asked the Minister for Health the number of medical cards currently held by residents of County Mayo; the number of applications made since 1 January 1983; the number of medical cards withdrawn to all categories since 1 January 1983; and the number of old age pensioners who have had their medical cards withdrawn since 1 January 1983.

On 28 February, the last date for which information is available, there were 38,762 medical cards current in County Mayo.

There were 1,343 applications received in the first four months of this year. During the same period 1,063 cards were withdrawn, which included 106 held by old age contributory pensioners.

I take it that 38,762 is the total number of cards held. Can the Minister of State tell me what percentage of the total population that represents?

The average for medical cards is 61.43 per cent and the average in respect of the overall population is 37.13 per cent.

Does the Minister agree that the withdrawal of 1,063 medical cards in such a short period in a county with a very high dependency on medical cards is quite significant and must be causing considerable hardship? Will the Minister indicate when he will bring in realistic guidelines for applications for medical cards so that medical cards will be issued on the net carry home pay and not on this ridiculous gross income system that exists at present?

We have guidelines and we operate them. They are the guidelines the Deputy operated when he was on this side of the House.

I must press this matter. Does the Minister realise that from the first week in July this year two non-contributory old age pensioners in receipt of the maximum pension will not be entitled to a medical card because they will be in excess of the £77 guideline which the Minister is trying to justify? Will the Minister give an undertaking to the House that he will reduce these ridiculous guidelines at present operated by the health boards to bring some relief to old age pensioners and others in the lower income group so that they can at least have the comfort of medical cards?

The guidelines were reviewed in January and they will be reviewed again before the end of 1983.

The Minister is not a friend of old age pensioners.

6.

asked the Minister for Health the revision, if any, that will be made in 1983 in the guidelines for the issue of medical cards; and if he will make a statement on the matter.

The guidelines for eligibility for medical cards are reviewed annually and revised, as necessary, with effect from 1 January to take account of changes in the cost of living during the previous 12 months. Such a revision has already taken place with effect from 1 January of this year. The guidelines will be reviewed again before the end of 1983. Any revision to be made at that stage will depend on changes in the cost of living during 1983.

Do I understand from the reply that there may be a change in the guidelines during 1983?

No. The guidelines will be reviewed again before the end of 1983. They will not be reviewed until the end of 1983, to be implemented by 1 January.

Will the Minister accept that there have been some fundamental changes in the use of medical cards since 1 January 1983 when the last guidelines were implemented? There is the use of the medical card for eligibility for school transport and there has been a tremendous increase in the cost to patients in respect of the drugs refund scheme under which patients are obliged to pay almost 100 per cent more than last year, £23 per month. This causes hardship for a number of people and therefore there is a legitimate reason why the guidelines should be looked at. Many people just above the guidelines are not in a position to meet their needs.

No matter what line you draw there will always be someone above the line who cannot manage. The review resulted in a 12.3 per cent increase from 1 January last based on the CPI from mid-November 1981 to mid-November 1982. That was a reasonable increase in the circumstances.

Do I understand the Minister to tell us that he accepts that a couple in advanced years with an income of £77 a week are capable of paying for their total medical expenses, doctors and prescriptions?

I did not say that.

But is that not the reality? That is the guideline. The situation is that from the first week in July two old age pensioners living together will not be entitled to a medical card if they have that income.

They will be if they have only that income.

If they have more than that they will not be entitled. With the miserable increase the Government have given in the budget they may be slightly in advance of £77. What will the Minister do to allow such people to hold medical cards?

The Deputy is making speeches.

I am making speeches on behalf of old people who are unable to make them for themselves.

The Deputy should take steps to have Standing Orders amended if he wants to make speeches at Question Time.

As the Minister responsible for social welfare beneficiaries, will he accept that it is not possible for people with that kind of income to provide for medical expenses?

The guidelines are long-established. They are being increased in the normal way as they were when the Deputy was on this side. For some reason he was not so vocal then. We must have guidelines. If we increase the income by another £5 people would still be coming to us asking if they were expected to live on that. A line must be drawn. I do not dispute that people are entitled to argue on it. The guideline in this respect was accepted by the Deputy when he was on this side.

Is £77 a suitable guideline? The Minister is shirking his responsibility.

I got the impression that the Minister said there is a possibility that the guidelines will be reviewed before 1 January next.

They will be reviewed towards the end of the year with a view to implementing them by 1 January. The health boards will then be informed before 1 January.

At present there is an annual review. Would the Minister revert to a half-yearly review?

Because of the constraints we have in regard to overall capital, and throughout the health board areas, one must weigh carefully any intention to have reviews other than once a year. The budget is presented on an annual basis and it is on that that we are able to make our recommendations.

Now that the Minister for Finance has his hands in the banks' kitty the Minister will have plenty of money.