Adjournment Debate.

Medical Smart Cards.

Dr. Devins

We are in the midst of reform of the health service and it is hoped this reform will take many different shapes and sizes. I welcome the fact that information technology or IT services will be centralised. Until now, IT services have been run on an ad hoc basis by each health board. In the past, certain health boards could not communicate with others through their IT services. I hope this problem will soon be a thing of the past.

Arising out of the fact that IT services will be centralised, I ask the Minister of State to give serious consideration to the introduction of medical smart cards. Everyone is aware that patient records are extremely important. Most GPs now keep comprehensive computerised records of their patients' histories, including information on drugs they are taking, their relevant past medical details, allergies they may have, their blood groups, etc. When a patient is referred to a hospital, it is frequently the case that all that accompanies them is a letter. Sometimes such letters are comprehensive and outline in great detail the information to which I have just referred. In many cases, however, tests are duplicated in hospitals.

Let us consider a case where a patient becomes ill while away from home. A doctor in a hospital or the GP who sees him will frequently not have access to the information relative to him. I propose, therefore, that each patient should have a smart card, similar to a bank card, to carry. All the relevant information could be stored on the card. Whoever sees the patient would then be able to access the information immediately. There will be situations where patient confidentiality could be disturbed. I propose, therefore, that each patient would be given a unique PIN number — again, similar to that which accompanies one's bank card — of which only he or she would have knowledge. Introducing smart cards would represent a strong step forward, while PIN numbers would ensure that patient confidentiality would be totally and utterly maintained.

In light of the reforms being put in place, I ask the Minister of State to seriously consider the introduction of such a card. I understand that such cards are available in certain states in Australia and that the system is working well.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

At present, there are no plans to introduce medical smart cards. The national health information strategy was launched earlier this year. This sets out a strategic direction for the future application of information technology in the health services. Following on from this, an information technology strategy is being finalised under the auspices of the Health Boards Executive. This will be more technology oriented and is designed to facilitate, in due course, consideration of the appropriateness of specific technology tools and services which would include smart cards.

In general the use of smart cards in health is being considered internationally for patient identification only, patient identification and emergency medical data or patient identification, emergency medical data, and some part of the patient's medical record. However, the use of smart cards in health is not widespread. Various pilot trials are in operation and the jury seems to be still out on the precise role smart cards will play in the future in health. The predominant view seems to be that they will be used for patient identification only, with medical information held on a separate database rather than on the card itself. Considerations of data security, costs and acceptability to patients are high on the agenda in discussions about the use of smart cards in the area of health. While the concept of using smart cards in health has been discussed for a considerable period, this has not been reflected in implementation on the ground.

The Department of Health and Children is participating in a recent initiative of the Department of Social and Family Affairs regarding the development of a standards-based framework for the public service card, using the personal public service number as a unique identifier. This will mean that any initiative for a public service card to access services, including those relating to health, will be fully compatible with the framework, rather than a client having to carry multiple cards that would, perhaps, require different types of access equipment. It is envisaged that use of the personal public service number as a unique identifier in the health service will be covered by legislation which will follow as part of the overall e-Government programme.

As well as our national initiative under the e-Government programme, the European Commission is also active in this area and is planning adoption of an electronic health insurance card by 2008. Discussion on this is at a very early stage. This would replace the European health insurance cards introduced this year as a replacement for E111 cards.

While there are no smart cards in use in the health services, the general medical services payments board uses a card with a magnetic strip for drug refunds. This can be used in a community pharmacy to validate eligibility. The general medical services board is participating in the Department of Social and Family Affairs initiative to which I referred earlier and any future developments of cards, including medical cards, managed by the board will be in compliance with whatever outcome emerges from that initiative.

Public Nursing Homes.

Mr. Perry

I am delighted the Minister of State is present and I hope he will be able to provide answers on this important issue.

Since 2001 the Government has illegally charged thousands of elderly pensioners in public nursing homes. Prior to that date, health boards were legally entitled to seek a contribution from medical card holders in long-term care. In other words, their full eligibility to free inpatient service was reduced and the health boards could legally seek a contribution from them. For anyone 70 or over, the Health (Miscellaneous Provisions) Act 2001 clearly confers full eligibility to free inpatient services. The Act does not allow for that eligibility to be diminished of for charges to be levied.

Does the Minister of State accept that all persons aged 70 or over in public nursing homes have been illegally charged since 2001? Will he quantify the number of pensioners affected and the amount of money they have paid in the past three years? How long has the Department of Health and Children and successive Ministers been aware of this illegal charging? Will he arrange to have those patients who have been overcharged reimbursed from the central Exchequer and not from the already over-stretched health budget?

I will now set out the position in respect of charges for persons in long-term care units. These units include community-district hospitals, community nursing units and those private nursing homes where the State contracts beds for the provision of long-term care. Under section 45 of the Health Act 1970, a chief executive officer is empowered to change the eligibility status of a card. However, under section 1 of the Health (Miscellaneous Provisions) Act 2001, section 45 of the 1970 Act was amended to include the term "a person who is not less than 70 years of age ... shall have full eligibility". This cannot be diminished.

The Department must be aware that this illegal charging has been implemented for the past three years and that it is ongoing. Has it sought an opinion from its legal advisers since 2001? What has it done about such advice and when will it remedy the situation? Has the Tánaiste been apprised of the huge liability that will befall the State?

There is no ambiguity about this illegality. The Minister must take immediate and decisive action to initiate a thorough inquiry into how her Department allowed this unacceptable scenario to arise and continue for more than three years. The Government must indicate whether the decision to give full eligibility to all persons over 70 years was intended so that they would not have to contribute towards long-term care. If such a person has been illegally charged, how much is estimated to be involved and what steps will be taken to refund the amounts charged? Will compensation be paid to those persons as a result of the losses they incurred?

The Ombudsman's reports of 2002 and 2003 highlighted cases in which refunds had been made. There is, therefore, a precedent. The health boards have raised this matter with the Department. What advice has been received? What is happening about these charges? Responsibility rests entirely with the Government, not the health boards, which sought legal opinion on this matter in the past three years. No decisive action has resulted.

The scheme was introduced prior to the last general election and the number of people eligible under it was miscalculated. Full eligibility was given to people in long-term care. Prior to that, the medical card could be diminished once the patient went into long-term care. These cards, however, cannot be diminished. There is a legal obligation on the State in this regard. I have dealt with several cases in which probate was taken out and the State recovered debt where people illegally received pension entitlements. It was taken from their estate. The State has taken money illegally from the most vulnerable people in society. I call on the Minister to ensure all illegal charges are refunded. This serious issue stretches back over three and a half years.

Mr. T. O’Malley

I thank the Deputy for raising this matter. Eligibility for health services is primarily based on residency and means. Under the Health Act 1970, determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board other than for persons aged 70 years and over, who are automatically eligible for a medical card.

Medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship.

However, the principle that it is fair and reasonable that those who can afford to contribute to the cost of their long stay care should do so is central to our system of publicly funded long-term care. The health strategy reinforces this point and states:

It is recognised that quality care is expensive and that the bulk of the cost of providing a high standard of quality care should be borne by the exchequer. Nonetheless, it is fair that all those in receipt of publicly provided residential long-term care should make some payment towards accommodation and daily living costs, if they can afford to do so, just as they would if they were living in the community. This principle supports the aim to provide as high quality a service as possible and to make the most equitable use of resources and thus to help maximise the availability of these services.

The current position reflects this approach.

Charges for long-stay care in health board institutions may be raised under the Health (Charges for Inpatient Services) Regulations 1976, as amended in 1987. These regulations enable charges to be made towards the cost of providing hospital inpatient services for persons with income who have been in receipt of such services for more than 30 days or periods totalling more than 30 days within the previous 12 months. Inpatient service charges are payable only by persons with limited eligibility. Medical card holders are exempt from the charges, as are persons with dependants.

Charges may also be made under the Institutional Assistance Regulations 1965 where the patient receives "shelter and maintenance" rather than treatment. These charges apply from the date of admission and are payable by all patients in receipt of incomes, including medical card holders and persons with dependants.

Health boards have regard to the person's individual circumstances in deciding the amount to be contributed. Allowance is made for the financial commitments the person may have and a reasonable amount is left to meet the person's needs. Charges may be waived if, in the opinion of the chief executive officer of the appropriate health board, payment would cause undue hardship. Different arrangements apply to financial contributions from people availing of public long-stay care, as opposed to those accommodated in private nursing homes, for example, under the Health (Nursing Homes) Act 1990.

The health strategy, Quality and Fairness — A Health System for You, acknowledges the need to clarify and simplify eligibility arrangements and sets down a commitment to introduce new legislation to provide for the introduction of clear statutory provisions on entitlement and eligibility. A review of all existing legislation in this area has been carried out in my Department and this will inform the approach to the drafting of new legislation in this area. As part of this exercise, my Department will attempt to resolve the current differences in approach in the consideration of individuals' ability to pay under the various regulations in this area. My Department is consulting the Attorney General on these issues and will address this situation in light of the advice received. I trust this assists in clarifying the position for the Deputy.

Flood Relief.

Mr. Sherlock

I am glad of the opportunity to raise the matter of the urgent need for the early implementation of the flood relief programme for Fermoy, County Cork, which was approved following public consultation, and the urgent need for the provision of finance at an estimated cost of €24.4 million, especially given the substantial damage to business and residential property. Business and residential premises were badly flooded in the Brian Boru Square and Rathealy Road area of the town.

Flood relief plans, which were drawn up simultaneously for Mallow, have received the go-ahead. They will be implemented in the new year at a cost of €25 million. Both schemes were drafted at the same time and I call on the Minister of State to commence the Fermoy scheme. It would be better to implement it rather than compensate people for damage to their property.

Mr. Coveney

I am glad the Minister of State at the Department of Finance, Deputy Parlon, is present. He visited Clonmel to view the damage caused last week but I do not know whether he visited Cork. It is also nice that the new Minister of State at the Department of the Environment, Heritage and Local Government, Deputy Batt O'Keeffe, is present and showing interest in this issue.

Mr. Kenny

Is he not from Ballincollig?

Mr. Coveney

He is Minister for the incinerator. A significant number of households and businesses in Cork were destroyed or severely damaged by flooding last week. Many of the businesses affected are not insured because of their location. It was too expensive for some to take out insurance while others were not quoted at all, particularly in the heart of Cork city and Carrigaline. The Minister of State was on radio discussing this issue earlier and he correctly informed people about what is happening. How much compensation is available to households and businesses? What are the criteria? How can people apply? How long must they wait before they get it? What plans has the Government to put funds and strategies in place to ensure the likelihood of such carnage is reduced in future? The flooding in Carrigaline, which the Minister of State, Deputy Batt O'Keeffe, will know well, mirrors the flooding of four years ago. Engineering solutions to the problems have been put on the long finger because the necessary grant aid from the Department of the Environment, Heritage and Local Government is not forthcoming in order to move forward schemes such as the Cork harbour main drainage scheme that affects areas like Carrigaline. The housing estate of Mount Rivers had between 30 and 35 houses under five or six feet of water at certain times during the flooding. We must ensure that everything possible is done to minimise the chance of that happening in the future. Generous and swift relief must be provided for people who do not have insurance cover for the damage caused. Some areas will not be provided with insurance cover in the future. Insurance companies have informed householders that they will be covered on this occasion but not in the future. The State needs to step in when instances such as these occur. The State has allowed development to proceed and this has added to the engineering problems that resulted in the flooding of last week.

Minister of State at the Department of Finance (Mr. Parlon)

I express sympathy on my own behalf and that of the Government to everyone affected by the flooding throughout the country over several days during the last week of October 2004. This has been a traumatic experience for everyone affected.

The Government has today approved and announced a humanitarian aid package to relieve hardship arising from the flooding of people's homes as a result of this severe rainfall. OPW officials will meet the Irish Red Cross Society in the morning to progress the matter and details of the scheme will be announced as quickly as possible. The Irish Red Cross Society has much experience in handling such schemes and invariably does so in the most efficient and humane way.

The Government is committed to a strategic flood management policy. Just last month the Government approved the recommendations of the flood policy review group. This confirms the lead role of the OPW in taking a strategic approach to flood management in the future and working in co-operation with the relevant local authorities. The programme of flood relief schemes currently on hand will be implemented as resources permit in the context of an integrated, long-term strategy on flood management. This strategy calls for considerable emphasis on non-structural flood management measures, for example, flood warning systems, flood mapping, guidelines on development and formulation of catchment flood risk management plans to foster a catchment-based approach to flood management. Account will be taken of the need to prioritise expenditure in the areas of greatest need and to be mindful of the implications of climate change.

The OPW has conducted feasibility studies to assess flood risk and to develop flood alleviation schemes in several areas throughout the country prone to flooding. These studies have been undertaken either by OPW's engineering services or through external consultants and include such areas as Clonmel, County Tipperary, Mallow and Fermoy in County Cork, Waterford city, Carlow town, Mornington, County Meath, and Ennis, County Clare. Other areas, which include Enniscorthy County Wexford, Templemore, County Tipperary, Arklow, County Wicklow, and Tullow, County Carlow, are currently in the process of having feasibility studies completed. The OPW works closely with local authorities in the development and implementation of flood relief schemes.

A number of these proposed schemes will be placed on formal public exhibition by the OPW early in 2005. Phase one of the Mallow flood relief scheme is currently being exhibited by the local authority under Part 8 of the Planning and Development Regulations 2001, and subject to it successfully completing the planning stage, will commence construction work in March 2005. These works will be funded by the OPW and executed by the local authority. The timetable for completing all phases of all these schemes will depend on the availability of funds and prioritisation of the large number of schemes that are required in the various locations.

Deputy Sherlock raised the issue of exhibiting the Fermoy flood relief scheme by a Part 8 process, but this will not be possible as most of the lands affected are in private ownership, which means that the best method of exhibition and construction will be under the Arterial Drainage Acts. In any case, before the Fermoy scheme is built it is essential to have an effective flood warning system in operation and the OPW has already commenced this development as part of phase one of the scheme. The formal public exhibition of this scheme, as required under the Arterial Drainage Acts, will take place early in 2005.

Asbestos Waste.

Mr. Kenny

I wish to share my time with Deputies Cooper-Flynn and Cowley. I was surprised last Sunday evening to receive a message on my telephone that it was proposed to unveil a new proposal for thermal treatment of asbestos to be sited at the old Asahi plant at Killala, run by Irish Environmental Processors Limited of Dublin, in association with ARI Technologies of Washington, USA. This has given rise to grave concerns in the area. Local people have expressed fears about the disposal of asbestos.

I wish to highlight the Government's policy on the disposal of asbestos. As the Minister of State will be aware, the Asahi plant was the recipient of acrylonitrile, a very dangerous substance that was transported by rail to Ballina station for many years and from there to the Asahi plant at Killala by special container. The road was specifically developed for that purpose. Six hundred people attended a meeting last night on the situation. I wish to ask the Minister of State about Government policy on thermal treatment of asbestos as distinct from disposal of asbestos in landfill as licensed by the Environmental Protection Agency.

Whatever proposal was made for an incinerator at Ringaskiddy, Cork County Council refused to zone the land for that purpose and the application could not proceed. Twenty thousand objections were received. The proposers brought their proposal to Bord Pleanála and the board's inspector gave 15 reasons the incinerator should not go ahead. However, it did go ahead, by virtue of an extraordinary decision by Bord Pleanála, because it was based on "Government policy". What is Government policy in regard to the disposal of toxic asbestos by thermal treatment? We know nothing about this. I understand that ARI Technologies has been licensed and certified by the EPA in the United States. This seems to be a proposal that will cause a great deal of controversy. The road system in that region is not capable of dealing with this proposal. If this is to be the only asbestos disposal treatment unit in Europe, does this not mean that imports of other contaminated and toxic waste could end up on the shores of County Mayo? For the sake of an investment of €10 million and 31 jobs, it does not appear to be a very favourable solution for an area that has been suffering from unemployment for some years. If it is possible I wish the Minister of State to inform the House of the Government policy on the disposal of asbestos by thermal treatment. Is the Government in support of that method?

With reference to Ringaskiddy, if the Government supports this method, there is little we can do about it but if it does not, then we can fight it.

Ms Cooper-Flynn

I thank Deputy Kenny for allowing me a few brief moments of his time. One thing on which we know Government policy is the issue of job creation. Government policy states that through the Government agencies, 50% of all new jobs created will go to the BMW region. In light of that fact, the House will be surprised to know that in 2002 and 2003, the net jobs created in County Mayo was minus 366 in 2002 and minus 87 in 2003. A cynical person and a cynical Deputy, which I do not believe I am, would say that the only two new projects that came to my county in recent years were a sludge drying plant for Geesala and this proposal for an asbestos thermal treatment plant at the old Asahi site near Killala. This will create a maximum of approximately 30 jobs over a period of ten years. Some 600 people from the local community, a large proportion of the people from the Killala area, attended a local meeting last night. They are totally opposed to this project. It means three to five truck movements carrying asbestos through the town of Ballina out to the plant every day. It might represent a €10 million investment at the plant but that is of no benefit to the people of the area. An examination of the risk benefit analysis, would cause one to ask what is in it for the people of Mayo. What is known about the pioneering technology that this company proposes to use? Does the Government know anything about it? Does it consider it to be safe? What is the track record of this company in the area in asbestos thermal treatment? What are the policies of the Government with regard to bringing asbestos from other countries into Ireland and treating it here thermally? What is the current level of asbestos?

Dr. Cowley

I am very grateful to Deputy Kenny for the opportunity to speak on this important matter. I attended the meeting last night, which was attended by several hundred people, and not one person spoke in favour of this project because Mayo is getting the jobs no other area wants. We do not want the jobs other areas do not want. We want the same jobs as other areas but we have not been getting them because we do not have the necessary infrastructure. The Indecon report and the mid-term review of the national development plan proved that we did not get the investment for infrastructure that was given to other areas. There is underinvestment in Mayo.

We already have too much waste in Mayo. The waste from Sligo is brought to Ballina. A super-dump is planned for Carracastle to take the waste from Roscommon. These are dirty jobs. There was supposed to be 1,000 jobs in Asahi but it turned out to be 300. Those people are gone now but the mess has been left behind, yet it is intended to bring all the asbestos in the State to Mayo. Moving asbestos is dangerous. It causes fibres which can cause fibrosis and cancer of the lungs. That is a fact. It is obvious this project will create a major problem. The people of the area are not prepared to take these dirty jobs. They want proper jobs but they will be powerless if a Ringaskiddy type job is done on this. Will that happen or will the Minister allow democracy take its course because no one in Mayo wants these jobs?

Minister of State at the Department of the Environment, Heritage and Local Government (Mr. B. O’Keeffe)

I thank Deputies Kenny, Flynn and Cowley for raising a matter that is obviously of major importance to them.

I am aware from media reports of the apparent intention of a company to seek to develop a waste facility for asbestos in County Mayo. I understand also that the proposers of the project have had discussions with the local authority. There is nothing to prevent individuals or companies from seeking to develop waste management facilities. Indeed, the private sector plays an important and growing role in the provision of waste management services and infrastructure. Any such development, however, must comply with our stringent planning and environmental standards. It would be necessary for such a facility to obtain planning permission from the relevant local authority and to secure appropriate licensing from the Environmental Protection Agency. These processes operate independently of the Government.

The EPA has prepared a national hazardous waste management plan, as it is required to do under the Waste Management Act, and established an associated implementation committee. This national plan recommends that Ireland strive to become self-sufficient in the management of hazardous waste. In this context, it recognises that the lack of hazardous waste disposal capacity is the principal bottleneck in dealing with this waste stream. Consequently, the plan recommends that hazardous waste disposal capacity in the form of thermal treatment and landfill be developed. Such developments would reduce or eliminate the unsustainable situation whereby significant and increasing quantities of hazardous waste are exported for recovery and disposal. There is an onus on Ireland to address this problem and to take responsibility for the waste we generate.

Proposals for hazardous waste treatment facilities will be examined by the EPA bearing in mind the national hazardous waste management plan's target that we move towards self-sufficiency in dealing with this waste stream. In dealing with licence applications, however, the EPA is precluded from licensing a facility unless satisfied that the activity, when carried out under licence, will not cause environmental damage. The agency sets stringent emission value limits to meet the accepted EU standards and guidelines as a minimum requirement. It also evaluates the potential impact of the maximum licensed emission on the environment surrounding the facility to ensure that all EU standards for the environment and all guidelines of the World Health Organisation are met. The agency takes the view that if the licensed emission limit is complied with, human health is protected in line with best international practice. Appropriate monitoring and auditing of the operation of the facility is carried out by the agency to ensure compliance.

The reality is that additional capacity is required nationally to deal with the hazardous waste we generate. However, proposals on the provision of such facilities will be subjected to the normal stringent and independent planning and environmental assessments. I am satisfied that these processes are sufficiently robust to ensure that necessary facilities are developed only to a scale and in locations compatible with the highest standards in terms of the protection of human health and the environment.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 3 November 2004.

Dáil Éireann debate - Tuesday, 2 Nov 2004