Billy Kelleher
Question:1. Deputy Billy Kelleher asked the Minister for Health when he expects to receive the 2014 Health Service Executive service plan; and if he will make a statement on the matter. [48345/13]
Priority Questions
HSE National Service Plan
The purpose of the question is to find out exactly not only when the service plan will be published but the detail it will contain. There is even an acceptance across the floor that the figures announced in the Budget Statement are not sustainable. A fanciful budget was again presented to the House in terms of the proposed €666 million in cuts. The Minister stated at the Oireachtas committee hearings that he felt they would be hard to achieve. We have a farcical situation where a budget was presented to the Parliament and the Minister is retrospectively verifying the figures. He refers to having the facts and figures available to him on a monthly basis while at the same time we find he has washed its hands of the budget in the context of the Estimates for 2014, which were presented to the House on 15 October. Will the Minister explain what will be in the service plan and whether the detail will be sustainable?
Under the Health Act 2004, the Health Service Executive, HSE, has 21 days from the publication of the Estimates for supply services on budget day to submit its 2014 national service plan for my consideration. This would have required the HSE to finalise and submit its service plan for next year by Tuesday, 5 November. The Act, however, allows the Minister for Health to provide the HSE with any such other period that he or she may wish to allow in this regard. In view of the challenging budgetary context, which my colleague has highlighted in florid terms, within which the 2014 plan must be prepared, I wrote to the HSE on Wednesday, 30 October to confirm that the executive would be given an additional ten days, that is, until Friday, 15 November, to adopt and submit its 2014 service plan for my consideration. This extended period also recognises that the earlier than usual presentation of the 2014 budget and the demanding Estimates ceiling for health spending in 2014 makes the task of preparing the 2014 plan particularly challenging and difficult for the executive.
Given the earliness of the budget, this gives more time to make sure hospitals and other services have their budgets in place on 1 January even if time is taken up doing so at this point. Clearly, a huge challenge must be met, to which the Deputy has alluded. It is premature to say it will be impossible before it is delivered.
There is a great deal of hand washing going on. The HSE is obligated under the Act to provide a service plan but at the same time officials from the Departments of the Taoiseach and Public Expenditure and Reform are trying to verify the figures while the HSE is expected to draft a plan to provide services in 2014. The Minister stated that he feels these figures are almost unachievable and it was reported that the distaste officials had for the probity drive relating to medical cards published by the Department of Public Expenditure and Reform as a way of slashing costs was almost palpable. The Minister of State, Deputy Alex White, rowed in behind the Minister some time later when he appeared before the Oireachtas Joint Committee on Health stating, "They look like very large figures. They look big to me, I will be honest with you". They look big to all of us. The difficulty is the HSE is trying to draft a service plan but we do not know whether the cuts that will make up the overall savings of €666 million or, for example, the €130 million saving in the probity drive for medical cards will be achievable.
I will initially respond to the Deputy's use of the phrase "hand washing". Nobody on these benches has washed his or her hands of anything. However, people who sit on the benches around the Deputy and particularly in the seat beside him are good at wringing and washing their hands about issues and they have a great degree of amnesia when it comes to their role in the formation of the HSE and all that went with it. It is extraordinary that at a time of unprecedented access to money that the health service went from bad to worse culminating in 569 people on trolleys in January 2011.
The Deputy quoted me as saying the figures were unachievable. I never used that word. I said I was deeply concerned about the challenge they represented and I remain concerned. A validation process is ongoing in this regard.
We could talk about amnesia a lot. The Minister has experienced a fair amount of it in the context of the commitments made prior to the election and even when he took up office. We will not go down that road.
A total of €666 million was identified a number of weeks ago in the health Estimate for 2014. The HSE is charged with drawing up a service plan for 2014 but nobody can tell me the Minister will save €130 million through medical card probity. He cannot say that will certainly happen. How in the name of God is the HSE meant to draft a service plan to provide for all the commitments being made in the House on a daily basis when the amount it will have to spend is unknown? It is not credible or tenable for a Minister to ask for a service plan in that environment.
It is incredible that the Deputy is referring to the unknown. We do not have the service plan. How can he comment on what is achievable or not achievable?
The Minister said the figure was not achievable.
I told the Deputy I did not use the word "unachievable" but he likes to twist things to suit his own end. The bottom line is he is arguing about something neither he nor I have seen.
The Deputy is telling me what is not possible before he has seen the plan to deal with it. I humbly suggest to him that he would be better waiting until the service plan comes out before he makes any further comments on it.
Hospital Services
Caoimhghín Ó Caoláin
Question:2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his views on the letter from the CEOs of the Mater, St. James's, Tallaght and Crumlin children's hospitals, Dublin, stating that the health cuts are unsustainable and a threat to the safety and quality of patient services; and if he will make a statement on the matter. [48146/13]
Does the Minister agree it is a seriously worrying development when the chief executive officers of four of the largest hospitals in the country write to the HSE to warn that the quality and safety of patient services in their hospitals is seriously threatened by the cuts imposed by his Government? These four large hospitals - the Mater hospital, St. James's Hospital, Tallaght hospital and Crumlin children's hospital - provide national services. As the responsible Minister, he has chosen not to respond, although the correspondence went to the HSE. I have not noted any response from the Minister in this regard. Why is that?
The issues raised by the hospitals in the letter referred to by the Deputy will be considered in the context of the HSE plan for 2014. I wrote to the HSE last Thursday, 31 October, to confirm that the executive has until 15 November to submit its service plan. In that letter, I also conveyed to the executive that my overriding priority is patient safety, with the next priority being to treat patients in as timely a fashion as possible.
Clearly, 2014 will be a very challenging year for the health services. In meeting this challenge, the goal, wherever possible, is to cut the cost of services rather than the level or quality of the services delivered, and to accelerate the pace of reform. The reform programme for hospitals, as set out in Future Health, aims to deliver more responsive and equitable access to services for all patients, to organise public hospitals into more efficient and accountable hospital groups, which can deliver better patient care for less cost, and to ensure that smaller hospitals continue to play a key role.
It can be difficult to achieve the necessary reform while hospitals exist in isolation from one another. The formation of hospital groups, which I announced last May, will allow each group to manage its own affairs and operate with maximum autonomy. It will also ensure that the treatment required by patients is received at the most appropriate level in the most appropriate and safest setting.
I have now appointed chairs to all seven hospital groups, the process of recruitment of CEOs has commenced and the process of establishing a strategic advisory group to guide the reorganisation of services by hospital groups is under way. The overall aim is to provide efficient and effective care, as close to the patient's home as possible, with a view to improved health outcomes and satisfaction for patients.
The Minister stated that his overriding priority is patient safety and yet from my reading of the correspondence from the four CEOs, that is also their overriding priority but there seems to be such a gulf between the Minister's and their position. The Minister falls back on the unpublished national service plan 2014 and yet the CEOs are clearly indicating that the situation, which they seek to have addressed, is current and is a consequence of the collective impact of a succession of five budgets that have seen €206 million removed from their spending capacity. They stated that this short-sighted and random application of budgetary reductions is clearly likely to seriously damage the foundation of the system. That has to be of concern to each and every one of us.
The CEOs are saying the cuts imposed by the Minister and the Government, coupled with demands for fewer staff while at the same time insisting on shorter waiting lists, are totally unsustainable. The Minister must have a better answer than what he just gave. It is not a pig in a poke situation. We cannot wait for the next national service plan and whatever further cuts it might outline for these hospitals.
With respect, there is nothing remotely random about the manner in which the budget was allocated for 2013. Hospitals were actually given an increase. The hospital budget got an increase. Two of the hospitals mentioned in that letter received increases of 5.5% and 2.8%, respectively, and two of the hospitals received a small reduction. That is what the rebalancing of the budget is about. I have no issue with CEOs writing to the head of the HSE seeking to protect their budgets. All groups do that. Patient safety is my main priority and patients being seen as quickly as possible, allowing for the constraints under which we operate, is my second priority.
The four CEOs make it very clear that the situation is as a result of the composite impact of a succession of five budgets, and there is no getting away from that fact. Their language shows they are at breaking point and if there are further cuts in the national service plan for 2014, the consequences will be dire. Patient safety will suffer. That is why they have taken the very bold, brave and welcome step of outlining the factual situation for all to note and not just the HSE, the Department of Health and the Minister and his colleagues.
Will the Minister recognise that any further cuts across the hospital network will have serious consequences for citizens? I appeal to him to take heed of the CEOs' appeal, which is what it is. They are saying to him that they cannot sustain any further cuts. It is reasonable that the Minister should respond because although he has lauded the advances made in cancer care provision on many occasions, make no mistake about it, even cancer patients are now experiencing unacceptable delays in access to treatment. The situation has become that grave.
On that very point, I am not aware of any untoward delays in the treatment of cancer patients in any of our adult hospitals. I am concerned to hear about a situation in Our Lady's hospital in Crumlin and l have asked for an investigation into it. The budget should allow for priority to be given to those who are most acutely ill, in particular children with cancer. The management of those budgets is a responsibility for the CEOs. I have also made it very clear that patient safety is a core responsibility of a CEO because there seems to be a mind abroad that thinks this is only an issue for doctors and nurses but it is not. It is a core issue for management. I expect the CEOs to do their jobs, as all CEOs do, in meeting their budgets and meeting their patients' requirement for which they are responsible.
The budget this year is more than €13 billion. We have an increasing population, about which there is no question. We have a demographic challenge in that every year we have 20,000 more people over the age of 65, which is a growth rate of 3.5% whereas the average rate of growth in the population is only 0.5%. It is great news we are all living longer but it presents challenges to us and it is why we must continue the reforms in our health service. As to whether money could have solved this, as the Deputies opposite know, there were halcyon years here when money was abegging and the money spent on health was more than quadrupled over a ten year period and yet the health service did not seem to improve.
Hospital Services
John Halligan
Question:3. Deputy John Halligan asked the Minister for Health his views on whether the current moratorium on recruitment within the Health Service Executive is negatively impacting on the provision of services across the spectrum and it is only a matter of time before the entire service is irreparably damaged; if the Health Information and Quality Authority has given its recommendations for minimum requirements regarding staffing levels; if he will make them available; his views on whether it is unacceptable that in a centre of excellence such as Waterford Regional Hospital the orthopaedic department has at times been running at less than 50% capacity with at least three of the surgical posts being unfilled which is exacerbating an already overstretched service and is resulting in waiting times escalating to years rather than months; if he will acknowledge that the orthopaedic department in Waterford Regional Hospital is now forced to set aside what are considered to be elective surgeries, although they are essential, as it does not have the capacity to maintain a full schedule for both inpatient and outpatient procedures; if he will make a firm commitment to review the moratorium and the effects it is having with a view to lifting the restrictions; and if he will make a statement on the matter. [48347/13]
Last week, an appeal went out to the people of Waterford not to use the accident and emergency department in Waterford Regional Hospital because of overcrowding. I have been told that trolleys containing very sick people were double parked in the corridors of the accident and emergency department. Will the Minister offer an explanation as to why two Indian doctors posted to the accident and emergency department in Waterford resigned last week? I have been told the HSE and the Department of Health are aware of the situation. What are the Minister's views on why Indian doctors brought into the country since 2011 to bridge the serious gap in services are not being permitted to join the Medical Council's training register and hence they are not afforded the same rights as their colleagues from elsewhere in the world to progress their training?
The first I have heard of this is today, as the Deputy will know. I have to confirm that, as of yesterday, Waterford Regional Hospital had its full complement of eight approved orthopaedic posts in place, including two on temporary contracts. If the two doctors to whom the Deputy alluded are the two on temporary contracts, then that is an issue I can take up with him. I will have to talk to the Department. It is primarily a matter for the Medical Council which is a statutory body independent of the Minister, and rightly so. It has its standards to meet and match. We will have to look into the situation to see what the problem is.
On the broader issue, the reduction in the size of the public service has been an essential component of the approach to addressing the State's fiscal difficulties.
This has been combined with a firm focus on improving public service efficiency and effectiveness. The Croke Park agreement and the current Haddington Road agreement have enabled health services to be sustained and improved despite a staffing reduction of 11,000 whole-time equivalents, or 10% of all staff, since the end of 2007. I acknowledge the major contribution staff have made to meeting the unprecedented challenges of recent years and putting the State’s finances on a sustainable footing for the future. It is an incredible tribute to their dedication and commitment that we have not only maintained a safe service, but improved it in terms of the number of people who have to endure long trolley waits and long waiting times for inpatient treatment.
The Haddington Road agreement provides for some 5 million additional working hours each year. It also provides for the appointment of 1,000 nurses and midwives and 1,000 intern support staff under targeted employment initiatives. These measures will enable the health service to reduce substantially levels of agency working and overtime and continue to reduce overall numbers while maintaining services and service levels to the greatest possible extent. The HIQA national standards for safer and better health care identify the need for service providers to plan, organise and manage their workforce to achieve the service objectives for high quality, safe and reliable health care. HIQA does not set minimum requirements for staffing levels on a national basis. The Deputy will be aware that public hospitals are being reorganised into more accountable hospital groups. I am confident that the group structure will allow for more efficient deployment of human resources, facilitating effective and flexible use of staff, thus allowing for a better response to service needs.
The potential exists for a very serious crisis in accident and emergency departments. I spoke last night to some consultants who work in Waterford Regional Hospital. They told me that the HSE and the Department of Health are sending a clear message to Indian doctors that they are sufficiently qualified to provide essential services in a time of crisis, but are not wanted in our hospitals in the long term.
I would like to put to the Minister two questions which are of importance to the people. We were happy to bring Indian doctors to work in Ireland and help us to bridge the gaps in our services. Were they adequately qualified to do the job? If they were, why are they not permitted to join the Medical Council's training register, as doctors from all other countries are allowed to do? I am concerned about the implications of giving doctors from Pakistan, Britain, France and all other countries considerably different treatment from Indian doctors. It has the potential to give rise to a crisis. I will conclude by informing the House that the consultants in Waterford Regional Hospital are sending a petition on this issue to the Indian Embassy today because they fear it could lead to a crisis.
There is no crisis in this country's accident and emergency departments. When I met Mr. Ian Carter two days ago, he took me through all the hospitals' compliance with the European working time directive, their inpatient waiting time targets and their outpatient waiting time targets. I have had discussions with the special delivery unit, through one of my colleagues, on the emergency department figures. There has been a 34% reduction in the number of people waiting on trolleys since I became Minister for Health. That is despite a 10% reduction in staff and a 20% reduction in the budget. I reiterate my gratitude to the men and women who work in our health services for achieving that. The specific issue raised by the Deputy is primarily a matter for the Medical Council. I cannot interfere in it. There should be no different treatment for people.
Thank you, Minister.
Qualifications are qualifications. There are differences between reciprocal arrangements in different countries. I would like to make an important point about the doctors we brought in a couple of years ago, if the Ceann Comhairle will bear with me.
I will let the Minister back in.
Okay. I will address it then.
The stated objective of this country's health service is that "staffing levels ... should be driven primarily by the need to achieve optimal health and quality of life". HIQA has said that the standards at Ireland's maternity hospitals, for example, are 30% lower than the standards recommended across Europe. There are 4,000 people on the waiting list and there is a four year backlog at the orthopaedic department at Waterford Regional Hospital in my city. As I have said previously, the number of consultant staff in the department was reduced by 25% over a two month period this summer. I have gone out to the hospital on a number of occasions and seen patients on trolleys. When my 86 year old father was taken to hospital two months ago, he had to wait on a trolley for 14 hours before he was given a bed. I do not know who is giving the Minister his information but it is not the case that there has been a reduction in the use of trolleys in accident and emergency departments. If the Minister goes to some of our hospitals to look at the conditions there, he will see that the contrary is the case. I am reporting and recording what is happening at Waterford Regional Hospital, which is one of this country's major hospitals.
On the last point, I respectfully ask the Deputy to look at what the average waiting time on a trolley was four years ago. People often waited on trolleys for two, three or four days.
I accept that. I would not argue that point with the Minister.
It takes a while to perform miracles. The impossible takes a little longer. We are making progress. I regret that the Deputy's dad had to wait on a trolley for such a duration. Our aim is to have 100% of people treated, and either admitted or discharged, within nine hours. We are also seeking to have 95% of people treated within six hours. Those targets are proving to be a real challenge, given the circumstances we find ourselves in. Having been in practice four or five years ago, I know that it was not unusual, sadly, to have people lying on trolleys for two or three days. That was certainly the case in Dublin. I am glad to say that rarely happens now. That is only proper. We will keep striving to meet the six hour target in 95% of cases. We want to ensure everyone is admitted or discharged within nine hours.
Thank you.
I was going to make a point about non-consultant hospital doctors before the Ceann Comhairle advised me that I would have a further opportunity to do so.
I was just applying the time rules.
I know the Chair will indulge me a little. All of the doctors that were brought in on that occasion were heavily screened and interviewed by consultants from this country. They were of a very high calibre. The issue of training is one for the training bodies and colleges. Neither I nor anybody else can interfere in the affairs of the Medical Council, which is an independent statutory body with a lay majority. The council is judicially and legally obliged to treat everybody the same, as long as their qualifications are of a similar type and character. We do not have reciprocal arrangements with a number of countries and that creates difficulties. I am sure the Medical Council is working hard to overcome those difficulties. It is in everybody's interest that we would have as much uniformity of training around the globe as possible.
Primary Care Strategy
Billy Kelleher
Question:4. Deputy Billy Kelleher asked the Minister for Health the key measures that will be implemented in primary care over the remainder of the Government's term in office; and if he will make a statement on the matter. [48346/13]
In this question, I am raising the issue of primary care services, rather than primary care centres. It is clear that general practitioner services are under great pressure at present. I received a letter last week from more than 50 GPs who indicated that they are not able to operate or provide the service they would like to provide. Continual cuts have been made in the context of the financial emergency measures in the public interest regime. There is no clear strategy for bringing forward the primary care strategy. I believe we have an obligation to support GPs in the delivery of the primary care strategy.
The key measures that will be implemented in primary care over the remainder of the Government's term in office are the introduction of a universal general practitioner service that is free at the point of access; the introduction of a new GP contract; the phased roll-out of chronic disease management programmes; the development of the primary care workforce to facilitate the universal GP service and chronic disease management; and the continued development of the primary care infrastructure. The Government is committed to introducing on a phased basis a universal GP service by 2016, as an essential prerequisite for the introduction of universal health insurance as set out in the programme for Government and the future health strategy framework. As announced in the budget, it has been decided to commence the roll-out of a universal GP service by providing all children aged five and under with access to a GP service without fees. This will mean that almost half of the population will have access to GP services without fees. Additional funding of €37 million has been provided to meet the full-year cost of this measure.
The new General Medical Services GP contract will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary primary care teams. The formulation of the new contract will have regard to the constraints of Irish and EU competition law, particularly in respect of the setting of fees and allowances. The HSE is developing integrated chronic disease management programmes to improve patient access and to manage patient care in an integrated manner across service settings, resulting in best health outcomes, enhanced clinical decision-making and the most effective use of resources. The HSE national service plan and operational plan for 2014 will see a continued focus on the asthma, diabetes and chronic obstructive pulmonary disease programmes which are particularly relevant to primary care.
In 2013, primary care funding of €20 million nationally is being invested to support the recruitment of prioritised front-line primary care team posts and to enhance the capacity of the primary care sector. Considerable progress has been made in the delivery of primary care centres and 32 have opened since May 2011. Since 2012, primary care infrastructure has been approved and is under way at 15 locations through refurbishment, extension of suitable properties or through new build. Construction is under way at six locations and planning permission has been granted at an additional 22 locations under the operational lease mechanism.
The HSE is working with the National Development Finance Agency to progress the PCC public private partnership programme. Planning applications for the 16 PCC sites have been lodged recently or will be shortly.
My only fear is that the Minister of State actually believes what he read because if he does he is completely removed from what is happening in primary care. GP services throughout the country are under huge pressure. In supporting GPs there is an obligation to deliver on the primary care strategy, including the roll-out of chronic disease management and the other things the Minister of State mentioned. However, the Minister of State simply cannot read that answer into the record of the Dáil and think that everything is fine out there. He spoke about a phased roll-out. The critical issue is to have enough GPs to provide the service the Government will roll out in coming years. We simply do not have them at present. Every day GPs and their services are being downgraded. We need to underpin the longer term strategy by providing them with support. He has come in here and said we have planning permission for a few primary care centres when the core issue is supporting the personnel who will deliver primary care - GPs and the allied health care professionals who support them in the community.
As so often, we come to the issue of credibility during oral questions on health. The Deputy's party, of course, did absolutely nothing on this agenda.
That is simply not the case.
It published a document in 2001 or 2002.
In 2001.
It then abandoned the health agenda completely and handed it over to Ms Mary Harney lock, stock and barrel.
We have handed it over to the Minister, Deputy Reilly, since then.
We are now welcoming Deputy Kelleher back into the debate about the future of our health services. However, he makes no contribution other than to come in here and present himself as - it would appear - a representative of the GPs. I understood the GPs had a representative body, but Deputy Kelleher now seems to have appointed himself as their representative. Of course the GPs are important and are professional people, who are part of the service we want to provide and will provide in the future. However, there is a big job of work to be done in the reform of the health services, especially in primary care.
At least Deputy Caoimhghín Ó Caoláin of Sinn Féin has welcomed the development in respect of free GP care, but has asked quite rightly what the next steps will be. Deputy Kelleher is completely at sea and appears to have no policy whatever.
It is a pity we did not get some answers. I remind the Minister of State that we are not in a courtroom but in the Dáil Chamber and my duty is to hold him to account.
With some credibility.
I am not here to advocate for GPs. However, the Minister of State might understand that GPs are the ones who see patients every week in their surgeries. However, they now cannot see them on the same day. In some cases referral times are down to two or three minutes. That is what is happening in surgeries and, as the person responsible, the Minister of State should know that, rather than coming in here and lecturing me. I am highlighting a simple fact. The Minister of State must understand that GP services are in crisis and GPs are crying out for help. I know the Minister of State is in discussions about a contract. However, in the meantime patients are suffering. The Minister of State talks about bringing more treatment of chronic illnesses into the primary care setting, but nothing is happening in that regard. We will end up with people being referred back to acute hospitals. I would like a few answers on the points I raised as opposed to lectures.
An enormous amount is happening in primary care. A huge amount of change is happening and much more needs to happen. The doctors and other professionals who carry out a service are central to that. I do not know what the Deputy means by saying that referral times are down to two or three minutes - perhaps he means consultations.
I mean consultations. The Minister of State knows that is happening.
He is suggesting that consultations may be as short as two or three minutes. In my job, I engage with doctors all the time, as does the Minister for Health. We are very well aware of what is happening on the ground in the services. It is simply not credible to suggest that we can address this enormous challenge for the health services overnight. We are introducing these changes and universal access to primary care is at the heart of it. I still do not know Deputy Kelleher's view of universal access to free GP services and whether he supports the proposal for free GP care for those aged under six.
I will tell the Minister of State if I get the opportunity.
It is a vital element of what we need to do. I appeal to him because we will never change our health services by constantly politicising it in this Chamber. For this generation and the next generation we need a completely new health service. Throwing this kind of brickbat back and forth is not achieving anything.
Medical Card Eligibility
John Halligan
Question:5. Deputy John Halligan asked the Minister for Health if he will clarify the situation whereby in assessing income for eligibility of a medical card, persons aged over 70 years are assessed on gross income but persons aged under 70 years are assessed on net income; his plans to rectify same and assess income based on net income for all applicants; and if he will make a statement on the matter. [48353/13]
I ask the Minister for Health if he will clarify the situation whereby in assessing income for eligibility of a medical card, persons aged over 70 years are assessed on gross income but under 70s are assessed on net income. Does he have any plans to rectify this and assess income based on net income for all applicants? I ask him to make a statement on the matter.
Under the Health Act 2008, automatic entitlement to a medical card for persons aged 70 and over ended on 31 December 2008. Under the arrangements effected by the Act, a revised system of assessment for eligibility was introduced for those 70 years of age and over, based on the significantly higher gross income limits rather than the standard net income thresholds. This advantageous arrangement for persons aged over 70 years has facilitated a much greater share of this cohort qualifying for a medical card compared with the population as a whole.
In the main, persons in the over 70 age cohort do not have the same outlays and expenses as those under 70 who are assessed on a means basis. Under the standard means tested medical card scheme, allowance may be made for rent or mortgage, travel to work and child care costs. Generally, for the over 70s, mortgages have been cleared, children have been catered for and they would not have costs for travel to work.
However, persons aged 70 or older who are assessed as ineligible under the gross income thresholds may also have their eligibility assessed under the means tested medical card scheme where they face particularly high expenses, for example, nursing home or medication costs. As I have outlined, this assessment is based on net income and assessable outgoing expenses and the qualifying income thresholds under this scheme are lower than the gross income thresholds for those over 70.
Furthermore, persons aged over 70 years may still be eligible for a medical card on a discretionary basis where they face undue hardship in arranging medical services as a result of medical or social circumstances. There are no proposals to change the assessment from a gross income basis to a net income basis for the over 70 age cohort.
In recent weeks I have come across three people aged over 70 who have been refused medical cards. They discovered the reason was that gross income is assessed in their cases. This is an issue of equality. One would imagine that those aged over 70 should be treated the same as those aged under 70 in the assessment of income and net income should be used for everyone. The HSE has launched an information campaign about the medical card system in recent weeks. One of its reasons for doing so was the widespread confusion about medical cards. Does this situation not add to the confusion and distrust citizens have in the operation of the system? There should be equity in the system regardless of how we assess the medical cards. The age of the applicant does not matter and the same criteria should be set for all. This is confusing for those who work within the health service, given the number of Deputies and local authority members contacting them on the issue of inequality in the assessment of medical cards.
This was a particular scheme introduced some time ago for the over 70s, as the Deputy will be aware and it is tailored to that age group. As I indicated in my reply, given that it is predicated on gross income, the arrangement facilitates a much greater share of that group of people being able to qualify for a medical card compared with the population as a whole. While I do not have the figure before me, I believe this is correct. Even after the changes announced in the budget - the legislation is to be introduced today or tomorrow - approximately 93% of those aged over 70 will still have either a full card or a GP-only card. It is a scheme specific to the over 70s and it is of advantage to those over 70. The rationale for having an assessment on gross income for the over 70s is based on that.
I agree with the Deputy on the need for more information and clarity, and the HSE has made great strides in recent weeks in doing that. We will listen carefully to any proposals Deputies have on how best to communicate the HSE's administrative scheme.
Could the Minister of State propose an amendment to the Bill going through the House this week to provide for equality of treatment thereby making the system fair? Like other Deputies, I have spoken to people in the health service who say making an application and assessment for people over or under 70 is confusing. An amendment to the Bill would clarify the situation.
There is no proposal to amend the Bill we propose to bring before the House. Does the Deputy think it should based on net income for all or gross income for all? There is no proposal to do either but I am curious as to which one the Deputy is proposing.
One way or the other. One cannot have it every way. The Minister of State accepts that people are confused.
I do not think people are confused when we explain that there is a different way of assessing income. It is net income for the general population and gross income for the specific group of over-70s. There may be some confusion on the part of people regarding forms and how the thing is managed and that is what we are trying to deal with and I think the HSE is doing a good job on that.