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Dáil Éireann debate -
Thursday, 26 Jun 2014

Vol. 845 No. 3

Health (General Practitioner Services) Bill 2014: Instruction to Committee

I move:

That, pursuant to Standing Order 177, Standing Order 131 is modified to permit an instruction to the Committee to which the Health (General Practitioner Service) Bill 2014 may be recommitted in respect of certain amendments, for which it has the power to make provision in the Bill in relation to--

(a) amending the Nursing Homes Support Scheme Act 2009, by amending the definition of 'transferred assets' to put it beyond any doubt that assets transferred after an application for financial support under the scheme is made, come within the definition of 'transferred assets'; and

(b) amending the Opticians Act 1956 to change the election year for the purposes of that Act from 2014 to 2015 to remove the requirement to hold elections to Bord na Radharcmhastóirí (the Opticians Board) in 2014 and to extend the terms of office of the current members of the board beyond 31st December, 2014 for a period of up to one year until the board has been subsumed into the Health and Social Care Professionals Council; and

to change the title of the Bill to take account of these provisions.

I am tabling this motion to enable an urgent and important amendment to be made to the Nursing Home Support Scheme Act 2009 and the Opticians Act 1956. I will summarise what I have in mind.

The nursing home support scheme, commonly referred to as the fair deal scheme, is an important one that provides financial support for people who need long-term nursing home care. Under the scheme, an individual makes a contribution towards the cost of his or her care while the community in the form of the State pays the balance. This applies regardless of whether the nursing home in question is public, private or voluntary. The HSE administers the fair deal scheme within the resources available and in line with the nursing home support scheme legislation.

The scheme is predicated on the principle that applicants must contribute according to their means. The Act provides that assets transferred within the five years prior to applying for the scheme are taken into account in the financial assessment. This provision does not affect a person's right to sell assets for full market value. Rather, it is intended to prevent people from depriving themselves of assets for the purpose of the financial assessment. If a participant in the scheme were to transfer assets immediately after an application for State support was made or at any subsequent point, the existing definition means that it may be possible for the asset to be excluded from the financial review.

The purpose of this amendment is to prevent a situation arising where an applicant could transfer assets immediately after an application for State support is made on the basis of an argument that such asset transfers are not definitively captured by the definition of "transferred asset" in Schedule 1 of the 2009 Act. Accordingly, this is a technical amendment to put it beyond doubt that assets transferred after an application for the scheme is made also fall within the definition of "transferred asset". It is essential that there be no ambiguity in this regard.

The Optician Act 1956 provides that 2014 is an election year.

However, the Opticians Board is due to be subsumed into the Health and Social Care Professionals Council in accordance with the Government's programme of rationalisation of State agencies. The drafting of the Bill to rationalise the Opticians Board and the Health and Social Care Professionals Council is currently being finalised.

The proposed amendment will change the election year from 2014 to 2015. It will also provide that the subsequent election years will be 2019 and each fifth successive year after 2019. The purpose of this amendment is to have the practical effect of removing the requirement to hold elections to the Opticians Board this year, a matter of months before the board is due to be subsumed into the Health and Social Care Professionals Council. It would also extend the terms of office of the current members of the board for up to one year until the regulation of the professions of optometrist and dispensing optician has been transferred to the amended Health and Social Care Professionals Act 2005 by the end of this year or early next year.

The amendment needs to be made before autumn of this year as the Opticians Act requires that the elections in an election year be under way by that stage. The alternative would be to hold elections and appoint a new board in 2014 to hold office for a very short period, if at all.

I apologise on behalf of Deputy Kelleher, who is unable to be here. Fianna Fáil will not be opposing the amendments, which appear to address certain lacunae in existing legislation. With regard to the changes proposed to the Nursing Homes Support Scheme Act, how much additional revenue does the Minister of State anticipate will accrue from them? It is a pity, however, that the Government is not amending other measures relating to the fair deal or nursing homes support scheme in 2014. As the Minister of State will be aware, great concern was expressed about the impact that changes to the scheme in the HSE's service plan for 2014 would have on the sickest and most vulnerable of older people. The 2014 service plan acknowledges the reality that waiting times for a nursing home bed under the fair deal scheme would increase in 2014. The 2014 service plan stated that 700 fewer beds - 22,061 beds - would be funded under the scheme in 2014 compared with the target for 2013. In reality, the 2014 target is 1,702 beds fewer than the 23,700-plus nursing home beds funded under the scheme at the end of October last year. In addition to these 23,000-plus people, a further 394 were on the waiting list in October for a nursing home bed. Now, according to figures given by the Minister, Deputy Reilly, to my colleague Deputy Barry Cowen, 1,265 are on the placement list awaiting funding.

Under the 2014 plan, the HSE is to allocate €23 million from the fair deal budget and earmark it for community care and home-based care initiatives, such as intensive home care packages, which will benefit 250 people; intermediate or transition beds, which will benefit 650 people; and beds for more complex cases, which will benefit about 130 people. However, as Age Action pointed out, there is a considerable gap between those who will benefit from these initiatives and those left waiting for a nursing home bed as a result of the changes. This will unavoidably lead to an increase in the number of older persons presenting at our already stretched and overcrowded acute hospitals. With inpatient and day-case waiting lists above 50,000 mark now, it is likely that the fair deal changes are having an impact.

Last year the Government also amended the nursing home support scheme through legislation. The fair deal scheme, as introduced, saw individuals contributing 80% of their incomes and 5% of their assets per year, fixed at a maximum of three years or 15%, and that included their principal private residence and, in some circumstances, farms or businesses. Last year the Government increased the maximum proportion payable from 5% to 7.5% per annum, with a cap at three years or 22.5% in the case of a principal private residence. Savings of €3 million for a half year were anticipated as a result of those changes to the contributions. I expect that at this point the Minister of State will be in a position to indicate whether those savings have been achieved.

Last year's Bill also abolished the requirement to backdate State support to the date of the scheme's commencement for those who were in nursing home care prior to that date. I would like the Minister of State to address an issue that also falls within his remit in primary care. Last week the Government announced that the HSE is to restore more than 12,000 discretionary medical cards that have been lost since 2011. However, last October, when Fianna Fáil tabled a Dáil motion on discretionary medical cards, the Minister of State, Deputy White, who was present, basically told the Dáil that just 1,000 discretionary cards had been lost between the start of 2011 and the middle of 2013. That does not even bring us into the discussion on whether a discretionary medical card even exists. The Government amendment to a Fianna Fáil motion on the issue stated: "[O]f the 24,000 reduction in discretionary medical cards from the start of 2011 to July 2013 almost 23,000 of these persons have been awarded medical cards on the basis of their financial means". In other words, just 1,000 people lost a medical card completely, as the other 23,000 were now qualifying for medical cards under the standard financial criteria instead of on a discretionary basis. The Minister, Deputy Reilly, agreed with the Minister of State, Deputy White, when he said:

The number of discretionary medical cards has fallen. As the Minister of State demonstrated clearly, this is because almost 23,000 people who would have had discretionary medical cards now hold full medical cards.

If that is the case, why is the Minister, Deputy Reilly, now pledging to restore more than 12,000 discretionary medical cards? Even if we add in the additional 6,000 or so discretionary cards lost after July 2013, only 7,000 cards would need to be restored if what the Minister of State, Deputy White, told the Dáil last autumn was accurate. The question is whether the Dáil was misled in this particular matter, even inadvertently, by the Minister. According to this morning's edition of the Irish Examiner, the Department of Health explained last night that the response to the Private Members' motion was "prepared by the HSE at short notice" and based on "preliminary analysis". The question that arises is whether the Minister of State was aware that this analysis, which was the cornerstone of his rebuttal last October, was just preliminary and that it had been produced at short notice. Most of us are required from time to time to produce information at short notice, but this does not remove from us the absolute requirement to be accurate in the information that we produce. Did the Dáil vote for a Government amendment which was factually inaccurate? Did the Department subsequently advise the Minister that the preliminary analysis given to him was inaccurate? Does the Minister of State now accept that he, on the basis of the information that he had, inadvertently misled the Dáil? I know we have a short time for discussing these particular matters, as the Minister of State has been engaged in other activity - we wish him well in that endeavour - but the questions we have posed are none the less relevant and I hope he will be in a position to respond.

With reference the earlier mention of time, I am not precious about my time in this instance and I will not be using my full allocation. Having gone through each of the Stages of the Health (General Practitioner Service) Bill 2014, I view this motion as most unsatisfactory. The Minister of State is introducing matters that are wholly unconnected to the address and purpose of this legislation at a very late stage, with the grafting on of two totally unrelated amendments to this Bill, and we did not receive due notice of that intent, nor of what alternative methods could have been employed to facilitate the address of the matters that the Minister of State believes are of such an emergency nature. The amendments relating to the Opticians Act 1956 are straightforward and I have no difficulty with them.

Regarding the amendment to the Nursing Homes Support Scheme Act 2009, the Minister of State has given us little information on its full implications. Perhaps he will indicate if the situations which the amendment seeks to preclude have occurred? Is it the case that there have been incidents of people making the case that assets are not assessable because they were transferred post the date of application? If so, how many? We are entitled to the information that has given rise to the amendments or to know if it is the case that legal opinion has flagged a deficiency in the legislation. If it is the case that this arises from experience, of which I have requested the details, what is the amount of money involved? Does the Minister of State have figures for the excluded accrued assets in whatever number of cases are involved under the fair deal scheme?

The motion presents us with an opportunity to address some long-standing questions about the Nursing Homes Support Scheme Act 2009, including how its financial elements have since worked in practice. I recall that a review of the so-called fair deal scheme was commenced in 2012 and, according to my notes, it was to be completed in 2013. I do not recall if it was completed. In the short time available between notification of the taking of the motion and it being addressed with related matters I could find no record of a published report post-conclusion of the review. I may have overlooked or failed to take proper notes on the matter. Perhaps the Minister of State might enlighten me on the current status of the 2012 review and the report promised on the conclusion of its work.

The so-called fair deal scheme is, as I described during the debate on the original Bill, flawed. It is long past time that there was a renewed Government and public focus on the care of older people, with older people being centrally involved in the process this time. The Minister of State may recall in the context of the publication in 2008 of the Nursing Homes Support Scheme Bill that organisations representing older people were kept out of the process. There was no consultation or engagement with them, in respect of which understandable anger was expressed by the various representative organisations to which I have referred. This must not happen again.

I take the opportunity to urge a renewed focus and re-evaluation of not only this identified deficiency but the Bill in its entirety, as originally drafted. I would appreciate receiving the information in response to the questions I have posed.

The next speaker is Deputy Denis Naughten who is sharing time with Deputy Róisín Shortall.

I hope it can be ensured that, as happened earlier, we will not in the future have to raise on the Order of Business the issue of the allocation of speaking time in order for us to be facilitated in that regard.

I will not be opposing the motion which is technical in nature and provides clarity on the two issues outlined by the Minister of State. However, in addressing the nursing homes support scheme it does not go far enough. There a couple of gaping holes, in respect of which I have tabled an amendment for discussion on Report Stage of the Bill.

Another issue that is causing huge problems within the health service is that of short-term nursing home support for persons in acute hospitals. I am aware that some hospitals are putting aside a dedicated fund in this regard. Under the old nursing home subvention scheme, a person being discharged from hospital who was too well to remain but too sick to be at home was facilitated by a short stay in a nursing home. Those involved are usually older people from isolated communities who have traditionally been branded bed-blockers. Sadly, I represent many such persons. Surely it makes financial sense to put in place a fund to meet the weekly cost of €850 or €900 of caring for such a person in a private nursing home for two or three weeks, rather than paying €1,200 a day to keep him or her in an acute hospital bed, resulting in congestion in hospital wards, delays in and the postponement of elective surgery, congestion in accident and emergency departments and ambulances being parked outside accident and emergency departments rather than being available to respond to meet community needs. I hope the Minister of State will be able to revisit this issue.

Under the nursing homes support scheme, it takes up to four weeks for an application to be processed. The person concerned is then placed on a national waiting list. Currently, it takes 12 weeks from the time a person is placed on the list for his or her payment to kick in. One particular individual whose sibling was discharged from Portiuncula hospital in Ballinasloe and is now in a nursing home is facing a bill of €5,000 which is accumulating by the week because an application under the nursing home support scheme has not yet been approved. The objective behind the scheme was to ensure financial liabilities would not be placed on older people or their next of kin. It now appears that the policy of the HSE is to wait for two beds to become vacant before releasing a patient under the nursing homes support scheme. This is resulting in chaos in the health system because families are not willing to have their next of kin discharged to a nursing home when they are facing such significant financial liabilities. I ask the Minister of State examine this issue.

Another issue that arises is at the other end of the age profile, which issue I raised with the Minister of State during the Second Stage debate on the Bill and have raised previously with him, namely, children with life-limiting conditions. The Exchequer, through the HSE, is paying approximately €8.2 million per annum in supporting children with life-limiting conditions in their communities. These are children who were born with profound disabilities, many of whom will not live to be five years of age, never mind ten or 15.

There is no co-ordinated approach being taken in regard to that and there is a piecemeal approach right across the country. By pooling resources into a national fund, there would be adequate resources to ensure provision would be made for the children in question. My proposal has been endorsed by LauraLynn and the Jack and Jill Foundation, which believe it represents a way of delivering better value for money within the existing budget.

Let me give the Minister of State an example of what I am talking about. At present, there are children trapped in hospital, costing approximately €147,000 per annum in a paediatric hospital bed. They could be put back into their own homes with their families, sometimes at a significantly lower cost. The Jack and Jill Foundation refers to a figure of approximately €24,000 per child. It refers to the PCCC community health figure of €47,000. It is still a small fraction of the money it costs to keep children in an acute paediatric bed in the three centres, but usually in Dublin.

There are families trying desperately to get beds in those hospitals; yet there are children therein who could be more appropriately accommodated in the community. Surely it is time to start joining the dots, particularly when we are not talking about additional funding but about spending existing money far more effectively.

My final point is on my amendment No. 3, that has been ruled out of order. This is the only opportunity I will have to raise the matter. During the Order of Business this morning, the Minister for Education and Skills said on behalf of the Government that new legislation would be introduced before the summer recess. It is to be rushed through so women who were in Magdalen laundries will actually get a medical card. If the Government had accepted my amendment today, it could have facilitated this process by statutory instrument.

My objective has been to ensure that, once the report on the review of medical need is published by the expert group at the end of September, the Government could introduce by statutory instrument an arrangement whereby children over the age of six would be automatically entitled to free general practitioner access based on medical need rather than having to wait for legislation to come through. We were told yesterday by the HSE that it will be at least 12 months before any additional provision will be made through the legislation process for medical cards for patients with chronic, long-term conditions.

As I stated on Second Stage, probably the most distressing thing public representatives have to do in their constituencies is battle through the bureaucratic system on behalf of distressed parents to obtain medical cards for children with terminal or serious chronic conditions. While the Minister of State has made some concessions in cases where discretionary medical cards issued prior to July 2011 were removed, the strict rules on discretionary medical cards that were in place last week, last month and last year are still in place for a child born today with a chronic, terminal or life-limiting condition. The family must still go through the same bureaucratic nightmare.

If the Minister of State accepted the amendment tabled by Deputy Shortall and me, he could, at the end of September when the expert group reports, introduce, at the very least, a doctor-only card for the families to give them some reassurance. It is disappointing that he has not been prepared to take on board the amendment. I ask him to reconsider that decision and table an amendment that would deal with the Magdalen laundry issue in the short-term and also with the very effective campaign by Our Children’s Health seeking a medical card for children under 18 with a chronic and serious condition. There is strong merit in this argument. Our amendment does not go that far, sadly, because we tried to draft it in such a way that it would be ruled in order. Disappointingly, it has been ruled out of order but the Minister of State has the power to table his own amendment along the lines we have proposed to reassure affected families that, when the expert group reports by the end of September, the sickest children will at least be granted free general practitioner access.

In the few minutes I have available to me, I want to make a small number of points. First, it is wrong that Members of this House who are not in parties or the Technical Group should have to fight for time. I very much recognise the fact that the Ceann Comhairle recognises that our group, the others, should have entitlements. I wish this principle were recognised by the Government Whips.

This morning we are debating proposed amendments by the Minister and an instruction to the committee. As a Member of this House, I have not been provided with any documentation relating to the procedure under way. There is a serious problem with that. It is believed everything is done through the Whips but it is not. My colleagues in the “others” group and I should be entitled to the same notice and documentation on proposed business in the House as everyone else.

I have no difficulty with the amendments being proposed and I am happy to support them. However, there has been and continues to be overemphasis on nursing home care. Many patients who are in nursing homes, at considerable expense to the State, should not be in them because their level of dependency does not warrant full-time nursing home care. This should not be happening. More important, we know the vast majority of older people want to stay in their own homes and do not want to be in institutional care. They want to be in their own surroundings and that is what we should be trying to facilitate because it is in their best interest from both health and welfare perspectives. Of course, the difficulty is that there is not adequate financial support available to older people who want to stay in their own homes. Equally, there are insufficient services. This is where primary care is required. We should have a sufficient number of public health nurses. There are large numbers of vacancies in the public health nursing services at present. We also need the allied health professionals, including physiotherapists, occupational therapists and speech and language therapists, who help older people to make a recovery after an incident, return to the best state of health possible and continue to live as independently as possible. This should be the focus of health policy in this regard. I am concerned that we depend too much on nursing homes.

With regard to medical cards, it is regrettable that the amendment to section 6 that Deputy Naughten and I tabled was ruled out of order. I question that decision and wonder where the impetus for it came from. It was ruled out of order on the grounds that it constituted a potential charge on the Exchequer. There may have been a potential charge on the Exchequer but there would only be an actual charge if the Government in power decided to make it a charge. The charge is not something that the Opposition is proposing, therefore, nor is it something it or this Dáil would have any control over. There would be a charge on the Exchequer only if the Government decided to avail itself of the opportunity. The point of the amendment is to facilitate the Minister in extending access to general practitioner care as he or she sees fit. It was a mistake not to do what we propose. It indicates the absence of an overall plan. Despite the Government's statement that it intends to extend general practitioner care across the population within its term of office, there is clearly no phased plan to do so. If there were, the Government would welcome this opportunity to extend access by ministerial order rather than having to return with primary legislation on each occasion it wanted to extend care.

It is very odd that the Government is opposed to that.

I would like clarity from the Minister in regard to what is happening to the proposed initiative for under-sixes. What happens when children who are now, say, five and a half reach their sixth birthday? They will be getting their birthday cards but will they be getting their GP visit card removed when they get to their sixth birthday? It is not entirely clear from the legislation. Is it the intention that, when a child gets to six, this entitlement will be removed? How exactly is it proposed to do that? It seems extraordinary that when somebody happens to reach the arbitrary age of six, he or she will no longer be entitled to free GP care. This needs to be clarified.

There are a couple of serious outstanding questions that need to be answered. I would also appreciate clarification on the decision by Government to reverse the withdrawal of discretionary medical cards. Why exactly does the initiative only go back to 1 July 2011? I would like an explanation of that because it is not clear why that date was selected. What about those who are in need of discretionary medical cards at this point, and from now until whatever date in the future that this or some future Government decides to introduce entitlement to a medical card based on medical condition? It would seem that the same kind of unfair treatment that was meted out to people in recent years in terms of the withdrawal of their discretionary medical card is now going to be meted out to people who will be seeking discretionary cards in the coming 12 months or more. It strikes me that it is not legally sound to treat people who are in similar circumstances in a different manner by virtue of the fact of an arbitrary date, before or after that date. There are many questions still outstanding in this regard.

With regard to Deputy Ó Fearghaíl's contribution, there are no revenue implications in respect of the proposed amendment dealing with nursing home scheme. It is a very limited amendment in terms of its effect. It is really just placing a matter beyond doubt in respect of assets that are disposed of post the date of assessment or post the relevant date.

On that question, Deputy Ó Caoláin asked whether the issue had ever arisen. I am aware it has arisen in one instance, in circumstances where a question arose as to the disposal of an apartment post the relevant date. The apartment was being transferred from a resident who owned three properties. That answers the question as to whether it has arisen. Deputies have recognised that this is a change to the provision to put matters beyond doubt. It might have been assumed that the definition of transferred assets would, in any event, have comprehended assets disposed of postdate, but this is just to make it absolutely clear in the legislation that it does cover such assets.

The Minister of State has cited a single case that has triggered address of this matter. Was there an outcome to that particular endeavour?

I do not know. Deputy Ó Fearghaíl also asked a question in respect of the discretionary medical cards, in particular the issues that arose in debate in the House last year. The statistical reporting of the medical card scheme, which covers 1.9 million individuals at a point in time, is complex and dynamic. Therefore, it can be difficult or problematic to make direct comparisons between different reports of slightly different criteria, dates and timeframes.

There were two reports, one in autumn 2013 and another in spring 2014, indicating that approximately 7%, or one in 14, of discretionary medical cards were being refused renewal. The first report was a preliminary analysis for a Private Members' motion debate prepared at short notice. The later report was a more detailed analysis. Different analytical reports on discretionary medical cards since last autumn produced a number of estimates of lost discretionary cards, that is, cards that were not renewed - 1,696 medical cards in the preliminary analysis, covering January 2011 to June 2013; 5,860 medical and GP visit cards in the May analysis, covering January 2013 to March 2014; and 15,305 medical and GP visit cards in the June analysis, covering January 2013 to May 2014.

The information from these reports was referred to in the Dáil on many occasions. There was no policy to deliberately focus on discretionary cards or cards awarded through the discretionary process, and there was no specific target to cut such cards. There was a budgetary policy of improving the accuracy and probity of the medical card scheme and eligibility for medical cards generally. The Government has never denied that discretionary medical cards were not being renewed, nor did it downplay the numbers involved. The analysis suggested that a refusal rate of approximately 7% did not indicate what was alleged to be a wide-ranging cull of discretionary cards, as suggested in the media and elsewhere. Nonetheless, the Government kept the situation under review given that this area related to a number of people with medical conditions.

Earlier this month, another analysis of discretionary medical card numbers was carried out. This analysis looked at all discretionary medical cards refused renewal throughout the period since the centralisation of medical cards was completed in July 2011. That is the answer to Deputy Shortall's question as to why July 2011 was identified as the bookend at the outset of the period, because that was the time when the centralisation of the process was initiated. The previous reports indicated what happened to discretionary cards held at a point in time, whereas the report I am talking about now was over a period. This final analysis indicated that, throughout a three-year period, the renewal of approximately 15,300 discretionary medical cards and discretionary GP visit cards was refused as the person did not meet the eligibility criteria.

As the House is aware, the Government has decided to develop a policy framework for providing eligibility for health services on the basis of medical conditions, including new legislation as appropriate. This is a major change to eligibility for the health system, which has been based on means since the 1970 Health Act.

Deputy Ó Fearghaíl also raised an issue in respect of waiting times, which was also raised by another Deputy, and I will come to that. I welcome Deputy Ó Caoláin's acknowledgement that the election in regard to the Opticians Board is a technical matter. I recognise and acknowledge his support for that, or at least his non-opposition to it.

Deputy Naughten raised a number of different issues in respect of funding, of which I have taken note and which I understand. He also raised an issue with me before on Topical Issues in regard to paediatric palliative care and has raised the issue again today, perfectly legitimately. I am not in a position to deal with it in any detail today but I am taking careful note again of what he has said, at least by way of reminder to me. It is a fair point and is a matter I will seek to pursue for him. I will try to keep in contact with him in this regard.

An amendment was ruled out of order on Committee Stage, and Deputies Shortall and Naughten have raised this issue. I never know whether it is in order for me to talk about matters that were ruled out of order. However, I will talk about it-----

Deputy Ó Caoláin raised this issue earlier. We will not have an opportunity to raise it in the committee.

I am in the hands of the Chair but I am very happy to deal with any issue I am asked about.

I understand entirely where Deputies are coming from and, if I could, I would do in the morning what they are seeking to achieve. However, I do not agree that a simple amendment to the legislation to facilitate, in Deputy Róisín Shortall's words, the Minister in introducing new groups, persons or categories in respect of eligibility would either be appropriate or legally sound. Why do I say this? I say it because it is now very clear, if it was not clear in the past, that these decisions on the allocation of resources are ultimately ones for the Oireachtas to make. One cannot give a current or future Minister plenipotentiary powers to determine who receives particular services and who does not. If the House sees fit to pass the legislation, we will set out clear principles and policies that are straightforward - resident in the country and being aged under six years. The Oireachtas will determine what will qualify a person for GP services. It is not appropriate and would be fundamentally flawed for us to purport to give a current or future Minister the powers to introduce additional eligibility criteria not passed by the Houses, even where, as the amendment puts it, it is done with the approval of the Oireachtas. Its approval is provided for through the legislation. That is how we make decisions here; we do not approve things. If we are giving eligibility to certain categories, as I would love to do because I agree with what the Deputies are seeking to achieve, it is not appropriate to outsource that power to a Minister because the Oireachtas must maintain the basic policies and principles-----

We do it every year in the case of the Offences Against the State Act.

I disagree. The principles-----

If what the Minister of State says is true and the Government is going to extend across the population-----

We will do it here n the Oireachtas.

Why come back with primary legislation? That is nonsense.

It is not. It is the complete opposite and absolutely straightforward, if the Deputy will bear with me. If the Houses pass the legislation, we will give eligibility to children aged five years and under. If and when we extend it, which I very much hope will be soon and substantially, it will be the Members of the Dáil and the Seanad who will do it, not the Minister. The Deputy may smile, but I think she knows I am right.

It is the Government that needs to decide.

If the Deputy was being fair, she would see that what I was saying was manifestly correct. It is a matter for the Oireachtas and cannot be something that is carved out, hollowed out and given to a Minister. That is the case and for the avoidance of doubt, that is the advice I have received. I accept that advice because it makes sense to do so.

In respect of what Deputy Róisín Shortall said about documentation, it is not within my remit to comment on it, other than to say I agree with her. As a matter of good practice in any parliament, all Members of the Dáil should have access to all documentation. I am not being dismissive, as I am agreeing with the Deputy. If Deputies believe they need or should have certain documentation and have been deprived of it or it has not been circulated to them, as a matter of good parliamentary practice, they should have access to any documentation being relied upon by a Minister, debated or put before the House. That seems to be an example of first principles.

I agree with Deputy Róisín Shortall in respect of nursing home care and the importance of transferring and realigning resources in the community as best we can. This has been done by the Government. A total of €23 million has been realigned, €10 million of which will be used to maintain short-term beds in the community. There will be 45 additional short-term beds at a cost of €3 million and 250 additional intensive home care packages at a cost of €20 million. The Deputy is absolutely right that the trend and emphasis should be on care in the community and that is what we are seeking to achieve. I do not disagree with her in that regard.

We are working on and have achieved much in respect of posts and various health care professional and staffing requirements. When the Deputy was Minister of State, she initiated some very important work in that regard which we have advanced.

What I have always said about the provision for the under-sixes is that this is an interim phase. It provides that all persons under the age of six years will be able to attend a GP free of charge. This service will not be available to a child who has turned or is over the age of six years, as stated clearly in the Long Title of the Bill. Of course, this is the first step in covering the entire population with a universal GP service. The Department is considering options for the next and further phases of this service. We indicated in the Government's statement last week that a paper would be put before the Government in September to guide the future implementation of this very important scheme.

The Minister of State did not respond on two matters I had raised. I asked about a review of the nursing homes support scheme initiated in 2012 which was signalled for completion in 2013. What is the status of that review?

The other matter I raised concerned an overview of the financial elements of the Nursing Homes Support Scheme Act 2009. How have these elements worked in practice? I appreciate that it might be a little more complex than the reply the Minister of State might have to hand, but I hope the review about which I am asking might shed some light on it.

I will take a question from Deputy Róisín Shortall, but we are nearly out of time and must proceed to the Bill.

Is it proposed to withdraw GP visit cards from children when they turn six years of age? How will this happen in practice?

A review is ongoing. When the nursing homes support scheme was introduced, a commitment was given that it would be reviewed after three years. The terms of reference for the review are:

Taking account of Government policy, demographic trends and the fiscal situation--

1. To examine the on-going sustainability of the Nursing Homes Support Scheme,

2. To examine the overall cost of long-term residential care in public and private nursing homes and the effectiveness of the current methods of negotiating/setting prices,

3. Having regard to 1. and 2. above, to consider the balance of funding between long-term residential care and community based services,

4. To consider the extension of the scheme to community based services and to other sectors (Disability and Mental Health), and

5. To make recommendations for the future operation and management of the scheme.

A consultation process took place in 2012 which included all of the various organisations involved. The review has not yet been completed, but we expect it to be completed in the autumn. Among other things, it will look at the balance of funding between community and residential care. As the scheme is statutorily based, the implementation of recommendations arising from the review may require amendments to the Nursing Homes Support Scheme Act 2009.

To answer Deputy Róisín Shortall's question, the Bill involves extending eligibility for GP services to children under the age of six years. When the legislation is passed, this will be initiated and established and all children under the age of six years will have access to these services. It follows that children aged six years and over will not have access to them, at least until we have an opportunity to extend the scheme. I very much hope there will be further legislation to allow us to do this, although no Government decision has been made in that respect. That is certainly my aspiration. Children under six years will have access to services, while children aged six and over will not. Some preparatory work has been carried out by the primary care reimbursement service, PCRS, and the precise details of the modalities in furnishing cards and the contacting and signing up of individuals will be provided if the legislation is passed by both Houses.

Question put and agreed to.
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