Deputy Spring has been given permission to raise on the Adjournment matters relating to the alleged Government decision to abolish the refund of drugs scheme with effect from 1 January next.
Adjournment Debate. - Refund of Drugs Scheme.
I thank the Ceann Comhairle for facilitating me this evening as this is a matter of great public importance. I also thank the Minister for being in the House.
The reason this issue is being discussed here tonight is that the Minister for Health revealed a week or so ago that he has identified a total of £11 million in savings in the community drugs schemes operated by the health boards. Having done this, the Minister today issued a statement in which he had the neck to deplore the anxiety caused to patients all around the country because we made that information public. That statement was out after 24 hours of scratching around for a response. The Taoiseach, the Minister, his Private Secretary and the Government Press Secretary had opportunities in that 24 hour period to defuse anxiety and each was asked to comment in the last 24 hours since I raised this matter in the House yesterday morning. Despite these opportunities they declined to say anything about the matter until the Minister today rather feebly made the statement issued just before the 1.30 news today.
If anxiety was caused by this news, the source of that anxiety was the decision by the Government to cut 73 per cent off the allocation for these two schemes. The delay in issuing a statement about the cuts merely compounded the anxiety which was already there. What makes things worse is that the Minister's statement today, rather than clearing up the situation, merely confirmed the worst fears which we in the Labour Party expressed on this matter in the last 48 hours. It is now obvious that the Government intend to reduce these schemes to a point where they will provide no assistance to persons in need who are already suffering from the trauma of serious illness.
Since this issue arose, I established that on 27 October last, the Department of Health wrote to each health board setting out the allocations for 1988 and the letter stated that the allocation notified took account of a proposed restructuring of the community drugs scheme, that details of this restructuring would be notified to the health boards shortly and that in the meantime provision should be made in the health board budgets for a reduction of £x million on these schemes in 1988. That means that health boards have already been instructed to make the cuts. I have verified the impact of this on four health boards on this very day. The Eastern Health Board will have spent £6.7 million in 1987 and only £1.5 million will be available in 1988. The North Eastern Health Board will have spent £1.3 million and next year only £0.5 million will be available. The South Eastern Health Board will have spent £1.8 million this year and only £0.8 million will be available next year. The Southern Health Board will have spent £3 million in 1987 and only £1.3 million will be available in 1988.
The true picture is worse. There is a two month lag in meeting claims under the refund of drugs scheme. That means that all the money available to health boards in the first couple of months of next year will be used to pay claims which arise now and which will arise between now and the end of December 1987.
In the vast majority of cases, as a result of decisions already made and communicated to the health boards, they will have no money available to meet any claims which arise in the New Year.
Will the Minister explain his actions in this regard? This is a scandalous decision, no matter what kind of picture the Minister tries to put before this House. We now know that this despicable cut has been in train since October last and that it is only now that the Minister has been forced to come clean on the issue. The Minister does not deserve to be taken seriously by this House no matter how he tries to extricate himself.
The Minister promised the restructuring of the health boards "shortly", and having made that promise he has now put the health boards in a position in which they will simply have to refuse to pay any claims after Christmas. The money has not been provided in the 1988 Estimates.
I question, the restructuring of the schemes. I worry about the expression "restructuring of schemes". What will it entail? It is a bureaucratic description of a major detrimental cut in the schemes. The Government have decided that the schemes can provide, in terms of their requirement for cash, rich pickings. The reason for that is simple. Obviously, little if any imagination is required to save money in this way. It does not need better management as it can be done at the stroke of a pen. This is the sort of cut that bureaucrats and politicians ruled by bureaucrats like best but unfortunately, cuts like these will always have consequences. This cut of all the cuts we have seen and of all the cuts about which we are warned by the Taoiseach in a speech last Thursday evening at a Fianna Fáil function in Dublin, is probably the cut that will hurt beyond description. Ordinary people will suffer most. There is probably no Deputy in this House who would not have encountered people in their constituencies over the last couple of months who are in jobs on very low incomes but in a position where they do not qualify for medical cards. Many of these people have illnesses in their families and expensive drug requirements. They are feeling the pinch. There is very little relief available to them from the State agencies and the health boards. The Minister obviously has a good knowledge of his constituency due to his experience as a medical practitioner. He is a very solid rural Deputy, if I may say so. He must know from his experience the number of people who will be affected, people who are trying to carve out a living against enormous pressures on very low incomes. We are dishing out further harsh treatment and making them suffer even more.
Under the first of the schemes which are now being threatened non-medical card holders are entitled to claim back expenditure on prescribed drugs in excess of £28 per month. In recent years up to 25,000 families per annum were able to get some assistance under the scheme. One of the most common examples is that of the family where there are children suffering from asthma. Unfortunately this is a very prevalent medical condition in this country, perhaps by reason of our climate. This scheme, ironically, was introduced by the present Taoiseach when Minister for Health and we should not underestimate the invaluable assistance it has provided to families who cannot afford membership of the VHI. The present threshold of £28 per month has been at that level since 1984. It would be obscene in terms of the pressures on families throughout Ireland if this scheme were to be abolished, as I detect from the allocations to the health boards it will be.
The second scheme is designed to cater for nearly 40,000 non-medical card families with members suffering from longterm illnesses. Under this scheme drugs prescribed to relieve the symptoms of these illnesses are supplied totally free. That is as it should be. Most Members of this House will have been involved at various stages in dealing with health boards on behalf of such families and will be aware of the pressures and strains built up among them. We should be doing everything possible and practical to assist these families, particularly in difficult economic times. I do not want to labour the latter point.
This scheme was designed very carefully following much consideration by the officials of the Department of Health, in consultation with medical officers of the health boards and practitioners. Much thought was put into the scheme in order to protect people who are among the most vulnerable in our society. It is designed specifically to cover a range of conditions which are as follows; mental handicap, mental illness in children, PKU, cystic fibrosis, spina bifida, haemophilia, cerebral palsy, epilepsy, diabetes, multiple sclerosis, muscular dystrophy, Parkinsonism and acute leukaemia. All of these illnesses are of themselves major problems for families which have to cope with them.
I implore the Minister to consider the options open to him in the five weeks before the budget of 1988. We appreciate the tremendous economic pressures on the Government but as a medical practitioner the Minister obviously has first hand knowledge of these conditions and their prevalence. I put it to him that he should give this House a categorical assurance that no person suffering from any of these conditions will be charged for necessary drugs. We have heard much about abuses of various schemes but this is an area where people have genuinely serious medical conditions and have no option but to avail of drugs on a regular and permanent basis. The Minister must be able with the assistance of his officials and the health board administrators to ensure that these people will continue to benefit from this enlightened scheme. I find it hard to believe that the Minister would allow a situation to come about where people suffering from the conditions I have outlined would be required to pay for drugs necessary to allow them some basic level of comfort in coping with their problems.
I am asking for assurances from the Minister on two fronts. In the first place I am asking for an assurance that no family will have to pay more than £28 per month for drugs. His statement, rather meekly put at 1.30 p.m. today, was to the effect that I was misleading and alarming people due to my concern in this matter. My concern is a genuine one relating to the problems which people will be facing from 1 January or 1 March. Obviously money will be available until 1 March. At this stage in my career I can read Estimates as well as anybody and it appears that the money provided for the various health boards will not suffice to ensure the continuation of these schemes. I should like to be corrected by the Minister, if he is in a position to give the assurances I seek which will have been a good day's work on his part. I hope the Minister will not treat us to a departmental script telling us about the restructuring of schemes, or that he is seeking cost effectiveness or efficiencies. We are talking about a very serious problem. I believe that unless the Government reverse this decision the consequences will be disastrous. I am asking, therefore, that this be done.
I listened attentively to Deputy Spring. He contradicted himself in his initial remarks, stating that these figures were revealed a week ago. Then he went on to say that I had given these figures to the health boards on 27 October last. When I wrote to each health board on 27 October last I gave these figures and they were available thereafter. The only thing that has changed since——
On a point of information——
Deputy Spring will appreciate that the Minister has 10 minutes only to reply. We do not have points of information or order on an Adjournment debate.
When somebody says that I have contradicted myself, then I think the Minister will allow me——
The Minister does not make Standing Orders. The position on an adjournment debate is that the Deputy has 20 minutes during which he makes his case, makes any accusations he wishes and the Minister has an opportunity then to reply.
A Leas-Cheann Comhairle, as I sit down in compliance with your ruling, I might say that the information was given to Deputy Desmond last week and it was not public even though it had been given to the health boards.
The information was available to the health boards. The only thing that has happened since in relation to it is that the Labour Party have discovered the figures.
The country has discovered the figures.
I would go further and challenge Deputy Spring to tell me which health board will not be in a position to pay the drugs refund scheme in the month of January next.
Are the figures accurate?
(Interruptions.)
I want to know which health board.
(Interruptions.)
Excuse me, Deputies, Deputy Spring was given 20 minutes during which he made his case without interruption. Deputy Quinn will realise that the Minister is entitled——
The Adjournment debate lasts for half an hour. At this stage may I contribute to the debate?
You may not, Deputy.
A Leas-Cheann Comhairle, at this stage——
Will Deputy Desmond please resume his seat? He is interrupting the Minister and must desist from interrupting. The Deputy knows that, as does every other Deputy present. We will have the Minister without interruption.
I thought he had finished.
Let me deny categorically that there is any intention to cease the drugs refund scheme or the long term illness scheme from 1 January 1988.
1 March next.
It is totally irresponsible to make deductions based on half knowledge, as did the Labour spokesman on Health, and cause so much——
(Interruptions.)
Is that the end of it?
It is totally irresponsible to make deductions based on half knowledge, as did the Labour spokesman on Health, causing so much anxiety and concern to many patients and their relatives.
The position is that these schemes are being reviewed as part of a comprehensive examination being undertaken of community care services promised in the health care system generally. When that review has been completed and I have considered the result, I will be making a statement of policy on the matter in the New Year.
This is outrageous.
In the meantime the drugs refund and long term illness schemes will continue to operate as they do now. Furthermore, let me say categorically that these schemes will not cease to operate until I am satisfied that those to whom they are essential are adequately provided for under any new arrangements introduced.
The Minister cut £11 million off them; this is outrageous.
The Dáil adjourned at 10.25 p.m. until 10.30 a.m. on Thursday, 17 December 1987.