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Dáil Éireann debate -
Thursday, 27 Feb 2014

Vol. 832 No. 3

Topical Issues

Human Rights Issues

I thank the Ceann Comhairle for allowing this debate and thank the Minister of State, Deputy Costello, for attending to deal with it. The issue concerns the plight of the Rohingya people from Burma. I must confess that, until very recently, it was a plight with which I was not too familiar. In Ireland, since 2009, there have been two communities of Rohingya people in Mayo and in Carlow town. I understand there are 75 to 80 people who were previously the occupants of refugee camps in Bangladesh and who were taken in by Ireland in 2009, having been displaced from their homeland in 1992.

I raise the issue today with the Minister of State and the Department primarily in view of the upcoming census that is due to take place in Burma at the end of March. As I understand it, this census is being partly funded by the European Union and it is the first such measure of population to have taken place in that country for more than 30 years. The estimated population of Burma is 60 million people from 135 different ethnic groups, so there is a huge amount of diversity within the borders of Burma currently. In particular, I want to speak of the plight of the Rohingya people, who are subject to terrible abuses, largely on the basis of their religion but also on the basis of pure ethnicity. The upcoming census is not going to provide them with the opportunity to state their ethnic background. The census forms have been printed and more than 100,000 invigilators have been appointed to cover the population of Burma. However, as I understand it, there are only eight principal ethnic groups to which people can say they belong, when in fact on the ground in Burma there are in excess of 135 different ethnic backgrounds. As a result, there is a great fear that many of the smaller ethnic groups within the country will just not be counted under their ethnic background, and this could have significant implications for them into the future.

I also want to raise with the Minister the ongoing civil rights abuses that are taking place within Burma against the Rohingya people. There was a massacre on 16 February where 16 people were shot in a wooded area on the borders of their homeland, which is near the Burma-Bangladesh border. Has the Minister of State or his senior colleague been in a position to raise the matter of the terrible abuses to which the Rohingya are subjected routinely? They are a peaceful people who simply wish to remain part of their own country. They need some hope for the future. I hope the census, which has been partly supported by the EU, may give an opportunity for the EU to have some input into the crisis that currently exists in that country.

I compliment the Deputy on raising this very important issue. The Government closely follows the situation of the Rohingya people in Myanmar-Burma. Recently reported incidents of serious violence against the Rohingya people in Rakhine state, in particular in Du Chee Tan village in January 2014, are deeply worrying. I welcome the announcement made by Myanmar's President, U Thein Sein, on 28 January that there would be an independent investigation into this incident. This investigation was launched on 7 February and is due to conclude at the end of this month.

Ireland's ambassador to Myanmar, based in our embassy in Hanoi, visited Yangon from 20 to 22 January 2014 and attended the monthly EU heads of mission meeting while there, when the situation in Rakhine was discussed. During this latest visit, the ambassador also received updates on the situation in Rakhine from the UN Office for the Coordination of Humanitarian Affairs, OCHA, and from non-governmental organisations actively working in Rakhine. From 29 January to 1 February 2014, the EU delegation in Myanmar, along with several EU heads of mission, travelled to internally displaced peoples, IDP, camps in Rakhine state to assess the overall situation in the region and get first-hand information by listening to those involved in ongoing communal conflict.

The EU has specifically called on the Government of Myanmar to address the status and welfare needs of the Rohingya people and to take a zero tolerance approach to violent extremism. The EU has also urged Myanmar to permit the establishment of a country office of the Office of the United Nations High Commissioner for Human Rights.

Since 2007, over €7 million has been provided by Irish Aid to NGOs and Irish missionaries for both long-term development and emergency and recovery responses in Myanmar. In December 2013, the Tánaiste announced an additional programme of funding worth €500,000. The EU is providing around €70 million to the people of Rakhine state. A large share of this assistance is to meet the humanitarian needs of the people of the region.

Ireland through multilateral organisations such as the EU and UN takes every opportunity to raise the plight of the Rohingya people and urge the Government of Myanmar to address humanitarian and human rights issues. At the 23rd session of the United Nations Human Rights Council in May-June 2013, Ireland and its fellow council members adopted a presidential statement regarding the situation for Muslims in Myanmar. Council members including Ireland expressed deep concern at the gross violations of human rights against Muslims, including the Rohingya community, urged the government there to grant full citizenship rights to the Rohingya in Rakhine and review the discriminatory 1982 citizenship law. At the upcoming 25th session of the United Nations Human Rights Council to be held from 3-28 March, the special rapporteur on the situation of human rights in Myanmar, Mr. Tomas Ojea Quintana, is due to present a report on the human rights situation in the country. The special rapporteur recently commented that the present situation in Rakhine "represents a particular obstacle and a threat to the reform process".

The Irish Government is also concerned about the issue of Rohingya people forced to leave Myanmar for neighbouring countries. There have been reports of mistreatment of Rohingya in Thailand and elsewhere. The EU has expressed concerns to the ministry of foreign affairs and the national security council in Thailand.

Myanmar continues to undergo a process of long-awaited transition towards full democracy. Ireland, together with our EU partners, recognises that while significant progress has been made, difficult and complex challenges remain. The situation of the Rohingya is one such challenge which requires the care and attention of the international community and the Government of Myanmar. Ireland will continue to utilise our bilateral and multilateral channels to urge the Government of Myanmar to address the human rights situation of the Rohingya, together with other challenges.

In fairness, the Minister of State has touched on most of the issues. The issue I really want to highlight and which was brought to my attention is the upcoming census which, if carried out along the lines of what is expected, will not even include a categorisation for the Rohingya people. There are about 2 million people in this population, most of whom do not live within the borders of Burma. Many of them are scattered all over the world, particularly in Bangladesh and Thailand. This census will take place over a 12-day period up until the end of March. I understand it is being at least partly funded by the European Union. The Rohingya will be classified under the heading of "other", which is not a very satisfactory classification given that I have been told there are only eight different classifications of ethnicity in the census when there are 135 different ethnic backgrounds in the country. That is the sense of urgency. I appreciate the Minister of State's view regarding the 1982 citizenship law, which is discriminatory. The Rohingya people are unable to ensure their children are educated and cannot move freely about the country. While many of them are living in refugee camps outside its borders, those who are still in Burma have very restricted lives in terms of movement and the ordinary things we all take for granted. I appreciate the gist of the Minister of State's response about keeping it as a priority, which is to be welcomed, but perhaps there is an opportunity to broaden the classification of different ethnic groups before the first census in 31 years takes place.

I thank the Deputy for those supplementary remarks. The actual thrust of the Topical Issue made no reference to the upcoming census so I could have better information on that. The census is being carried out in the context of forthcoming elections. As the Deputy mentioned, there has been no census for 30 years and the EU is indeed part funding the taking of the census and the organisation of it.

I will be meeting the ambassador of Bangladesh in the next few days. Certainly it is an issue I can take up with him because many of the Rohingya people are originally from Bangladesh. I will be attending the United Nations Human Rights Council in Geneva on Monday where I will be addressing the council on human rights. In addition, the special rapporteur on the situation of human rights in Myanmar, Mr. Tomas Ojea Quintana, will give a special report on human rights at the council so it will be an opportunity to raise it again. I can come back to the Deputy with further information in respect of the specific issue of the census. Indeed, if he wishes to raise a Topical Issue on the census in Myanmar, I would be very happy to come back to the House.

Carbon Tax Implementation

The carbon tax was introduced in 2010 as a very important element of our climate change strategy. The rate of tax with effect from 1 May 2013 is based on a €10 charge for CO2 and will increase to €20 per tonne with effect from 1 May 2014. This will have a particular impact on people who use solid fuel. Leaving aside large industry, businesses and SMEs who may be able to absorb costs even though that is not even said, it will translate into a very tangible price increase of €1.20 on a bag of coal and 26 cent on a bale of briquettes. This will be a doubling of that charge on those products compared to the year before so we are talking about €2.40 on a bag of coal. One is talking about possibly two to three bags of coal per week for people who use coal as the main fuel to heat their homes, for example, pensioners who have to keep the range on to keep warm. That is €7 and if one puts that out over a year, one is talking about a significant amount of money from people who are very challenged financially at the moment. It is not a luxury. It is not like we are talking about incentivising and different emissions or that there are other products they can use. If one has a range in one's house or a fire one uses to heat the home, coal is what one uses. Unless we are going to give people grants to change their method of heating their homes completely, which I do not think is on the cards, this is simply a punitive tax on people who really cannot afford it.

I know we have obligations in this regard but what I am asking for is that we delay it. We are finally starting to see this little bit of hope in the economy. People are getting back to work. It is not there fully and we are not realising it in people's pockets. There is a case to be made to delay the implementation of this tax to keep the bag of coal at its current price. It is not fair to have a €1.20 increase last year and another one this year so suddenly when we have not seen the impact of that bit of hope in the economy on people's pockets. I am asking that the Department consider the cost and delay it for another year.

We all understand that we have obligations under the climate change agenda but there is a question here about domestic versus industrial. The increase of €1.20 last year and now another increase of €1.20 represent a significant amount of money to people on limited incomes. It has been widely reported and spoken about in this House that one in five people experiences fuel poverty. As Deputy Nolan has said, this is not a luxury item. It is a very basic item for people. In urban areas like Waterford city, Dungarvan and Tramore, many people are reliant on it as are those in rural parts of my constituency in places like Lismore and Tallow. They are reliant on solid fuel.

I do not need to tell the Minister of State that the unemployment rate in Waterford is the highest in the country, at 19%.

I concur with Deputy Nolan that we need to delay this tax and allow the economy to kick in outside the greater Dublin area. There has been some good news in respect of jobs, but that effect has not been felt in the south east. This punitive tax will impose difficult circumstances on people with limited incomes.

I thank my colleagues for raising this important issue. I have been asked by the Minister for Finance, Deputy Noonan, to respond.

The Minister provided for the application of a carbon tax to solid fuels in budget 2013. In order to lessen the potential impact on lower income households, he chose not to introduce it until after the 2012-13 winter period and opted to introduce the tax in two phases, that is, €10 per tonne of CO2 from 1 May 2013 and a further €10 per tonne from 1 May 2014, thus bringing the carbon tax on solid fuels in line with that on all other fossil fuels, namely, €20 per tonne of CO2. The net effect of the €10 carbon tax from 1 May 2014 will be approximately €1.20 on a 40 kg bag of coal and 26 cent on a bale of briquettes.

Deputies will be aware that the application of the carbon tax to solid fuels remained subject to a ministerial commencement order dating back to 2010. This approach was primarily adopted to delay the application of the carbon tax to solid fuel in the residential sector so as to allow for the development of a robust mechanism to counter the large-scale sourcing of coal from Northern Ireland, where lower sulphur standards apply. The Department of the Environment, Community and Local Government undertook to provide such a robust mechanism in conjunction with the National Standards Authority of Ireland, NSAI. As part of that exercise, the Department, in conjunction with the NSAI, consulted with a stakeholder working group that included officials from the Department of Finance, the Revenue Commissioners, the industry representative - the Solid Fuel Trade Group, SFTG - the Environmental Protection Agency, EPA, and representatives of selected local authorities. Such a mechanism has been in place since June 2011. The application of the carbon tax to solid fuels was further postponed in 2012, given the overall tax increases in budget 2012, including in the standard rate of VAT.

The introduction of carbon tax was about sending a price signal that there was a cost associated with the consumption of fossil fuels to the detriment of our environment. It should also be noted that solid fuels have the highest carbon content of all fossil fuels. As a result, they are considered the dirtiest fuels and, given the environmental impact, it is important that they be taxed accordingly.

In the context of domestic heating provision, the carbon tax is intended to apply to all types of coal and commercial peat. According to the ESRI, low-income households usually make extensive use of cheaper, but more carbon-intensive fuels such as coal and turf. The effect of the €10 per tonne of CO2 emissions from 1 May this year will result in an increase of €1.20 on a bag of coal and 26 cent on a bale of briquettes. The issue of fuel and energy poverty is being addressed through the energy affordability strategy, which aims to tackle energy affordability through a combination of institutional supports, investments in improving the energy efficiency of our housing stock and wide availability of advice on energy efficiency. In a decision of 14 September, the Government agreed to publish the strategy with a view to its full implementation.

While tax increases are always unpopular, where member states are under fiscal pressure it makes sense to increase taxes in areas where some benefits can arise. In this instance, a carbon tax promotes energy efficiency, reduces emissions and reduces our total dependence on imported fossil fuels. Accordingly, and unfortunately for the purposes of this debate, the Minister does not intend to defer the further increase of €10 per tonne of CO2 emissions from 1 May.

When I return to Galway this evening and speak with people who are worried about this issue, I will give them some details of the Minister of State's answer. They will get the contradiction quickly. The Government decided in September to publish a strategy to deal with energy affordability with a view towards its implementation. That strategy is still being implemented, yet we are moving ahead with a punitive increase in the cost of people's fuel. There is a contradiction in that strategy versus €1.20 extra on a bag of coal.

I realise that the Minister of State is not the Minister for Finance, but will he ask the Minister to produce information on how much revenue will be generated this year by that tax and to reconsider the possibility of delaying its introduction by just another year to give the economy a little bit of a chance to pick up and to give people a bit of slack and breathing space? Otherwise, a €2.40 tax on a bag of coal will be applied within the space of one year. For the people under discussion and who we are trying to represent, that is a great deal of money.

I concur with Deputy Nolan's sentiments. Will the Minister of State relay our message to the Minister, Deputy Noonan? The Government is trying to implement an energy affordability strategy. Supports will be available to houses to make them more efficient, but what will the budget be, where will the money come from and how will people benefit from it? Currently, much of the strategy is being delivered through Leader programmes and, for example, the Waterford city development area networks. I hope that the reforms under way in that regard will ensure that this type of work continues, as it is of vital assistance to those on limited incomes in particular. What resources will be put behind this strategy?

I appeal to the Minister for Finance to allow people some time to get back on their feet before this proposed tax is imposed on 1 May.

I do not want to give anyone a false impression of the Minister's position, as he is clear on this - the budget is set for this year. Deferring this tax would effectively change a budget that had already passed through the Houses. I appreciate the points raised by the Deputies. The same have been raised in my constituency. This tax is difficult for people. One of the Minister's reasons for choosing to increase the tax on 1 May was that the winter months would be behind us and we would have some time to get ready for the next winter period. We held a good debate on this matter in the context of the Finance Bill.

I managed to get some information from other Departments in preparation for this debate, as the strategy on warmer homes is cross-departmental. The State has already invested significant funds in this regard. For instance, the national fuel scheme is a direct subsidy to the poorest homes and effectively amounts to €20 per week household supplement. More than €280 million is spent on it. This is rightly welcome, given the difficulties posed by fuel poverty, which is an issue for people with little income.

On 18 February, my colleague, the Minister of State, Deputy Jan O'Sullivan, announced a significant retrofitting programme for local authority housing amounting to more than €30 million this year. This will make a considerable difference. This year's spend on the energy efficiency upgrade is €57 million. I also understand that a total of 105,000 homes have benefited in recent years from retrofits under better energy awareness housing schemes.

We will solve this problem by improving thermal efficiency, particularly in poorer households. The Government is committed to doing this and is rolling out a substantial investment programme. We need to continue this initiative.

Building Regulations Application

Thank you, a Cheann Comhairle, for allowing me to raise this issue, given that the new regulations are due to commence next week.

I recognise the need to have a strong regulatory system to maintain a high quality standard of building for family homes. The experience of hard-pressed residents in Priory Hall and in other developments underlines that. However, the regulatory measures coming into effect on 1 March will penalise own-build home owners who want to build their own family home. One-off homes will be hit with a regulatory framework designed for large-scale developments in major towns and cities. This will dramatically increase costs and has the potential to damage the construction industry at a time when the Government claims it is trying to boost it. There has also been a failure of the Government to communicate the changes, leading to speculation about their impact, further damaging the construction industry. It may well be seen as another anti-rural bias of the Government.

The regulations can essentially be broken down into three broad principles. Anyone wishing to building anything - with the usual exemptions - must, by law, employ what is referred to as an assigned professional, such as an engineer, architect or surveyor, to inspect the property on-site. This assigned professional must inspect the building, and at the end of the procedures, issue a certificate warranting that they have inspected the works and that they comply with the regulations. The professional also warrants that he or she accepts responsibility for the legal liability for the inspection of all works as necessary, to ensure they are neither defective nor contravene any requirements of the second schedule of the building regulations "notwithstanding the responsibilities of other persons or firms in relation to the works". What implications does that have for indemnity insurance? Some would say that some have left the market or are planning to do so because of what does not appear to be a clear delineation between the owner and the inspector. The assigned professional must submit a full set of completed drawings to the building control authority on completion.

There are various problems with these regulations. The cost of the regulations will place a hefty and disproportionate burden on one-off housing. There has been no public information campaign, leading to speculation about the consequences of the changes that may potentially harm the construction sector. What level of resources have been given to local authorities to handle the deluge of information and paperwork that will result from the new system? When we consider the crisis in respect of roads and housing and the fact that development charges have diminished to such an extent that the income does not exist any more and there are recruitment embargoes in local authority planning departments, we should acknowledge the pressure all this will put on the system. Up to 500 architects' practices may well be out of the loop with these inspections, with all the implications this has on that sector.

Perhaps the Minister can respond to those issues, and maybe then I will make suggestions if I do not feel he plans to examine them. Ultimately, I ask him to consider a deferral in the first instance, with a review panel and a targeted approach. It is incumbent on him to consider a deferral for six months, re-engagement with the stakeholders, and to take on board some of the suggestions that have been made to me and to many of the Minister's colleagues.

The new building control amendment regulations will greatly strengthen the arrangements currently in place for the control of building activity by requiring greater accountability in relation to compliance with building regulations in the form of statutory certification of design and construction, the lodgement of compliance documentation, mandatory inspections during construction and validation and registration of certificates. These new regulations are necessary following the widespread instances of failure by owners, designers and builders to comply with their statutory obligations under the Building Control Act 1990 to design and construct buildings in accordance with the building regulations.

Every effort has been made to ensure arrangements are in place for a successful transition to the new building control arrangements from 1 March 2014. Discussions have taken place with all stakeholders for the past two years in respect of implementation. The new online building control management system has been developed to provide a common platform for clear and consistent administration of building control matters across the local authority sector. The local government sector has been involved from the beginning in dealing with these measures. Briefing and guidance on the new system has been provided for local authority staff and representatives of the key construction sector professional bodies, as well as for the Construction Industry Federation in recent weeks. The definitive code of practice for inspecting and certifying buildings and works was circulated to industry stakeholders on 7 February 2014.

Standard forms of contracts used for both private and public sector projects fall to be revised to reflect the new regulatory environment. The Government construction contracts committee and the key construction professional bodies both report strong progress in advancing this work within their respective sectors. The Government has established an oversight group to ensure no unavoidable delays will occur in critical public infrastructure projects at a time when construction activity and employment depends so heavily on public sector investment. Briefing and guidance is available within the Government and within the private sector to deal with contractual challenges and procurement issues that will inevitably arise as change takes place. The above measures are the key supports necessary to ensure the new regulatory arrangements can work well in practice.

The training for professionals has been taking place for the past few months. The Construction Industry Federation, the chartered building surveyors, the chartered quantity surveyors and the local authorities have all welcomed these particular measures. The Royal Institute of Architects of Ireland has been a bit reluctant to come to the table in respect of these matters, and there has been a difference of opinion within its own membership, and I am sure the Deputy alluded to that. In the past ten days, however, I understand that 1,200 architects have been subject to training and are now very familiar with the new contractual obligations and regulations.

Concerns that the new regulations prevent a self-build situation are unfounded. I notice that on four occasions this week, misinformation was provided on Mr. Duffy's programme, in spite of the fact that the Department of the Environment, Community and Local Government has been providing the appropriate information, which he refuses to read out. These allegations on cost are unfounded, although all house builders and owners must comply with the regulations. An owner who intends to self-build - known as direct labour - will, as before, assume legal responsibility for ensuring the building or works concerned are compliant and he will be required, as builder, to sign the undertaking by the builder and the certificate of compliance on completion.

As local authorities and industry move to full implementation next week, the Department will continue to work with all parties to ensure they understand their obligations and the steps necessary to meet them. These changes are essential to deal with the disgraceful legacy issues we have seen with Priory Hall, unfinished estates and the supply of pyritic material.

I agree with the Minister's final statement. A strengthening of regulations is required to maintain and confirm that a high quality standard of building is put in place. Notwithstanding the fact the Minister said he will not agree to a deferral, I ask him again to consider a specified term of three to six months before this comes into effect. Would he also consider putting a review panel in place to monitor the new regulations thereafter? This will assure us it will not have a detrimental effect on rural Ireland and on the elements of the industry that find themselves outside the loop in respect of their ability to carry out inspections. Will he make a committed effort to launch a public information campaign to allow us to be sure the public is well aware of the implications of the changes?

Would the Minister consider a national building inspectorate? There could be targeted inspections, a system of licensing or registration of builders, and information on builders shared among the relevant authorities, with full prosecutions of any designers or contractors who are negligent in their duties. An open register of inspections and prosecutions and reports of inspections could be made public.

The Minister acknowledged that developers should lodge a bond with the local authority. This should be a mandatory rather than discretionary requirement, as is currently the case. The bond should not be returned until such time as the council is satisfied that the development is complete and meets the required standards. Under the current process, it may be too late when the council initiates proceedings.

I ask the Minister to give serious consideration to the four or five proposals I have made before proceeding as intended on 1 March. We must not misconstrue or misrepresent some of the comments we have heard on the public airwaves and elsewhere in the past week or two. Many members of the public honestly believe there are means and methods to strengthen the process the Minister proposes to enable us to stand over them. We need certainty that the system will not fail to achieve the objectives set for it, as it did in the past with detrimental results.

I do not know for how long or how often people have been refusing to listen and acknowledge that we are proceeding with new building regulations on 1 March 2014. The new regulations have been the subject of consultation with all of the people involved in the construction industry for the past two years. I am prepared to establish an oversight group, as suggested by Deputy Cowen, to monitor the implementation of the regulations. I concur with him that the implementation of a new regime inevitably gives rise to teething problems. Nevertheless, comprehensive consultation documents have been published, including a document strengthening the building control system, a document to inform public consultation on the draft Building Control (Amendment) Regulations 2012, which sets out the context in which the reforms will operate and their regulatory impact for building owners and industry stakeholders. This document remains available on the Department's website.

The arrangements being introduced for the control of building activity may result in some additional costs. Certification will be required if one proposes to build to a higher quality design or have a risk-based inspection system. It is not expected that single houses in rural areas will require many inspections. However, inspections will be required for blocks of apartments and commercial developments, as we know from the past. The costs will be modest compared to the outcome.

A register of builders will be established on a voluntary basis in 2014 and will be made statutory in 2015. I am proceeding with this measure, with which the Construction Industry Federation agrees.

Owners and developers who are worried about these matters, for example, draughtsmen, who tend to work in rural communities, will be able to proceed as present on a direct build basis. They will, however, be required to have an architect, building surveyor or chartered surveyor sign off the job to certify it has been done properly. This requirement has always been in place but was not always complied with. If individuals who do a good job want to register with the professional bodies, I appeal to them to do so. I have commissioned a report from the chairman of the architects admissions board, Mr. Garrett Fennell, to examine how to make it easier to register with the professional bodies. I will immediately implement Mr. Fennell's recommendations to enable people to become the assigned certifiers in respect of the regulations.

I assure Deputy Cowen that all of the nonsense on RTE this week is absolute misinformation to the extent that it is being claimed that the cost of building a house by direct labour in a rural area will increase by as much as €50,000. Additional compliance should cost between €1,000 and €3,000, depending on market forces and where the best deal can be secured. I encourage small business professionals, such as draughtsmen, to register with the professional bodies in order that they can act as assigned certifiers. I will careful monitor the position to ensure the regulations are implemented fairly.

Medical Card Reviews

The issue I raise relates to reviews of medical cards which have been granted on medical hardship grounds. Reviews are frequently carried out soon after the medical card has been granted. I am aware of a number of cases where reviews are being done of medical cards that were allocated until April 2015. A problem arises because the evidence provided by medical card holders is not retained and is, therefore, not available to the officials carrying out the review. This means the medical card holder must gather this evidence again as part of the review, which can be costly, especially if they need to visit a general practitioner or consultant. While data protection issues may well arise in these circumstances, these could be overcome if medical card holders were asked to sign a data protection waiver.

I will illustrate the problem I describe by citing a number of cases with which I am dealing. One case involves a young father aged in his 30s who has experienced kidney failure and is being maintained on medication. He is not yet on dialysis. The young man has a mortgage to pay and was awarded a medical card on medical hardship grounds. As part of the review, he must again gather all the evidence he provided for the initial application. His medical card has been withdrawn and he has lodged an appeal. It will not be in anyone's interests if this man cannot afford his medication as the cost to the health service will be higher.

Another case involves an eight year old child with profound disabilities who is in a wheelchair and is fed through a tube. She has the mental age of an eight month old baby and while her parents would love her medical diagnosis to change, that will not happen. The child was awarded a medical card until April 2015 but an early review was initiated, with the result that the parents must go through the whole process of gathering the evidence again because it is not retained by the relevant officials. The same problem arises in respect of another child with a heart problem, which is not likely to change.

In another case, a man in his early 60s who is receiving chemotherapy treatment is unable to work because his condition has worsened. The family do not want to get a letter stating his condition is terminal because they want to hold out some hope. He, too, is being put through a rigorous review.

While I understand that people's financial circumstances change, the medical conditions of many of the individuals in question are unlikely to change. I ask that the rules governing medical card reviews be relaxed to assist people who genuinely need a medical card for reasons of medical hardship. They should not have to endure the torture of having to repeatedly gather certain information given that their health condition will not change.

I thank the Deputy for raising this issue.

Under the Health Act 1970, eligibility for a medical card is founded primarily on the undue financial hardship test. Under the legislation, determination of an individual's eligibility for a medical card is the responsibility of the Health Service Executive. The 1970 Health Act obliges the HSE to assess whether a person is unable, without undue hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure. If an applicant's means are above the financial thresholds for eligibility for a medical card or a GP visit card, as set out in the national guidelines, the HSE examines for any indication of medical or social circumstances, which could result in undue financial hardship. However, even where a person exceeds these financial thresholds, eligibility may be granted on a discretionary basis if these circumstances are such that a person cannot access general practitioner or other medical services without undue financial hardship. In these cases, social and medical issues are taken into consideration by the HSE when making a decision on eligibility.

It is important to note that discretion is not a stand-alone exercise. Exercising discretion remains an integral part of the assessment process for a medical card.

Eligibility for a medical card continues for as long as a person meets the criteria set out in the Health Act. The legislation requires a person to notify the HSE of any change in their circumstances, including income, expenditure, medical or social issues, which renders them no longer entitled to a medical card. In practice, few people do so. As a result, the HSE has an obligation to ensure that the medical card register is as accurate as possible and that its voted budget is being spent appropriately in the medical card scheme. One recognised auditing practice now carried out by the HSE is random reviews.

All card holders, irrespective of the basis on which the card was awarded, may be subject to a periodic review of eligibility to determine continuing eligibility. As Deputies will be aware, each person eligible to a medical or GP visit card receives a plastic card on which a "valid to" date is printed. This is the latest date that a review may be conducted in respect of that person. Notwithstanding the "valid to" date printed on the card, the HSE reserves the right to review eligibility at any time and to take appropriate action in circumstances where the cardholder no longer fulfils the criteria for eligibility under the medical card-GP visit card national assessment guidelines.

Persons who have been granted a medical card under the financial hardship provisions of the medical card scheme are required, when the subject of a review assessment, to submit all relevant and up-to-date details. This is necessary so that the HSE can make a correct determination of continuing eligibility. Where an applicant indicates on a review application that medical evidence has been previously submitted relating to a life-long medical condition, and this has been confirmed by the HSE, the HSE will not request further medical evidence in this regard. The applicant will, however, be required to submit all other information material to a review assessment.

A critical element of probity in the medical card scheme is the ongoing review of client eligibility by the HSE. Overall, the HSE assessed the eligibility of more than 700,000 individuals in 2013. More than 95% of complete applications were processed within the 15 working days target. I am satisfied that all reviews undertaken are appropriate and carried out in an appropriate and a facilitative manner.

The Minister stated in his reply that additional information will not be sought in respect of a life-long condition. However, that is not the true in two of the cases which I have brought to the Minister's attention. I will bring that information to the attention of the HSE, using the reply given to me today by the Minister.

I understand that economic situations can change and I am not disputing that reviews should be carried out. However, requiring a person who, for example, is suffering kidney failure and is in receipt of chemotherapy and cannot work to provide information which is costly to obtain in order to prove that he or she has a medical condition is unfair. The Minister said that the expiry date on the card is the latest date for a review. In the cases of the two children I mentioned the cards were valid to end April 2015 and they had been issued on a three-year basis. There appears to be a systematic review that occurs way short of the expiry date of the card.

The Minister will be aware that for a child with a major disability, such as one of the children to whom I referred, a medical card is of critical importance in the context of access to other services within the HSE, including a public health nurse and so on. As such the medical card becomes critically important in keeping a child like that in reasonable health. I hope the Minister will consider requesting that further changes be made. I do not think it is unreasonable to ask that people whose condition is not going to change not be asked to provide the same information in a fairly short timeframe, when doing so puts them under huge pressure.

On the Deputy's final point, the HSE has guaranteed me that people will be approached three months before a review to advise that one is due and that further details may be required.

On the individuals to whom the Deputy refers, I would like to have their details privately so that I can examine their cases. I do not believe there is anybody in this House who wishes to see families who already are bearing the burden of ill-health or life-long disability subjected to unnecessary distress. That is certainly not what I, as a doctor or a Minister, want to see. I would like to see a situation whereby if medical cards are selected for random review and a desk-top study reveals that the person's situation is unlikely to have changed because he or she has a life-long condition, terminal illness, renal failure or other such problems which are unlikely to have improved, they will be set aside until the regular review is due. I will raise that matter with the primary care reimbursement service, PCRS, and the Minister of State, Deputy White.

We do have to audit our system. If we did not, the Deputies across might not be the first but they would certainly be among those who at the Committee of Public Accounts would hold me to account for not guarding scarce public resources and ensuring they go to those who need them most. We know that we have a lot of need in our society, that we need to bring fairness and equity to the system and that in the past people in some parts of the country could get medical cards based on very loose criteria while those desperately in need in other parts of the country could not. As stated by the Chairman of the Joint Committee on Health and Children, Deputy Buttimer, in the old days in certain parts all it took was a telephone call and a representation and a person got a medical card. That is not fair.

We want equity in the system in so far as we can. We want consistency of approach. I believe in discretion. Not long after I became Minister I asked the PCRS to set up a team of doctors to ensure that there was a medical input in terms of discretion. They do their best to ensure that people who have life-long conditions, disabilities and other serious conditions that are unlikely to improve are given medical cards. Even those who may now have a poor outlook but may improve in six months or a year's time with new treatment, etc., get the benefit of the doubt in all cases. That is what we try to achieve. In any system of the size of the PCRS, with almost 2 million people on medical or GP visit cards, people will fall through the cracks. A good system should try to catch them. This Chamber is another avenue to highlight those cases. I welcome when cases are highlighted so that I can look into them and ensure that all matters have been carried out in a way that allows those who are most vulnerable in our society to get the most help and support that we can give them. That is the purpose and function of the health service.

The Dáil adjourned at 5.40 p.m. until 2.30 p.m. on Tuesday, 4 March 2014.
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