age of 70.
The Government has decided to go a stage further and target those within the medical card scheme who will benefit most, namely, the significant number of people who are socially and economically disadvantaged. Its initiative is part and parcel of being a caring Government. The Taoiseach has been accused of political opportunism for saying he was a socialist. A Taoiseach puts his or her own stamp on the Administration he or she leads. As Head of Government, all initiatives flow from the Taoiseach to other Departments in terms of policy and legislation. Given the Taoiseach's background, he saw at first hand deprivation at its worst in the inner city of Dublin as he grew up. Why would he not claim to be a socialist, if it means directing his Government to introduce policies to help the deprived? As a recent report pointed out, many people are still deprived. Sadly, this most affluent of cities still has within it some of the highest levels of poverty anywhere in the Republic.
8:00 pm
Maurice Hayes (Independent)
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I will be brief as the Minister of State has already heard most of the arguments and comments. Senator Mooney was somewhat kind to the subsidiary legislation by suggesting its flaw was minor when in fact it was ultra vires. It attempted to change the intent of the main legislation, not to bring it into effect. This is an elementary point and legal advice would have been clear and consistent on this over the years. However, we have a chance to discuss the issue tomorrow.
I have sympathy with two points made by Senator Mansergh. The first is that it is rather much to take up to 80% from an old age pensioner. It is all very well to say he or she would spend the money outside, but one is taking choice from them. A pensioner might decide to have another cigarette instead of another loaf of bread.
The second point concerned the need for flexibility. It is important to remember that what was done under the flawed legislation was neither irrational nor shameful. It is not an unreasonable principle to expect people to pay towards the costs of maintenance and ordinary expenses, particularly when the result of them not doing so is simply to increase the patrimony of their heirs. Whatever is done regarding the correcting of the retrospectivity of the charges, I see no grounds for paying the heirs and successors of people who were charged.
I would like to raise an issue regarding the health economics of the issue. I had some experience of this in another jurisdiction and some of the difficulties that have arisen in terms of definition and practice are the result of the blurring of the division between residential care and nursing care. That comes from the fact that people are living longer and frailer people are being maintained in these homes. There might be an argument for greater flexibility in determining what it is. Doctors were under tremendous pressure in the North, where there was a charging regime for residential homes, to certify people and keep them in hospitals, where they did not have to pay. There was huge resistance to the transfer of a patient from an acute hospital bed, which he or she was blocking up, to a residential home where he or she would be better looked after. There is a need to avoid those kinds of hiccups. There is much to be said for a comprehensive look at the system in general to see if providing more support to keep people in their homes might not allay much of this problem.
It has been stated that the full cost of granting everyone free care might be €300 million per year. I am not suggesting that this should happen. Even if it did happen, €300 million against a health budget of €10 billion is not an enormous sum if it produces savings and frees up acute hospital beds elsewhere. The Minister might ask some of his officials to examine what has happened in Scotland in the last year or so because the Scottish Parliament made the decision to grant nursing and other care to older people, a decision that was not replicated in England and Northern Ireland. It would be interesting to see the difference that decision has made. I would like to reinforce the plea made by Senator Mansergh for flexibility. A maximum amount that might be charged could be proscribed but after that, professionals should be allowed to deal with the individual case in a way that maximises the benefit to the individual and reduces generally the burden on the health services.
Joe O'Toole (Independent)
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I would like to make a brief intervention on the Bill. I have spoken over the past week or so with a number of different groups that have concerns about some of the elements in it. I do not oppose the levying of some form of payment; there should be some form of payment where people can afford it. I am clear on the Supreme Court's reflection on this fact. The court did not object to the retrospective element of it. However, the court ruled that it was depriving people of their private property. It was a constitutional point about the protection of private property.
I agree in principle with the general thinking behind the argument that a person in a nursing home whose only income is his or her pension should be prepared to pay a significant portion of it towards the costs of their care. If we could look at the practice of "a third, a third and a third" used in many parts of the professions and if a person in a nursing home could keep one third of that money for himself or herself and pay 65% or 66.3%, it would be considerably fairer and easier. I am making this point on a human level because the amounts of money are not hugely significant to the State but the amount of disposable income for people in nursing homes is very important. It is about having the money to buy the little things like a present for a grandchild, to be able to give at some stage at some time.
I ask the Government to have a rethink on the Bill. I am aware that it will not accept amendments here because I am sure that the last thing it wants to do is to bring this Bill back into the House. However, I consider there is a need to put down an amendment, to discuss this part of the Bill further and to hear the rationale. If we accept the rationale that there should be some element of payment, could I ask the Minister to ask for an examination of how it should be implemented?
We should ease back when implementing this policy and recognise how we can significantly help people. We are faced with paying back an amount that the pundits put at up to €2 billion. I do not know if this figure is correct in terms of the assessment of the total cost of the mistakes that were made over the past 20 years or so. I will not dwell on this aspect now as we will be debating the whole issue in the House tomorrow. However, I would ask the Minister to outline how much it would cost the State in net terms if we reduce the amount demanded of pensioners to two thirds of their pension. Reducing the amount to this level would give a great element of independence and dignity to people who have given their all to this country and show that the political establishment empathises with them. The Government should reflect on this.
Tim O'Malley (Limerick East, Progressive Democrats)
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I thank the Senators for their contributions to this debate. Regarding the 80% charge mentioned by one or two speakers, this is a maximum of the old age non-contributory pension that can be deducted. There is flexibility in this regard.
Senator Henry raised a point about flexibility regarding the doctor-only card and expressed concern over whether patients would have a choice of doctors. Patients will have a choice; the arrangements will be the same as those for the medical card scheme. I am not pleased to see some politicians placing advertisements in the newspapers advising people to go to clinics for this matter. This practice politicises the issue and does not help the situation. I was unaware of these advertisements until I came into the Seanad this evening.
I agree with Senator Mooney that the Government is trying to respond in a humane manner to a problem that has been before successive Governments for 29 years. This extremely important legislation represents a symbolic gesture to the over 70s and we must get it right.
Senator Henry referred to a recent newspaper report about psychiatrists who are appointed and left for months or years before getting a team or accommodation. This is the first time the matter has been brought to my attention but it worries me. It is a waste of expensive resources if the consultants' management fails to put in place working facilities and registrars for them. Senator Henry gave an example of someone who did not have an office or secretarial staff for several months after being appointed. It is extremely disappointing that this could happen in this day and age, especially when Comhairle, the Government and the HSE appointed these people.
The Government has introduced this Bill to establish a sound legal basis for the policy of requiring some contribution towards the shelter and maintenance of people with full eligibility in long-stay institutions. The issue has been put beyond legal doubt after nearly 29 years as the Supreme Court has confirmed that it is constitutionally sound for the Oireachtas to legislate for this policy. The other matter addressed in the Bill, the introduction of a doctor-visit medical card, is a major step in ensuring that people of low incomes will have access to GP services and advice. Senator Mooney referred to the evidence that many people, particularly mothers of young children, are just above the limit for a medical card and have problems if there are illnesses in their families necessitating several visits to doctors in the space of a month.
It is important that the Government has taken this decision to allocate GP-only medical cards. The general public and the future recipients of these cards welcome them as they will be a consolation for many families, especially those with young children. It has always been a problem that children are struck by illness most often. A mother may unexpectedly be at home with two or three sick children, which can cause undue hardship for families. I do not view this as a generic or yellow pack card, as some have called it. It will be extremely significant in helping many people and families.
The HSE was established to administer the health services on a national basis and will be in a position to commence the introduction of these cards as soon as the Bill has been enacted. It is a long-standing feature of our system under various Governments over 30 years that most people in publicly-funded long-term care should make some contribution to the cost of their care. Quality care is expensive and the bulk of the cost must be borne by the Exchequer alongside these contributions. The quality of care provided in many public nursing homes and what were formerly called workhouses, now public institutions, is far superior to many of the most expensive nursing homes. It is wonderful that successive Governments have raised the standards and it is a tribute to the care and diligence of the nurses and doctors involved. I am sure Senators agree with me.
The income foregone by the HSE for as long as these charges cannot be raised is estimated to be in the region of €2 million per week. Even if one does a quick sum and agrees with Senator O'Toole on reducing that figure by 10% to 20%, the amount lost to the State will be sizeable. However, there is flexibility in the scheme and the HSE will have the right to waive charges.
A statutory framework that puts the long-standing policy on a sound legal footing and safeguards the income generated from this source is vital. The provisions of the Health (Amendment) Bill 2005 will secure this source of income, which has been an essential element to the funding of our health services in the past and must remain so. The introduction of a doctor-visit medical card is the most efficient way to help a significantly increased number of people to access primary care. It is in line with the commitment contained in the health strategy to ensure that the allocation of medical cards is on the basis of prioritising the groups most in need and is intended to benefit approximately 200,000 people. Those who speak about the percentage of people on medical cards are missing the point. If those who use the services most are prioritised, it is right that the Government proceeds with this and gives GP-only cards to young families, as they will benefit the most.
I will respond to some of the points made by a number of speakers during this debate. Concerns have been raised that the percentage of the population covered by the medical card has declined in recent years. It must be recognised that this is attributable in large measure to the economic success Ireland has enjoyed, which has reduced the need of many people for State support to meet health care and other living costs. The Government's objective is to ensure that the people most in need have a medical card rather than simply achieving coverage of a certain percentage of the population or issuing a specific number of medical cards. In order to give effect to this targeted approach, changes to the income guidelines expected to result in the issuance of an extra 30,000 medical cards in 2005 have recently been introduced by the HSE at the request of the Tánaiste. This is in addition to the doctor-visit cards, which will be introduced subsequent to the passage of this Bill.
The Department will ask the HSE to keep the medical card's revised income guidelines under close review to ensure that the Government's policy decision on the extra 30,000 cards is delivered upon. I emphasise that there is no question of the Government seeking overtime to reduce the number of standard medical cards in favour of issuing increased numbers of doctor-visit cards. This initiative is intended to complement the existing arrangements that have been in force for many years. Several Members of both Houses were under the impression that the Government has taken the decision to change the former full medical card into the doctor-only card. The Government has taken a conscious decision to make this an add-on.
The Department of Health and Children has recently written to the interim CEO of the HSE to formally indicate that the Government's objective in introducing this initiative was to enable in the region of 200,000 medical cards to be issued in respect of general practitioner services. The Tánaiste wishes to have the necessary administrative arrangements in place to enable the new cards to be issued from April onwards.
The HSE has been requested to have the necessary preparatory steps taken and operational guidelines developed, such as will enable applications for doctor-visit medical cards to be accepted as soon as possible after the enactment of the relevant legislation, and the cards subsequently issued to persons who meet the relevant criteria. It is important to emphasise that with the establishment of the HSE, the administrative arrangements for this card will be operated on a standardised basis across the country.
The Department has written to the Irish Medical Organisation to notify it formally of the Government's decision regarding doctor-visit medical cards and of the provisions of this Bill. It has also indicated that the HSE has full operational responsibility for the delivery and funding of all health services and that it is the appropriate body with which the IMO should deal with regard to the introduction of these cards.
I wish to reiterate that while the HSE intends initially to set the income threshold for the doctor-visit cards at 25% higher than applies for the standard medical card, this threshold will, if necessary, be reviewed in the light of experience so as to ensure that the desired number of cards are issued to those intended to benefit under the initiative.
The Bill will bring clarity to the issue of charges for long-stay care where it is clear there has not been a sound basis for the practice going back almost 30 years. The legislation will also ensure that the income flow from charges imposed to date will remain secure and continue to support and continue to support the provision of quality services to those in long-term care. I am pleased that none of the major parties have registered any difficulty with the principle involved here.
The introduction of doctor-visit medical cards is a supplementary initiative which will enable some 200,000 additional people from lower income households to attend a doctor free of charge. This will help to overcome barriers to assessing general practitioner services for many individuals and families who are above the standard medical card income guidelines. I thank all the Senators for their contributions.
Labhrás Ó Murchú (Fianna Fail)
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When is it proposed to sit again?