Health Bill 2008: Committee and Remaining Stages.

Friday, 12 December 2008

Seanad Eireann Debate
Vol. 192 No. 17

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Question proposed: “That section 1 stand part of the Bill.”

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I wish to make a point in respect of the Short Title because a number of amendments were ruled out of order in the Dáil yesterday as they were perceived to be declaratory. I ask the Minister of State whether there has been an overnight response from the Department to this concept because a number of Members have observed that they had never seen this happen before. Will it be stated today that some of the tabled amendments are declaratory and are not relevant to the Title of the Bill?

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  That is a procedural question on section 1 and the House will deal with each amendment as it reaches it. Does the Minister of State wish to comment?

Minister of State at the Department of Health and Children (Deputy Máire Hoctor): Information on Máire Hoctor  Zoom on Máire Hoctor  I am satisfied that section 1 should remain part of the Bill. The aforementioned decision yesterday was made by the Ceann Comhairle and not by the Department of Health and Children.

Question put and agreed to.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 1:

This amendment entails the inclusion of a new section, which requests that the “Minister shall, on a monthly basis, lay before the Dáil a report on the number of General Practitioners that have accepted any new capitation rate in place since October 2008, or any subsequent variation to that rate”. Fine Gael seeks information on this issue because making savings on the changed capitation scheme appears to be one of the critical reasons for the introduction of the legislation in the first place. As the scheme negotiated by the Government in 2001 was considered to be [1163]too expensive, it was deemed to be in need of urgent change. Will the Minister lay before the Dáil a report, on a monthly basis as requested in this amendment, so that Deputies will have an opportunity to ascertain how many GPs have taken up the new capitation rate suggested by the working party, as well as the extent of the savings on an ongoing basis?

Members are short on detail on this scheme. This mechanism would ensure the Houses of the Oireachtas were kept informed as the issue progresses. At present, Members do not know whether any GPs have agreed to the scheme. While technically, the Government cannot negotiate with the GPs, I am unsure whether the Minister of State has information on the number of GPs who have indicated their acceptance of the new capitation rate. However, this matter is central to the type of savings the Minister of State outlined in the House earlier today. I understand she spoke of substantial savings in respect of this change. It is too bad that it was necessary to negotiate such change on the backs of elderly people losing their medical cards. Nevertheless, it would be useful to ascertain what progress was being made on this recommendation, what proportion of GPs agreed to it or otherwise and its potential impact on the delivery of treatment, particularly in respect of those in receipt of medical cards.

Senator Paschal Donohoe: Information on Paschal Donohoe  Zoom on Paschal Donohoe  I support Senator Fitzgerald’s amendment. One of the grounds for the introduction of this Bill is the need to find cost economies, given the difficulties in which we find ourselves at present. Undoubtedly, it would be easier for the public and the Oireachtas to understand the effectiveness of such measures were the Government to produce a regular report informing them of progress on negotiations with GPs in respect of the new medical card scheme.

I will conclude by making an additional point on public understanding — I refer to an earlier comment by the Minister of State that only one member of the public was in the Gallery. That visitor was my constituent. If more members of the public were aware of how quickly this was being moved through the Oireachtas, there would be more people here to listen to the debate.

That lady was here representing 6,000 retired primary school teachers. She was here representing many members of the community. It was a bit rich for the Minister of State, Deputy Hoctor, to have a go at members of the public or to make a comment about them. They cannot answer back. They are here showing interest in what we are doing——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on section 2, amendment No. 1.

Senator Paschal Donohoe: Information on Paschal Donohoe  Zoom on Paschal Donohoe  ——and that should be recognised.

Senator Phil Prendergast: Information on Phil Prendergast  Zoom on Phil Prendergast  I support Senator Fitzgerald and the Fine Gael Senators on the amendment. I would support her party in regard to the points she articulated.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  The disparaging remarks about members of the public made by the Minister of State, Deputy Hoctor, at the end of her speech gave a very bad turn to a very good speech. I refer to the idea that Sligo people were coming up here for the craic. I have just spoken to the secretary of the Sligo branch of the retired teachers who was appalled at the suggestion, but nonetheless it was made.

I have discussed this issue with many different retired groups. I had a meeting approximately two weeks ago with representatives of retired primary and post-primary teachers in Parnell Square. It was a crowded meeting where representatives of primary teachers and post-primary teachers from every county were present. They asked me a question. It is interesting how they want to get themselves——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on the amendment.

[1164]Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  The issue is why we put forward these amendments and the matters with which we want to deal.

At that meeting, people asked how they could get involved in the political process and they wanted to do various things such as crowd places and so on. In this regard, I said the thing to do is for people, in a mannerly way, to visit their local politicians in their constituencies to put their points of view. I said they should engage with the politicians, explain their problems and get a reaction. They then asked my view on whether they should all crowd into the Visitors Gallery. I said they should not do that. Nonetheless, the secretary of the Dublin branch of the Retired Teachers’ Association, the largest branch in the country, was in here this morning with an active member of the community to meet, as it happens, Senator Donohoe, and they asked that one person would stay to keep a record. That one person represents — I guarantee the Minister of State will get this in writing from me and from them — the Retired Teachers’ Association. I have spoken to the general secretary of that association, primary and post-primary, in the past hour and I have just put down the telephone from a representative of the retired teachers in Dublin. They are appalled.

I can have the Visitors Gallery crowded for the Minister of State any time she wants, if that is the way she measures it. It was a cheap remark. It was unnecessary and unfair on people who will now think the Minister of State has interpreted their position in a most appalling way. They deserve a full apology for it.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on the Health Bill.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  That is the way, if we want to play politics. Some of us are trying to control that kind of politics and to get proper respect for politicians in their constituencies by engaging with the public and listening to their point of view. I spoke to members of that group for a full hour on that point. I cannot state how disappointed I am with the view that has been offered on this.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Naturally, I will not be supporting the amendment. As a member of the Joint Committee on Health and Children, of which Senator Fitzgerald is also a member, where on a three-monthly basis we have a meeting with Professor Drumm and the Minister for Health and Children, Deputy Harney, I believe such a forum would be a much better arena in which to get feedback and to hear how many general practitioners have opted out of or into the scheme.

The Cathaoirleach will probably rule me out of order, but others have been allowed have their say. It was disingenuous of Senator O’Toole——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on Committee Stage of the Health Bill, section 2, amendment No. 1.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  What I mentioned was that one Fine Gael member from Sligo told me he was up for the day for the craic.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I am not a bit interested.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I never mentioned retired teachers.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I am not a bit interested what a Fine Gael member from Sligo told Senator Feeney or anyone else.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Senator O’Toole was allowed, a Chathaoirligh. I did not mention retired teachers.

[1165]An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Senator Feeney, please.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I am meeting the retired teachers on Monday next——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Senator Feeney, please.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  ——as are all my Fianna Fáil colleagues. A Chathaoirligh——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  No, Senator Feeney.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  ——if the members of the Opposition are allowed put their case across——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  No, no.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  ——it is only fair that we should be allowed. We are being hammered here——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on the Health Bill.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  ——and we cannot come back in to correct ourselves.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I ask Senator Feeney to resume her seat.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I, for one, am meeting the retired teachers on Monday next in Sligo.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on the Health Bill, section 2.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  They do not have to come to Dublin.

Senator Paschal Donohoe: Information on Paschal Donohoe  Zoom on Paschal Donohoe  They were in the Visitors Gallery.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on the Health Bill, section 2.

Senator Paschal Donohoe: Information on Paschal Donohoe  Zoom on Paschal Donohoe  They were in the Visitors Gallery. They heard what Senator Feeney had to say.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  We are on the Health Bill, section 2. I will not allow anyone——

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  A Chathaoirligh——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  If Senator Feeney wants to stick with the Health Bill——

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  ——on a point of order, are we allowed to defend ourselves?

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Not on the Bill.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Then why did you allow the Opposition speak the way it has?

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I am disappointed with Senator Feeney. I am seriously concerned. I interrupted the two speakers previously because they were not sticking to what is in the Bill. I can guarantee it will be out the door one after the other they will go if they do not stick to the Health Bill.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  My apologies. I would not undermine the Cathaoirleach in any way.

[1166]An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  That is what Senator Feeney is trying to do, and I will not accept it from anyone here.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I have too much respect for the Cathaoirleach to undermine him in that way.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I note the Cathaoirleach’s decision to take this amendment. It is interesting when compared to the attitude that was taken in the Dáil. Obviously, they are different Houses.

It is important to note that this was turned down in the Dáil yesterday when people felt it would be of huge benefit to have this kind of information laid in a report before the Houses.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Do not worry about the Dáil. We will worry about the Seanad here today.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  It would bring an element of transparency to what is happening. With this major reversal of Government policy, it is important that we see how this reversal of Government policy is progressing and that we are updated on it, particularly in the new year when these changes are meant to come into effect.

The number of general practitioners who sign up for this scheme will be critical to the delivery of health care, and particularly to the delivery of health care to people with medical cards. That is why I tabled this amendment. I note that the Seanad, unlike the Dáil yesterday, is in a position to consider this amendment, and indeed agree it. I appreciate it is a different House where different rules apply. I would be interested in the Minister of State’s reply.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I wish to clarify my reference to the one person who remained in the Visitors Gallery this morning. We all know that the Visitors Gallery is open to all members of the public.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I would prefer not to go down that road.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I just want to say that it was a clear indication to me that, from the day of the protest to today, which was an important day for legislation, the revised income thresholds have been duly recognised by the public, as was the fact that 95% of people over 70 retain their medical cards.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  The Minister of State cannot take it to suggest such an indication.

Senator Paschal Donohoe: Information on Paschal Donohoe  Zoom on Paschal Donohoe  The Minister of State cannot say that.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  The Minister of State is replying to the amendment.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Amendment No. 1 refers to a new capitation rate introduced in October last. The new capitation rate, recommended by Mr. Eddie Sullivan, is not due to commence until 1 January next. Second, the matter referred to here is of an administrative nature and does not warrant a report to the Oireachtas. I do not propose to accept the amendment.

Senator Nicky McFadden: Information on Nicky McFadden  Zoom on Nicky McFadden  My colleague and friend was in the Visitors Gallery this morning.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  No.

Senator Nicky McFadden: Information on Nicky McFadden  Zoom on Nicky McFadden  She was representative of the over 70s. She is not one of these people who will qualify——

[1167]An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I do not care who is representing whom in the Visitors Gallery.

Senator Nicky McFadden: Information on Nicky McFadden  Zoom on Nicky McFadden  ——and neither will any of her bridge club.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I am not discussing anyone who is in the Visitors Gallery.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  On the amendment, I ask the Minister of State in good faith to give the House an assurance that such information will be supplied on an ongoing basis, perhaps, as Senator Feeney suggests, to the Joint Committee on Health and Children, if the Minister of State is not in a position to agree to this amendment and ensure this information is placed before the Dáil.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  There will not be a difficulty in providing Senator Fitzgerald with that information, should she request it.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  As I stated on Second Stage, the problem is that getting information from the HSE always takes time and it is often incorrect. That is the issue here. It is not a case of trying to put extra pressure on it. It is the only way in which we can be sure of knowing what is happening and it is a very reasonable request.

There is a way out of it. The Minister of State could give a guarantee, without accepting the amendment, that she will take responsibility for providing this information to the appropriate committee of the House on a monthly basis. It is important information. This is the kind of information we were discussing. This is the kind of information that led to me to ask this morning that if people themselves decided to pay the cost to the Government, where would they stand.

There is a long-standing convention of the House. If it had not been breached this morning, unfortunately, the altercation would not have occurred.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I do not want to——

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  There should never be reference to people in the Visitors Gallery.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I always said that.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  However, the minute the Minister of State did that, the floodgates were opened. It was a breach of convention.

Amendment, by leave, withdrawn.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 2:

This amendment requires reports to be laid before the Houses on the implications for the health of elderly people of the withdrawal of certain medications from the medical card and other schemes. It attempts to obtain quality information on the impact of such changes and to [1168]ensure that public representatives have timely access to this information. The media have reported on the possibility of a range of medications being limited or restricted.

Medical cards allow patients to access a variety of medication. Obviously we are not opposed to efficiencies being made but we do not want to give carte blanche in this regard if the result is that people suffer. My amendment makes patient care paramount when changes are made to the medications available in the medical card scheme and requires the Minister for Health and Children to report to the Houses. It is difficult at present to access in a timely manner the information we need. At a time of extensive change in the care of the elderly, we want to ensure information is made available by the HSE and the Department of Health and Children in a timely and comprehensive manner.

As this amendment could not be debated yesterday, the House has a unique opportunity to consider it. It would be good for democracy if we were able to share information on these issues with the Houses.

Senator Phil Prendergast: Information on Phil Prendergast  Zoom on Phil Prendergast  I support this amendment. Reports which will in any event be prepared for the Department should be made available to all Members so that we can meaningfully assist the people who look to us for guidance.

Senator Nicky McFadden: Information on Nicky McFadden  Zoom on Nicky McFadden  This is a worthwhile amendment in view of the fact that savings can be made by prescribing generic medication. Greater control is needed over prescribing because the level of waste in this regard is huge. Repeat prescriptions are lying around in houses throughout the country. I am sure we will be able to reinstate the universal medical card if we have these reports because they will allow us to make significant savings.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I do not propose to accept this amendment. The matters to which it refers are not specifically related to the Bill and I do not consider that such a sweeping obligation should be imposed on the Minister. While it is standard practice to release reports when called upon to do so, I am conscious that the information contained therein may have implications for sensitive commercial practices. This amendment is not sufficiently flexible for me to support it.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The Minister of State should accept the amendment because those over the age of 70 are vulnerable to changes in prescribing practice. Although this area comes within the remit of HIQA, it is relevant to the Bill before us because of the specific implications for free health care. HIQA’s mandate is similar to that of NICE in the UK in that it can legally restrict medication for people over the age of 70. A report should be laid before both Houses of the Oireachtas setting out the economic and medical reasons for changing the types of medication available on the medical card.

Amendment put and declared lost.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 3:

A lengthy debate was held in the Dáil on the wording of this section. Deputy Shatter identified a number of constitutional issues in the Bill. I ask the Minister of State whether she can respond [1169]to the legal points raised by the Deputy. Clarity was lacking in a number of areas of the Bill. This amendment is straightforward. I ask the Minister of State to elaborate on the meaning of this section.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I do not propose to accept this amendment. The form of words used in the Bill to describe cohabiting couples is the standard form used in many Acts of the Oireachtas. To amend the language of the Bill in the manner proposed could have implications for other legislation referring to cohabiting couples. I cannot indicate what these implications might be, but for that reason the safest course is to oppose the amendment.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Is the Minister of State implying that the Bill before us will have to be amended when the civil partnership legislation is introduced, given that it excludes same sex couples?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I understand that the civil union Bill will impact on a range of legislation.

Senator Mary M. White: Information on Mary M. White  Zoom on Mary M. White  The fair deal nursing home legislation makes reference to same sex couples who share a house. What is different in this Bill?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Senator White is correct that the legislation to which she referred makes provision for cohabiting same sex couples. However, the fair deal scheme is different in that it is concerned with the assets of a couple.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I ask the Minister of State to explain why it is so different. The Bill as it is currently worded is unclear in that regard.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Long-term residential care could impose an extreme burden on the finances of a same sex couple but that is not the case in respect of applications for medical cards. For that reason, I do not propose to accept the amendment.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  I was unaware of this matter and I commend Senator Fitzgerald on raising it. In one such set of circumstances the Government will recognise that the cost of nursing home charges will definitely be taken into consideration on each occasion. In other circumstances, such as those contemplated by this legislation, it will not. Is there not invidious discrimination in that respect and is it not the case that this Bill prevents people from getting arrangements exactly in line with the other fair deal legislation?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  We are not here to debate the fair deal legislation. The Senator is speaking about two entirely different pieces of legislation and there is no reason we cannot have differences in the approach. I will not accept the amendment.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  I draw the Minister of State’s attention to the section of the Constitution that outlaws invidious discrimination. This occurs where people are discriminated against for no valid reason, which is what the Minister of State is describing. Not even the law can do this; it cannot be decided in law that action will be taken in certain circumstances and not in others, unless there is an extremely good reason for it. The reason is not apparent, or at least I do not understand it if it is. I should be careful about what I am saying as I was not completely aware of the issue until it was raised.

I was aware the arrangement stood but I raised the issue on Second Stage that where people are burdened with the cost of nursing home charges, it should certainly be taken into consideration in all cases. That would allow people access to a medical card. The Government has [1170]difficulty with that concept but in another set of circumstances it does not. Surely that leaves the Bill open to challenge and there is a question of discrimination arising from it.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Is the Minister of State accepting the amendment?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  No as it would be premature to debate the issue at this stage in light of the fair deal scheme, which is only on Second Stage. The Civil Unions Bill has not been brought in yet.

Amendment put and declared lost.

Section 2 agreed to.

Section 3 agreed to.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Amendment No. 4 in the name of Senator Frances Fitzgerald and all other Fine Gael Senators is out of order as it would impose a potential charge on the Exchequer.

Amendment No. 4 not moved.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 5:

I accept the Cathaoirleach’s ruling that amendment No. 4 is out of order. It is most unfortunate that three years after a person being widowed, a medical card will be taken from them.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  The Senator must speak to the amendment. We are on amendment No. 5.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  They will lose the medical card when they are at their most vulnerable.

Senator Nicky McFadden: Information on Nicky McFadden  Zoom on Nicky McFadden  It is heartless.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  This is a new amendment. I appreciate this legislation is being rushed through the House today and, as I stated, it is not the ideal way to produce legislation. We would have preferred more time and I would like to think that the Government would have had the time to consider this amendment because it deals with a specific issue.

This amendment proposes that the Bill allow a divorced or separated person the option of continuing to be assessed as either a couple or an individual for the purpose of obtaining a medical card. It conforms to our constitutional idea of a family unit and similar provisions are in place with regard to Irish tax law. We are saying that separations or divorces can be difficult or traumatic enough without the State interfering further into someone’s private financial position or living arrangements.

[1171]The ultimate concept is that these couples should continue to avail of this provision, either as a couple or individually for the purposes of obtaining a medical card. It is in line with the constitutional understanding of a family and provides some choice to ease hardship for separated or divorced couples. I am interested in the Minister of State’s response to the amendment.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I do not propose to accept this amendment. Such a provision could have implications for eligibility for health services generally and requires more detailed consideration, rather than being rushed in by way of amendment to this Bill. Furthermore, the gross income limits are set at a level at which it is expected that the vast majority of persons over 70 will continue to hold a medical card. It is also open to them to apply for a medical card under the existing medical card scheme, which allows the HSE to exercise discretion in awarding medical cards in individual cases.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I have a quick question. If somebody is divorced, how would they be assessed?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  A divorced person, in applying for a medical card, would be considered a single person, as opposed to separated.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  What about a separated person?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Separated people are not divorced so they would still be considered a couple.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  If there is a judicial separation, the people would be assessed as a couple. If a couple is divorced, they are assessed as individuals.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The Bill applies to people who are either married or single so a person in the case mentioned by the Senator would have to apply under the 1970 Act.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  For a divorce.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  He or she would apply for a medical card as a single person.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  If a judicial separation is involved, the people are not divorced. Would a person in such a case be considered single?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The person would apply as a single person for assessment under the normal medical card scheme under the Health Act 1970.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The new scheme does not apply.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  With a couple which has just reached a divorce settlement, somebody could be without a house but have half the value of a house. The person may be waiting to purchase a place. The person may have a very low income but much money generating income for a short period and he or she would not be in a position to apply for a medical card. I can understand how the Government, under this section, has brought in a period after a person becomes a widow or a widower to allow settling afterwards. I do not agree with the length specified, but the Government has provided for it and there was a good reason for it.

Surely similar arrangements must be made if there is such an upheaval in a person’s life and he or she is suddenly in a position where his or her life has changed and he or she is not part of a couple anymore. The person may have half the value of the family home and this could [1172]potentially earn much interest. With no other real source of income, the figure would be false. Surely this must be taken into consideration and it would be utterly unfair otherwise.

I rise in answer to the Minister’s comments to the Fine Gael Senators, which indicated a person would be treated as a single person in the case of divorce. It is grossly unfair that a person could find themselves in such a position at a time when he or she is trying to come to terms with single life. The person would be hit with another hammer blow.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  As I pointed out earlier, there are still options for such people to apply. They can apply under the discretionary card scheme, leaving the decision at the discretion of the general medical officer. They can also apply under the existing scheme, where the income threshold is no more than €201 per week.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  That does not take into account a very substantial issue. When people are living in a house, the only factor considered is the stream of income. The Government does not consider the capital value of the property. It is not worth anything to anybody living there — they go in and out, sleep and eat there and they own it. It is of some value to the people they leave after them.

If the people separate and the property is liquidated, it looks as if the people are sitting on a pot of money. This is only as they are trying to organise themselves. Surely the Government must make some appropriate arrangements to deal with such a case? Otherwise, capital assets are being trundled into current income and seen as one. It does not matter if the people are dealt with as a couple or an individual. It is surely unfair.

The Minister of State spoke of things not being thought through. This issue is significant. Will she explain what will happen if someone walks into her constituency clinic in three or four months’ time, whom she knows was married but is now separated. The former husband or wife is now separated and does not have a large income; the person concerned may be on a pension. I do not know how one could deal with such a situation. If such a person sells his or her house to enter a nursing home he or she may be sitting on a pot of money having liquidated his or her assets. How can one get around that in a fair manner?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Income will not be imputed from the property of the person in question for means testing purposes, unless it is rented and the rental income is included as part of his or her income. Savings or similar investments up to €36,000 in the case of a single person, or €72,000 in the case of a couple, will be disregarded and only the interest from savings above these figures will be considered as income for means testing purposes.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I think the Minister of State said that a judicially separated person who is not yet divorced is treated as being single. He or she is still married, however, although he or she is judicially separated. I do not think, therefore, what the Minister of State said is correct.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The Senator has answered her own question.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  The important thing is how it is understood by the law.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Yes, the Senator is correct. Once they are not divorced, they are still considered to be married.

Amendment put and declared lost.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 6:

[1173]

This is a protective amendment in terms of how this issue is handled, given the definitions in the Bill.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I do not propose to accept this amendment. The HSE is under a statutory obligation to satisfy itself that applicants for medical cards satisfy the criteria set down in the legislation. In doing so, I would expect the HSE to act reasonably, fairly and objectively. However, the language of the amendment — in particular, the words “unnecessarily intrusive or invasive questions”— is unclear, ambiguous and open to debate. Who is to determine what is or is not intrusive? In view of this uncertainty, I feel the safest course is to oppose the amendment.

Amendment put and declared lost.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Amendment No. 7 is out of order as it involves a potential charge on the Revenue.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  May I ask one question?

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Yes.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  Every single Government statement over the past 24 hours has indicated that there could be deflation next year. The consumer price index could drop, which would save the State money. I cannot understand how this will necessarily involve a potential charge. It may, but it will not necessarily do so.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Amendment No. 7 has been disallowed as it involves a possible charge on the Revenue. The amendment seeks to make it compulsory that gross income limits for purposes of medical health be increased in line with the consumer price index.

Amendment No. 7 not moved.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 8:

The amendment is self-explanatory and I await the Minister of State’s response.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I do not propose to accept this amendment as this provision has been drafted in the standard format, which gives the Minister regulatory powers to amend the income limits. I do not propose to depart from this approach.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  This is an important amendment because there has been so much discussion about income limits. In addition, there has been much disagreement about their impact and the number of people who will be affected. I feel it is important to try to bring some information back not just to the Department of Finance but also to the Houses of the Oireachtas. The changes in the Bill will impact on the public through front-line services. In [1174]the interests of transparency and information, it is important to report such information to the Oireachtas.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  The Minister of State is arguing that the Minister has power of regulation under the subsection. Does the application of such a regulation require the positive approval of each House of the Oireachtas, or is it merely required to be laid before both Houses without approval? In other words, does it need the positive or negative process?

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  Will the Minister of State explain how these figures are reached? Why is she picking the figures of €700 and €1,400 per week? Are they just arbitrary? Another issue arises as to how this legislation may affect people. Some people who were issued with medical cards since the budget were told that their cards were valid only until the end of December. Does that mean those individuals are outside the scope of this legislation because they must apply under the new scheme in January? Has the Department sent out letters to all GPs informing them about their contracts with the HSE regarding this issue? To the best of my knowledge, there is a three-month period for those contracts. The Minister of State said she is introducing a provision on 1 January, but she has not yet terminated the contracts that will support this legislation.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  To answer Senator O’Toole’s question first, that regulation just needs to be laid before the Houses of the Oireachtas.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  It does not need to be discussed or approved by the Houses?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  No.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  That is unfortunate.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Senator Twomey asked me about the €700 and €1,400 figures. Those are based on the income bands of the majority, some 95%, of people over 70, given the available figures that we sourced. It was aimed at the highest number of people who would still retain the medical card, hence the figures of €700 and €1,400 per week.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  That is the guarantee that only 5% of the population will not get medical cards?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Yes. The Deputy also asked about the letter to GPs. We must wait until this legislation is passed and the Department will be then in contact with the HSE which will, in turn, make contact with GPs about this.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  This legislation, therefore, will not come into effect on 1 January.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  It will come into effect on 1 January.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  There is some confusion here. There must be a three-month period before the old contracts are over. Is that true or not?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  That is not the advice we have received.

Amendment put and declared lost.

Question proposed: “That section 4 stand part of the Bill.”

[1175]Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  I want to refer to the provision concerning a person’s savings or similar investments. This comes back to the earlier question I raised about interest. I want to know what “similar investments” means. I know what savings are and everybody is clear about that, but I gave two examples earlier. If a person had to sell his or her house, one would not generally consider that money to be savings. I think anybody would accept that. It would be helpful if the Minister of State could put on the record of the House that it would not come under the term “similar investments” either. That would solve my initial problem about the interest rates concerning a person who had to liquidate his or her house or property. Irrespective of whether that person needed to do so to take care of himself or herself, to go into a nursing home or to move home, it would not be a matter of “similar investments”. What does that phrase mean? I accept that this is a tricky issue. I understand that complexities are involved and I am not trying to be difficult.

If someone retires from a business or the public sector, the amount of money that he or she receives as part of a superannuation lump sum is easily recognisable. Would this be considered a saving or similar investment? Given that pension lump sums help many people, they are concerned that they may need to liquidate and spend their savings.

While I am sure that the words “the person’s savings or similar investments” were carefully chosen, do they include the proceeds from the sale of a property that someone has kept in a bank so that he or she can change houses, downsize or share it out with his or her separated spouse or the superannuation lump sum, which would not be a normal saving or similar investment?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  If a person has a capital sum in a bank, the interest on the sum will be taken into account in the assessment. A superannuation lump sum in a bank is considered a capital sum.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  Where is the reference to a capital sum?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The Senator is using the term “capital sum”, not us.

  4 o’clock

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  No, I am not. Let me clarify. On page 5, line 11, the Bill reads, “...not including the income from the portion of the person’s savings or similar investments whose capital value does not exceed €36,000”. Line 19 reads “€72,000”. These provisions are clear, but there is no interpretation of “similar investments” or “savings”. If a person must liquidate his or her house and puts that money, perhaps temporarily, into a bank while trying to change, downsize or divide homes, will interest accrue as if the money is savings or a similar investment? I do not know whether they are the same. How is it rated? Where would a person’s superannuation lump sum, which he or she put aside to help in later years, fall in the calculation?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The person would be assessed only on the interest of the bank deposit. I understand the Senator’s questions and I appreciate that the person in question might not have a house. For example, he or she could have only half of a house.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  Yes.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  He or she might need to pay rent. All of these matters would need to be taken into account in an assessment. Only the interest on what is lodged in a bank is assessed.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  The Minister of State is missing the point. Someone went to the trouble of writing down those phrases. He or she did not just write “interest income”. Rather, he or [1176]she referred to income from a portion of a person’s savings or similar investments. What does this provision cover? One could not consider the sale of a house, as outlined in my example, as savings or a similar investment.

I want to be clear. It boils down to a choice between keeping money under the mattress at home and putting it into a bank. If the latter, a person could be ruled out of getting a medical card. If the former, a person could qualify for a medical card. We are discussing income.

I am trying to work out why the phrase “savings or similar investments” was included. For example, would a superannuation lump sum be taken into consideration? It could amount to €150,000. If a person’s house sold for €1 million, would the interest on the amount in excess of €36,000 or €72,000 be counted or could alternative arrangements with his or her bank be made? It is confusing.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The phrase “similar investments” was included to refer to, for example, shares. We are still discussing the interest generated from a lump sum lodged.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  I understand.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Through our amendments, we are seeking to ensure that the elderly do not suffer from inflationary measures that devalue the set gross limits, nor from any efforts by the Government to reduce the limits under the guise of deflation. For this reason, our amendment sought to substitute “shall” for “may” in section 4.

From the Minister of State’s replies, I am unsure as to whether the issues of separation and divorce are addressed clearly in the legislation. Our amendment would have addressed the issues that may arise and provided a mechanism through which to deal with assessments.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  We must recognise that this legislation provides that the Minister, following a review, can only increase rates. They cannot be reduced. The Senator referred to inflation, but protection is provided for on page 5, line 29, which reads, “specified for the purposes of this section”.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  We suggested that the word “may” be replaced with “shall”, which would impose an obligation. “May” implies an option.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  It must be pointed out that the Minister cannot reduce the gross income limits.

Question put.

The Committee divided: Tá, 27; Níl, 18.

Information on Dan Boyle  Zoom on Dan Boyle  Boyle, Dan. Information on Martin Brady  Zoom on Martin Brady  Brady, Martin.
Information on Larry Butler  Zoom on Larry Butler  Butler, Larry. Information on Ivor Callely  Zoom on Ivor Callely  Callely, Ivor.
Information on John Carty  Zoom on John Carty  Carty, John. Information on Donie Cassidy  Zoom on Donie Cassidy  Cassidy, Donie.
Information on Maria Corrigan  Zoom on Maria Corrigan  Corrigan, Maria. Information on Mark Daly  Zoom on Mark Daly  Daly, Mark.
Information on Déirdre de Búrca  Zoom on Déirdre de Búrca  de Búrca, Déirdre. Information on John Ellis  Zoom on John Ellis  Ellis, John.
Information on Geraldine Feeney  Zoom on Geraldine Feeney  Feeney, Geraldine. Information on Camillus Glynn  Zoom on Camillus Glynn  Glynn, Camillus.
Information on John Gerard Hanafin  Zoom on John Gerard Hanafin  Hanafin, John. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Terry Leyden  Zoom on Terry Leyden  Leyden, Terry. Information on Marc MacSharry  Zoom on Marc MacSharry  MacSharry, Marc.
Information on Lisa McDonald  Zoom on Lisa McDonald  McDonald, Lisa. Information on Brian Ó Domhnaill  Zoom on Brian Ó Domhnaill  Ó Domhnaill, Brian.
Information on Labhrás Ó Murchú  Zoom on Labhrás Ó Murchú  Ó Murchú, Labhrás. Information on Francis O'Brien  Zoom on Francis O'Brien  O’Brien, Francis.
Information on Dennis O'Donovan  Zoom on Dennis O'Donovan  O’Donovan, Denis. Information on Fiona O'Malley  Zoom on Fiona O'Malley  O’Malley, Fiona.
Information on Ned O'Sullivan  Zoom on Ned O'Sullivan  O’Sullivan, Ned. Information on Ann Ormonde  Zoom on Ann Ormonde  Ormonde, Ann.
Information on Kieran Phelan  Zoom on Kieran Phelan  Phelan, Kieran. Information on Mary M. White  Zoom on Mary M. White  White, Mary M.
Information on Diarmuid Wilson  Zoom on Diarmuid Wilson  Wilson, Diarmuid.  


[1177]Níl
Information on Ivana Bacik  Zoom on Ivana Bacik  Bacik, Ivana. Information on Paul Bradford  Zoom on Paul Bradford  Bradford, Paul.
Information on Paddy Burke  Zoom on Paddy Burke  Burke, Paddy. Information on Jerry Buttimer  Zoom on Jerry Buttimer  Buttimer, Jerry.
Information on Paudie Coffey  Zoom on Paudie Coffey  Coffey, Paudie. Information on Paul Coghlan  Zoom on Paul Coghlan  Coghlan, Paul.
Information on Maurice Cummins  Zoom on Maurice Cummins  Cummins, Maurice. Information on Paschal Donohoe  Zoom on Paschal Donohoe  Donohoe, Paschal.
Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Fitzgerald, Frances. Information on Nicky McFadden  Zoom on Nicky McFadden  McFadden, Nicky.
Information on David P.B. Norris  Zoom on David P.B. Norris  Norris, David. Information on Joe O'Reilly  Zoom on Joe O'Reilly  O’Reilly, Joe.
Information on Joe John O'Toole  Zoom on Joe John O'Toole  O’Toole, Joe. Information on John Paul Phelan  Zoom on John Paul Phelan  Phelan, John Paul.
Information on Eugene Regan  Zoom on Eugene Regan  Regan, Eugene. Information on Shane Peter Nathaniel Ross  Zoom on Shane Peter Nathaniel Ross  Ross, Shane.
Information on Brendan Ryan  Zoom on Brendan Ryan  Ryan, Brendan. Information on Liam Twomey  Zoom on Liam Twomey  Twomey, Liam.

Tellers: Tá, Senators Déirdre de Búrca and Diarmuid Wilson; Níl, Senators Maurice Cummins and Joe O’Toole.

Question declared carried.

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Amendments Nos. 9 and 10 are related and may be discussed together. Is that agreed? Agreed.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 9:

This amendment concerns discretionary medical cards. The two amendments to section 5 aim to flesh out and provide a statutory basis to comments made by the Minister and her Department on the issuing of discretionary medical cards. Under these amendments any terminally ill person or person experiencing hardship may apply to the Health Information and Quality Authority for a recommendation that he or she be issued with a medical card.

The amendment also proposes that if such a recommendation is made, and given the extreme circumstances a person in such a situation would find himself or herself, a medical card must be issued to the person within four weeks.

We also propose the insertion of a new section to give HIQA the authority to make such recommendations. This would provide older patients with an additional opportunity to obtain or avail of the services of a medical card should their income levels exceed those in the Bill, but if terminal illness or hardship of other sorts exist, provision would also be made in such circumstances.

This issue was discussed here previously and in the Dáil when examples were cited of people who were terminally ill who were refused medical cards. I read that the Minister said yesterday that she did not believe that should be the situation. These amendments are an attempt to ensure that such provision is enshrined in the legislation, that such people would be issued a medical card and that HIQA would be given the authority to make such a recommendation.

[1178]Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  It is not appropriate that HIQA be involved in the administration of the medical card scheme. I will repeat what the Minister, Deputy Harney, said on this issue. She said she wanted to make the position in relation to discretionary medical cards to the terminally ill very clear. She said that terminally ill patients will not be affected by any cap on the issue of discretionary medical cards and that the Department will monitor the situation to ensure this is the case.

Determination of eligibility for medical cards under both the new arrangements and section 45(1) of the principal Act is a matter for — as it has been — the HSE. Furthermore, a statutory appeals process exists for people who wish to avail of it. Therefore, I do not propose to accept this amendment.

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Is the amendment being pressed?

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  We should try to be more sensible in dealing with this issue. Terminally ill patients still have to go through the wringer to get medical cards. Likewise, cancer patients have to give all their information to the HSE. It is not that the HSE wants to be bolshy about it, but it is covered by legislation which requires it make such people jump through a number of hoops to get a medical card.

A discretionary medical card is always issued for a limited period. There is a limit on the number of them that can be issued, but the number issued is way below that limit. Given that the impact of this legislation will be dramatic for the little savings that will accrue on foot of it in the long term, there is a possibility of the Government gaining some saving grace by being a bit more humane towards cancer patients and terminally ill patients.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Is the Minister giving a 100% reassurance on this issue, based on what she said yesterday? Perhaps the Minister of State would like to clarify that.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I am sure Senator Twomey is aware, as am I, of many cases where once it was made known to the HSE that a patient was terminally ill, it immediately fast-tracked the issuing of a medical card for that person. I must be fair to the HSE in that respect.

The Minister, Deputy Harney said that 70,000 people currently avail of discretionary medical cards. She also said that terminally ill patients will not be affected by any cap on the issue of discretionary medical cards. She further said that her Department will ensure this is the case in terms of the HSE.

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Is the amendment being pressed?

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Yes.

Amendment put.

The Committee divided: Tá, 17; Níl, 27.

Information on Paul Bradford  Zoom on Paul Bradford  Bradford, Paul. Information on Paddy Burke  Zoom on Paddy Burke  Burke, Paddy.
Information on Jerry Buttimer  Zoom on Jerry Buttimer  Buttimer, Jerry. Information on Paudie Coffey  Zoom on Paudie Coffey  Coffey, Paudie.
Information on Paul Coghlan  Zoom on Paul Coghlan  Coghlan, Paul. Information on Maurice Cummins  Zoom on Maurice Cummins  Cummins, Maurice.
Information on Paschal Donohoe  Zoom on Paschal Donohoe  Donohoe, Paschal. Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Fitzgerald, Frances.
Information on Nicky McFadden  Zoom on Nicky McFadden  McFadden, Nicky. Information on David P.B. Norris  Zoom on David P.B. Norris  Norris, David.
Information on Joe O'Reilly  Zoom on Joe O'Reilly  O’Reilly, Joe. Information on Joe John O'Toole  Zoom on Joe John O'Toole  O’Toole, Joe.
Information on John Paul Phelan  Zoom on John Paul Phelan  Phelan, John Paul. Information on Eugene Regan  Zoom on Eugene Regan  Regan, Eugene.
Information on Shane Peter Nathaniel Ross  Zoom on Shane Peter Nathaniel Ross  Ross, Shane. Information on Brendan Ryan  Zoom on Brendan Ryan  Ryan, Brendan.
Information on Liam Twomey  Zoom on Liam Twomey  Twomey, Liam.  


[1179]Níl
Information on Dan Boyle  Zoom on Dan Boyle  Boyle, Dan. Information on Martin Brady  Zoom on Martin Brady  Brady, Martin.
Information on Larry Butler  Zoom on Larry Butler  Butler, Larry. Information on Ivor Callely  Zoom on Ivor Callely  Callely, Ivor.
Information on John Carty  Zoom on John Carty  Carty, John. Information on Donie Cassidy  Zoom on Donie Cassidy  Cassidy, Donie.
Information on Maria Corrigan  Zoom on Maria Corrigan  Corrigan, Maria. Information on Mark Daly  Zoom on Mark Daly  Daly, Mark.
Information on Déirdre de Búrca  Zoom on Déirdre de Búrca  de Búrca, Déirdre. Information on John Ellis  Zoom on John Ellis  Ellis, John.
Information on Geraldine Feeney  Zoom on Geraldine Feeney  Feeney, Geraldine. Information on Camillus Glynn  Zoom on Camillus Glynn  Glynn, Camillus.
Information on John Gerard Hanafin  Zoom on John Gerard Hanafin  Hanafin, John. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Terry Leyden  Zoom on Terry Leyden  Leyden, Terry. Information on Lisa McDonald  Zoom on Lisa McDonald  McDonald, Lisa.
Information on Marc MacSharry  Zoom on Marc MacSharry  MacSharry, Marc. Information on Brian Ó Domhnaill  Zoom on Brian Ó Domhnaill  Ó Domhnaill, Brian.
Information on Labhrás Ó Murchú  Zoom on Labhrás Ó Murchú  Ó Murchú, Labhrás. Information on Francis O'Brien  Zoom on Francis O'Brien  O’Brien, Francis.
Information on Dennis O'Donovan  Zoom on Dennis O'Donovan  O’Donovan, Denis. Information on Fiona O'Malley  Zoom on Fiona O'Malley  O’Malley, Fiona.
Information on Ned O'Sullivan  Zoom on Ned O'Sullivan  O’Sullivan, Ned. Information on Ann Ormonde  Zoom on Ann Ormonde  Ormonde, Ann.
Information on Kieran Phelan  Zoom on Kieran Phelan  Phelan, Kieran. Information on Mary M. White  Zoom on Mary M. White  White, Mary M.
Information on Diarmuid Wilson  Zoom on Diarmuid Wilson  Wilson, Diarmuid.  

Tellers: Tá, Senators Maurice Cummins and Liam Twomey; Níl, Senators Déirdre de Búrca and Diarmuid Wilson.

Amendment declared lost.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Amendment No. 10 has been discussed already with amendment No. 9.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 10:

Amendment put and declared lost.

Question, “That section 5 stand part of the Bill”, put and declared carried.

Section 6 agreed to.

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Amendment No. 11 is out of order, as it in conflict with the principle of the Bill.

Amendment No. 11 not moved.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move amendment No. 12:

[1180]I regret that amendment No. 11 has been deemed out of order as it would have reversed the Government’s decision to take medical cards from persons over 70. It is clear from today’s discussion that the Government is not prepared to accept any amendments in the Seanad. That is unfortunate, as some of the amendments would have reversed some of the damage that has been done by the decision. For example, if the amendment had been accepted it would have also dealt with discretionary medical cards.

Amendment No. 12 is in line with some of the earlier amendments. Its purpose is to seek to have a report made to the Dáil and Seanad on the number of people being excluded from the medical card on a monthly basis once the legislation is enacted. When the letter is issued asking persons to declare their means in order to find out whether they are eligible to retain their medical cards, it would be important to hear from the Minister on a regular basis. The amendment seeks to provide information to the Houses on the number of persons over 70 who are being excluded from the medical card scheme according as it is obtained. We need that information because there is much disagreement about the number of people affected by the Government decision. The situation is far from clear. The Minister of State is aware of the significant disagreement about how many persons will lose their medical cards once the returns are made by individuals. She said today the letter will be sent out in January. This is an information exercise on the impact of the Government’s decision to withdraw the medical card from over 70s.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I do not propose to accept this amendment. The matter referred to is of an administrative nature and does not warrant imposing an obligation on the Minister to make monthly reports to the Dáil.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  The effects of the amendment are obviously far from being administrative as the provision affects people’s eligibility and whether they have a medical card and access to services. It is actually an amendment that considers what is happening to individuals and the number who will have their medical card withdrawn as the new system commences.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Perhaps the Joint Oireachtas Committee on Health and Children, at its quarterly meeting with Professor Drumm and the Minister, can consider the report rather than the Houses.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  When former Minister for Health and Children, Deputy Martin, announced in 2001 that there would be medical cards for everybody over the age of 70, the one point that he got dramatically wrong was the actual number of people in this category. The Minister of State, Deputy Hoctor, stated the reason she is fixed on the figures of €600 and €1,200 is because the Revenue Commissioners have told her the establishment of thresholds at these values would ensure 95% of the population will be covered.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The figures are €700 and €1,400.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  It is arbitrary to state 95% of people over 70 will have free medical cards while 5% will not. This is a funny way of doing business at the best of times. Our amendment seeks to ensure that we get it right. If we notice that many people over 70 are losing their medical cards at a quite dramatic rate and it is indicated that the Department’s figures could be wrong, there will be a need to adjust the figures pretty rapidly so we will not remove the medical card from people from whom it was never intended to remove it. We want coverage of 100% but the Minister of State is happy with 95%. However, the percentage could [1181]decrease to 90% or 93% and the way of adjusting for this is to have the HSE provide us with the relevant information in this regard rapidly so we can make rapid adjustments, if necessary.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  My statement remains the same; I do not propose to accept the amendment.

Amendment put and declared lost.

Question, “That section 7 stand part of the Bill”, put and declared carried.

Section 8 agreed to.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I move amendment No. 13:

This amendment might be a bit difficult to understand but it concerns the health levy. It goes without saying that everybody with a medical card does not pay a health levy, regardless of whether one is over or under 70. A new section is being introduced such that everybody over 70 who will not receive a medical card will not have to pay the levy. Is it possible that the Minister could provide to the House the amount of the health levy that is not paid by those over 70 with a medical card and the amount of the health levy not paid by those over 70 without a medical card? Could the Revenue Commissioners provide this information to the House so we will have an indication of how important the Government’s section was? There is much talk about millionaires and billionaires and very rich people to whom the Government feels it should not be giving a medical card. In respect of these people, the 2% health levy would amount to a significant sum. Does the Minister of State feel we should examine the two figures I seek? If the multimillionaires and billionaires about whom the Government representatives are talking were actually paying the health levy, we might be able to give the medical card to 99% of those over 70.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  As a point of information, widows and widowers, irrespective of age and income, do not pay the health levy. I know this from personal experience. It would be very difficult to try to ascertain who does not pay the levy. I am not trying to be awkward in saying this.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I do not propose to accept the amendment. The matter being referred to is of an administrative nature and does not warrant a report to the Oireachtas. I will not be accepting the amendment.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  Is the Minister of State opposed to making the information available?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  We have no means of calculating the amount people who do not pay. Therefore, the amendment does not stand up.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I do not pay the levy because I am a widow, but if I were not I would feel it were an invasion of my privacy if someone were giving out information I did not want given out.

[1182]Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I would not want to see the Senator’s tax returns or anybody else’s. We are simply seeking the gross figures in the same way that all those who availed of tax loopholes in recent years must now include the relevant figures in their tax returns, which they did not have to do for very many years.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The Senator’s proposal would impose an unnecessary administrative burden. I do not accept the amendment.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  There is no administrative burden. It has been said that people over 70 have lost their medical cards because of the number of millionaires and billionaires over 70 running around with their gold cards in their back pockets. If the payment of the income levy is not required by those who are extremely wealthy, it contradicts the purpose of the legislation in the first instance.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  What is the purpose of obtaining the information the Senator seeks?

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The Senator may well be right that there is a substantial number of millionaires and billionaires over 70 benefiting from not having to pay income tax. However, it may also be the case that there are not many people over 70 with such wealth. Consequently, it serves no great purpose to abolish their medical cards.

Senator Geraldine Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  What would we do with and what is to be ascertained from the information on the amount of people who do not pay the levy?

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  That is not the issue; the point concerns the actual amount. I just want the details on whether this information could be obtained. The information would point out whether there are people over 70 earning vast incomes. It may be too late on Friday evening to discuss this. Perhaps we will discuss it when considering the Finance Bill.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I still see no sense to the proposal.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I will try to obtain the information myself from the Department of Finance.

Amendment, by leave, withdrawn.

Question proposed: “That section 9 stand part of the Bill.”

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  On section 9, it is unfortunate that the Government has not been willing to accept any amendments.

Some of these amendments would have proved to be very useful in the months to come and would have obviated confusion for various groups. I believe it is a very retrograde step that this legislation is coming before the House today. The Government has made five U-turns on the legislation and it is unfortunate that it is before us in its present form and will be pushed through this House.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  I have no more to say on it. I already stated that I will not be accepting——

Question put and declared carried.

[1183]Sections 10 and 11 agreed to.

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Amendment No. 14 is in the name of Senator Fitzgerald.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I move amendment No. 14:

  5 o’clock

The Minister of State referred to the sharing of information between the Registrar of Births, Deaths and Marriages and the HSE, which already applies under section 45 of the 1997 Act. Will the Minister of State confirm whether there is a formal system for supplying information from the Registrar of Births, Deaths and Marriages to the HSE on children under the age of one, or five, and patients over 70? Is some formal arrangement in place with the HSE to identify specific age groups within the health services? Perhaps she will clarify the situation in that regard.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Yes, we can get that information directly from those sources to update our records.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  Will the Minister of State explain then how we GPs are often accused of getting paid for patients who have died? There appears to be a problem here. I am aware that the HSE in my local area is very involved in registering patient deaths in County Wexford. Concern has been expressed, and I realise it has been rebutted several times, about the HSE paying for patients who are deceased. Is that because this shared arrangement is not working?

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  The Senator will appreciate that there is sometimes a time lag between the death of a person and the registration of his or her death. There are also cases, of course, where deaths are not registered. As a GP, Senator Twomey will appreciate that doctors are requested and obliged, indeed, to inform the HSE when patients die and——

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  They are not.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  ——-when there is a change of address, for example.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  Half of patients die in hospitals. Nobody tells us half the time.

Deputy Máire Hoctor: Information on Máire Hoctor  Zoom on Máire Hoctor  Where the information is available to the GP, he or she is obliged to inform the HSE so that it can have its records updated.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  It was something I was not aware of, but I just wanted to get confirmation that it was the case, and it should be improved.

Amendment put and declared lost.

Title agreed to.

Bill reported without amendment and received for final consideration.

Question put: “That the Bill do now pass.”

[1184]The Seanad divided: Tá, 27; Níl, 15.

Information on Dan Boyle  Zoom on Dan Boyle  Boyle, Dan. Information on Martin Brady  Zoom on Martin Brady  Brady, Martin.
Information on Larry Butler  Zoom on Larry Butler  Butler, Larry. Information on Ivor Callely  Zoom on Ivor Callely  Callely, Ivor.
Information on John Carty  Zoom on John Carty  Carty, John. Information on Donie Cassidy  Zoom on Donie Cassidy  Cassidy, Donie.
Information on Maria Corrigan  Zoom on Maria Corrigan  Corrigan, Maria. Information on Mark Daly  Zoom on Mark Daly  Daly, Mark.
Information on Déirdre de Búrca  Zoom on Déirdre de Búrca  de Búrca, Déirdre. Information on John Ellis  Zoom on John Ellis  Ellis, John.
Information on Geraldine Feeney  Zoom on Geraldine Feeney  Feeney, Geraldine. Information on Camillus Glynn  Zoom on Camillus Glynn  Glynn, Camillus.
Information on John Gerard Hanafin  Zoom on John Gerard Hanafin  Hanafin, John. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Terry Leyden  Zoom on Terry Leyden  Leyden, Terry. Information on Marc MacSharry  Zoom on Marc MacSharry  MacSharry, Marc.
Information on Lisa McDonald  Zoom on Lisa McDonald  McDonald, Lisa. Information on Brian Ó Domhnaill  Zoom on Brian Ó Domhnaill  Ó Domhnaill, Brian.
Information on Labhrás Ó Murchú  Zoom on Labhrás Ó Murchú  Ó Murchú, Labhrás. Information on Francis O'Brien  Zoom on Francis O'Brien  O’Brien, Francis.
Information on Dennis O'Donovan  Zoom on Dennis O'Donovan  O’Donovan, Denis. Information on Fiona O'Malley  Zoom on Fiona O'Malley  O’Malley, Fiona.
Information on Ned O'Sullivan  Zoom on Ned O'Sullivan  O’Sullivan, Ned. Information on Ann Ormonde  Zoom on Ann Ormonde  Ormonde, Ann.
Information on Kieran Phelan  Zoom on Kieran Phelan  Phelan, Kieran. Information on Mary M. White  Zoom on Mary M. White  White, Mary M.
Information on Diarmuid Wilson  Zoom on Diarmuid Wilson  Wilson, Diarmuid.  


Níl
Information on Paul Bradford  Zoom on Paul Bradford  Bradford, Paul. Information on Paddy Burke  Zoom on Paddy Burke  Burke, Paddy.
Information on Jerry Buttimer  Zoom on Jerry Buttimer  Buttimer, Jerry. Information on Paudie Coffey  Zoom on Paudie Coffey  Coffey, Paudie.
Information on Maurice Cummins  Zoom on Maurice Cummins  Cummins, Maurice. Information on Paschal Donohoe  Zoom on Paschal Donohoe  Donohoe, Paschal.
Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Fitzgerald, Frances. Information on Nicky McFadden  Zoom on Nicky McFadden  McFadden, Nicky.
Information on David P.B. Norris  Zoom on David P.B. Norris  Norris, David. Information on Joe O'Reilly  Zoom on Joe O'Reilly  O’Reilly, Joe.
Information on John Paul Phelan  Zoom on John Paul Phelan  Phelan, John Paul. Information on Eugene Regan  Zoom on Eugene Regan  Regan, Eugene.
Information on Shane Peter Nathaniel Ross  Zoom on Shane Peter Nathaniel Ross  Ross, Shane. Information on Brendan Ryan  Zoom on Brendan Ryan  Ryan, Brendan.
Information on Liam Twomey  Zoom on Liam Twomey  Twomey, Liam.  

Tellers: Tá, Senators Déirdre de Búrca and Diarmuid Wilson; Níl, Senators Maurice Cummins and Frances Fitzgerald.

Question declared carried.


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