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Dáil Éireann debate -
Wednesday, 8 Mar 2017

Vol. 942 No. 1

Health (Amendment) Bill 2017: Second Stage

I move: "That the Bill be now read a Second Time."

It is my pleasure to introduce the Health (Amendment) Bill 2017. In A Programme for a Partnership Government, the Government set out its aim to increase access to safe and timely care as close to patients' homes as possible. We outlined that progressing this objective will be a priority for the partnership Government. In our programme, we committed to extend the entitlement to a medical card for all children in receipt of the domiciliary care allowance. This initiative was subsequently announced as part of range of health measures included in budget 2017. This Bill delivers on this important commitment in full, on time and without qualification.

We also committed to reducing prescription charges for medical card holders. The Bill, which will see the prescription charge reduced for medical card holders over 70 years of age and their dependants, delivers on this commitment for the group most affected by prescription charges.

The legislation has two primary purposes. First, it will ensure all children currently in receipt of a domiciliary care allowance payment will now receive a medical card. Up to now, over 33,000 parents were in receipt of a domiciliary care allowance payment for their children but over 9,800 of these children did not qualify for a medical card. This Bill will rectify this and now all 33,000 children who receive a domiciliary care payment will be entitled to a medical card. The scheme will be operational from 1 June with the Health Service Executive, HSE, having a paper-based and online pre-registration system in place from 1 May. This pre-registration will assist in allowing all those who wish to do so to use their new medical cards from 1 June.

There will be several ways in the initial roll-out of the scheme for a child to receive the medical card. First, for a child in receipt of domiciliary care allowance but who currently does not have a medical card, the parent or guardian will register for the scheme either online or through the paper-based form. Second, for children who are currently eligible for a medical card, discretionary or otherwise, and are confirmed to be in receipt of a domiciliary care allowance, the HSE will automatically issue them with a new medical card. Finally, for a child who is currently eligible for a GP visit card, under discretion or otherwise, this card will automatically be upgraded to a full medical card.

The second purpose of the legislation is to reduce the prescription charge for medical card holders aged 70 years, or older, and for their dependants to €2 per prescription item with a monthly cap of €20 for an individual or family. This targeted measure, which will cost €12 million in a full year, will benefit nearly 390,000 people. It is expected to save this group of patients €10 million in 2017. Deputies will note this reduction has been implemented from 1 March. I decided, following consultation with the Attorney General, to introduce the reduced charges on an administrative basis by the HSE, pending this legislation, in order that older citizens need not wait. A circular was issued to pharmacies from the HSE setting out the reduced charges and process. I take the opportunity to thank the HSE and pharmacies across the country for the swift implementation of this important measure. In addition, I stress the importance of delivering this legislation in March to place the measure on a statutory basis. I ask for the support of Deputies and Senators in enabling this benefit for older citizens.

Shortly after I was appointed Minister for Health, I spoke with a campaigner for Our Children's Health outside Government Buildings on my way into the first Cabinet meeting. Many of us, as public representatives, have been struck by the practical challenges that parents face in meeting the needs of a child with a disability. As we discussed the issue that day, I came to understand that, for many of these parents, meeting their child's needs was the first time they had sought assistance from the State. Children in receipt of a domiciliary care allowance payment are children under the age of 16 years whom the State has considered to have a severe disability which requires ongoing care and attention substantially over and above that required by a child of the same age.

Caring for a child with a serious disability is a most difficult, stressful and worrying time. Dealing with a diagnosis can at times require every ounce of strength from parents. These parents face many struggles in dealing with a difficult diagnosis. Accordingly, struggling to access services should not be a further burden that the State adds to them. That is why we are committed to ensuring all children in receipt of a domiciliary care allowance payment will have access to a medical card. It will be an automatic entitlement with no reviews or concerns about what further paperwork must be submitted. This medical card will be an automatic entitlement and will provide security to 33,000 children, along with comfort to their families and carers. Providing a medical card for these children will alleviate the stress and anxiety of parents in terms of dealing with medical costs associated with their child's disability. Undoubtedly, it will also relieve some of the financial burden these families have experienced. It will also ensure they can more easily access health services which their children require.

By virtue of now having a medical card, these children will be eligible for the following services free of charge: inpatient and outpatient hospital, GP care, prescribed drugs and medicines, subject to a co-payment; dental, ophthalmic and aural services; and aids and appliances. In addition, parents will now not be required to undergo the process of providing family financial information, expert or medical reports and additional supporting information when applying for a medical card. This was a real burden on parents. All Deputies know from their constituents the hassle and stress a parent, already busy caring for their child with a disability, encounters when they have to fill out more forms and a note from the HSE seeking a review when the child clearly has a disability and is in need of a medical card. Providing these children with a medical card without the need for the detail required by the standard application process will ensure a quicker and easier process for parents.

The reduction in the per item and monthly maximum prescription charges will also apply to children in receipt of the domiciliary care allowance. To ensure all families are treated equally, where there is more than one child in a family in receipt of the domiciliary care allowance, and the payment is made to the same parent for each child, the legislation allows that a family prescription cap of €25 per month will apply. The Government is committed to reducing the cost of medicines for patients. Several actions are currently reducing medicine costs. Pricing arrangements agreed with the industry last year are providing ongoing and increasing savings, both for the taxpayer and for patients in pharmacies. The list of medicines approved for substitution, allowing pharmacies to dispense the most cost-effective version of a drug to patients, continues to expand. The introduction of biosimilars, the equivalent of generics for very expensive and complex biologic products, will free up significant resources to allow more people to be treated across the health system.

The commitment to reduce the cost of medicines includes reducing prescription charges for medical card holders. The prescription charge was introduced in the Health (Amendment) (No. 2) Act 2010, to address rising costs in the medical card scheme. The charge is set by regulation. The current charge of €2.50 per item, with a monthly cap of €25 per person or family in, was set in 2013. It reduces the cost of the GMS, General Medical Services, scheme by approximately €120 million a year. Under the existing legislation, specific groups such as asylum seekers and children in care have been exempted from the prescription charge. However, while the Act provides for exemptions, it does not allow the charge to be amended for a particular group. Accordingly, this Bill will identify the over 70s and provide for a lower charge to over 70s and their dependants.

The most effective use of the resources available for reducing the charge, at this stage, is to target a particular group of people who are under greater pressure because of their medical needs. People aged 70 years and over have higher medication requirements than the general population. Over 70s patients are just under 20% of the medical card population, but nearly half of the drugs dispensed under the scheme are for over 70s. I am advised the average number of items dispensed per person over 70 years is seven, compared to two items per person under 70. In addition, this group are generally on fixed incomes. Given this, it is fair and just to direct the resources available to reducing the cost of medication for this group.

Budget 2017 announced a reduction in the prescription charges for this group. The reduction will be from €2.50 to €2 for each prescription item, up to a maximum of €20 per person or family per month, reduced from €25. I would like to further build on these reductions in prescription charges in future but this first step in reducing prescription charges rightly targets our older citizens, and their dependants, for the variety of reasons I outlined.

The main provisions of the Health (Amendment) Bill 2017 are as follows. Section 1 provides a definition for the purpose of reference to the Health Act 1970. Section 2 provides a definition of who is eligible for full general practitioner and other health services, in this case, the children in receipt of domiciliary care allowance.

Section 3 amends section 59 of the Health Act 1970. This section provides a definition of those over 70 years and their dependants and those in receipt of domiciliary care allowance access to drugs, medicines and surgical items. It outlines the charging of fees in respect of prescribed items dispensed by community pharmacy contractors to persons with full eligibility.

Section 4 amends section 59 of the Act by inserting a new section, section 59A, into the Act, to allow for the variation of the prescription charge and monthly expenditure cap for over 70s medical card holders. The current section allows for exemption of specified groups from the charge and for the variation of the charge overall but does not allow for variation of the charge for a specified group. Section 59A(1) identifies medical card holders aged 70 and over, and their dependants, as the class of persons to whom the section applies. Section 59A(2) sets the prescription charge for this class of persons at €2 per item. Section 59A(3) sets the maximum amount of prescription charges payable in a month by this class of persons at €20. Section 59A(4) provides that the Minister may, with the consent of the Minister for Public Expenditure and Reform, make regulations to vary the amounts in this section. It also provides criteria to which the Minister should have regard to when making such regulations. This will make it easier in the future if one wishes to make further changes regarding the level of charge.

Section 5 states the short title of the Act and includes a standard provision relating to commencement of the provisions of the Act.

I am personally very pleased to bring forward this legislation. It is our obligation, as the representatives of the citizens of Ireland, to provide ease of access for all to health care. Providing ease of access to a medical card for this group of people, children with disabilities whose parents are in receipt of domiciliary care allowance, is the right and appropriate thing to do. People have been campaigning for this measure for a long period. I acknowledge, as I did at the outset, the work of Our Children's Health and that of so many advocacy groups. It is because of the work of those groups, their campaign, perseverance and important highlighting of this issue that I am on the floor of Dáil Éireann introducing this important legislation which I hope will be passed on Second Stage. We should not underestimate the importance in terms of peace of mind that this Bill can provide to those families. We do not need a situation where children who are in receipt of domiciliary care allowance are constantly having reviews of their medical card and medical circumstances by the HSE. This will provide certainty of access to a medical card for as long as a child is in receipt of domiciliary care allowance. It is not only the nearly 10,000 children who will receive a medical card who do not currently have one as a result of this Bill, it is the entirety of the 33,000 who will have certainty that they will be review free once they have a medical card under this legislation while they are in receipt of the domiciliary care allowance.

The legislation will give children in receipt of domiciliary care allowance access to the services that they need, without unsustainable financial burdens on their families. At the other end of the spectrum we are talking about medical cards for children with disabilities. The other issue this Bill addresses is prescription charges for those aged over 70 years. For both the young and the old, this legislation endeavours to make life that little bit easier for those two cohorts of people in society who deserve and require these supports.

For me, this is all about people. It is about looking after the most vulnerable in society. I am committed to doing everything we can to help those who most need it. I acknowledge, as I am sure we will hear in this debate, the unanimous and cross-party support for this measure. This is an issue that nearly every party in this House subscribed to during the general election. It is one that we are delivering and that we will get over the line, and I hope we will do that as quickly as possible. I thank everyone who has brought this measure to this point and who campaigned so hard for this. This is not the answer to all the burdens that families encounter on a regular basis, but we hope it is one little step along the road to making life that little bit easier for a family caring for a child with a disability. I hope the Bill will receive the support of all Members of this House because it provides support for that vulnerable group of children and also for older people in a very tangible fashion.

I wish to share my time with Deputies Jack Chambers and Eugene Murphy.

We will support the Bill. We thank the Minister for bringing it to the House in a reasonably timely fashion on foot of the commitments that were made in the programme for Government and the negotiations in that context. This measure was contained in most parties' manifestos in the run up to last year's general election. However, that is as far as I can go in welcoming it.

This issue must be viewed against the background of what has been the policy on medical cards generally in recent years. The Minister spoke about new politics but often this can mask the fact that people may still be entrenched in their views as to what is right and what is wrong with regard to ensuring people, particularly those who most need it, have accessibility to medical care. Whatever way we decide to fund health services and whatever we decide on universality, we must ensure in the meantime in getting to that point that those who most need health care and the support of the State for access to health care get it first. I have instanced the issues of people who are sick and children with serious illnesses and rolling provision out from that level. The concept in this respect that has been pursued for the past few years has beggared belief. While we still have limited resources, there has been an increase in the overall budget, but we are still rationing health care in the State every day of the week. Somebody has to do without because somebody else gets what they need. Until such time that we get to the stage where everybody can get what they need, we have to make decisions and choices on who gets health care and support from the State in accessing health care, who does and does not qualify for a medical card and who qualifies for general practitioner, GP, services. In that context, when we reflect on and analyse the previous five years, it tells a fairly harrowing story. I point to that because it is important if we are framing policy and trying to get to a stage where there is universality, that we do it in a humane way that is fair and primarily fair to and supportive of those who need it most.

People often talk about equality and fairness but there is a big difference between something being equal and it being fair. We must be honest with ourselves about that and until such time as we get to a stage where everybody can be treated equally we must be fair. We have not been fair to many thousands of people in recent years in terms of access to medical cards. To take the example of the discretionary medical card, eventually a compassionate scheme was put in place but it was beaten out of the last Government. It was incredible to think that week after week following harrowing story after harrowing story, there was an absolute denial that there had been a change in policy. There had to have been a change in policy because the number of discretionary medical cards decreased to 49,000 and the number of them is now more than 100,000 and yet we were told for a long time that there was no change in policy. Children with cancer were unable to access a medical card. Women who were dying of cancer were told that they could not get a medical card. People requiring end of life palliative care could not get a medical card.

We raised these issues in the Dáil time and again. I am not reminding the Minister of this to get at him because he is only in office ten months and I will not hold him culpable, but when we are trying to get to a place of equality let us be fair in the meantime and being fair is ensuring that those who need support most get it first until such time as we have enough resources to give it to the others. That is something I believe was missing in health policy development in recent years with regard to medical cards. The discretionary element was, to say the least, distasteful in how a system, be it a Government or an administration, could preside over something that was heartless and without feeling.

We simply said "No" to people who were dying. Week in, week out, Deputies all across this House, including those on the Government side, raised the issue, yet the whole Administration, the whole system, said there had been no change. Ministers told me there was not even such a thing as a discretionary medical card, that it did not exist, as quoted in the Dáil by the Minister of State with responsibility for primary care.

While we wait for the Committee on the Future of Healthcare to publish its report, while we wait perhaps for a health policy from the Government and while we wait for policies from the various Opposition parties, I ask the Minister to put at the heart of our policy the issue of fairness. If universality is our aspiration or our goal, in the meantime the pathway must be fair. To decide to target one age cohort over another is equal but not necessarily fair. I have had representations from children and families who are still under huge pressure. They get the exact same as families who can well afford these costs. We must think clearly about this. It is welcome that the legislation to make the domiciliary care allowance available is to come before the House. The targeting of this at children with disabilities is the right concept because it is fair. However, is it fair to give it to everybody else and not to children with disabilities, or to give them the exact same as everybody else? I do not think so.

Regarding decisions to come from the Government, if there are to be any - I do not mean that in a dismissive way - let us be honest that there are no policies from the Government on health. There was a general election last year, there were manifestos and negotiations and there is a programme for Government. However, there are some statements in the programme for Government but no clear, defined policy or vision on health. We do not know whether the HSE is to be dismantled or retained. We do not know whether we are moving to hospital trusts or hospital groups or whether they are all being scrapped. We have no concept of a Government view on health, which is worrying in view of the fact that many people depend on a public health system underpinned by a policy that can in turn be supported by financial means and choices in respect of taxation and funding. We have none of that. Nothing has come from the Government in the past year. Even before last year, policy was chaotic, from universal health insurance to no universal health insurance; from no prescription charges to prescription charges of €2.50; and from marchers on the street saying we will never take medical cards off our over-70s to reducing the threshold from a very high point down to €900 and €500. All these things did happen and they were all opposite to the stated view at the time and the commitments made. At least in this area, the commitment made has, thankfully, been honoured. This might restore some element of confidence in what one says and what one does, and the public might buy into the concept that we live up to our word in this House.

Regarding the broader issue of prescription charges, there is no doubt that €2.50, to some people, is not a lot, but to the people paying the €2.50 who are on medical cards, it is a huge sum. It adds up at the end of the month to €25, which is a substantial amount of money being one tenth of the old age pension for a week. This is the kind of money we are talking about. We must therefore put things in context. When people are drafting or drawing lines on how much we will charge individuals, they should at least take into account their ability to pay, a very simple, basic concept. However, I am definite that whoever decided to change the charge from 50 cent to €2.50 was not on an old-age pension or a medical card. If he or she was, there is no way he or she would have asked a person on an old age pension to pay €25 per month for prescription charges to avail of medication. The concept is simply not that those who have the most pay the most in the context of fairness as opposed to equity.

When this legislation passes, 33,000 people with disabilities will be on medical cards. I know that the Minister will consistently say the Government is waiting for the report of the Committee on the Future of Healthcare but I wish to raise two issues with him because I want to give my colleagues plenty of time to consider them. The first concerns the long-term illness scheme. We have been up and down on this issue but at some stage we will have to consider an imaginative way of addressing it. I will make proposals as to how this might be done but, in the meantime, the discretionary element will have to be revisited in a more meaningful, compassionate way. I accept there have been major improvements, for which I give the Minister credit, but there is an issue of long-term illness and people with very serious conditions being unable to access medical cards, even conditions which 30 years ago were unknown or at least in respect of which the research was not as readily available.

Negotiations between the IMO and the Minister's Department are ongoing, wherever they are going. I have heard that the National Association of General Practitioners was previously outside the window but is now even further from the window; it cannot even look in now. The reason I raise this issue is that I am of the firm view - perhaps the Minister should go back and check this with his Department - that his Department officials have no interest in negotiating a major new contract, despite the pretence continuing there. They are tinkering around the edges with the old contract.

If the Minister does not believe me, I am afraid they have pulled the wool over his eyes as well-----

-----because that is what they are at. The bluff is continuing. The IMO and the boys are inside, they are sitting down and they will start scratching each other's backs. The Department of Health, the IMO and others have no interest in negotiating a new contract. They are just tinkering with the old one. I urge the Minister to consider this.

I thank my colleagues, Deputies Billy Kelleher and Eugene Murphy, for sharing their time with me. I will start on a positive note. This is a very good measure, and it is good that all parties across the House are supporting it. We all campaigned in the general election on a platform of supporting people with disabilities, but particularly giving people in receipt of domiciliary care allowance the full range of primary care services and interventions they require. This Bill will deliver that for them. I welcome the fact that they will no longer have a cost impediment to addressing their complex needs in the context of the primary care system. The Minister stated in his speech that there will not be a charging mechanism in our hospital system for these people. However, the core issue we have seen in recent weeks is that their complex needs are linked with the relevant interventions, and it is a matter of providing this in the context of our acute hospital system.

As we know, the waiting times are beyond an obscenity. Delivering on a primary care basis and handing these people cards is one thing, but our core priority should be to deliver on all the other levels within our hospital system. The Minister has mentioned repeatedly in the press and elsewhere that he has the biggest health care budget ever seen in this country. However, we need only consider the outcomes for people in terms of their wait times, the acute hospital system and how people with certain diagnostic issues are being left with long-term disabilities because our health system cannot deliver for them. How much more allocation of money for the health system does Deputy Simon Harris need as Minister to deliver for those people for whom he seeks to deliver medical cards today? As Deputy Billy Kelleher said, this should have been the first thing the Fine Gael-Labour Party Government delivered for people. Handing a free GP card to everyone under the age of six was a popular, broad-ranging measure but it did not consider need or means. When we are apportioning resources in the context of a very difficult health budget, we should prioritise those who have complex needs and those who cannot afford health care.

That is something the Government failed to do in its negotiations with the National Association of General Practitioners, NAGP, and the Irish Medical Organisation, IMO, to deliver that previous measure.

I also welcome the change to the prescription charges. In 2011 the Government stated it would abolish prescription charges but they multiplied significantly. It is ethically wrong that the State is profiteering on prescriptions which improve patients' long-term outcomes or keep them alive. A lady in my constituency spent four weeks in Connolly Hospital because she could not afford the prescription charges. She receives a non-contributory pension and could not manage her bills or buy her prescription and developed cardiac failure. She recovered and was discharged but people like her present at emergency departments.

We need a vision and pathway for the health service. The Minister has repeatedly referred to the outsourcing of that to the Committee on the Future of Healthcare, which is playing an important role. The Minister, however, needs to define what system he wants to create and how he sees it in the short to medium term. We have the biggest health budget ever but the worst delivery. This Bill contains a welcome measure for those in need. It does not, however, give any indication of health policy or whether people who cannot pay can be guaranteed the orthopaedic or cardiac intervention or whatever they require without having to wait a significant length of time.

Deputy Billy Kelleher said during Priority Questions that under the health care legislation people who pay for private health insurance, and have paid their taxes, must in effect pay twice in the public hospital system. That is a form of double taxation. It is wrong. The State is incentivising hospital management to profit from people who pay their insurance. That needs to change. However, I welcome the overall thrust of what the Minister is doing tonight.

I welcome this Bill and the fact that medical cards will be made available to the almost 10,000 children in receipt of the domiciliary allowance. It is good news that this will happen on a given date.

The Minister spoke about reducing medical costs for children, which is very important. I hope that in the next week or two weeks the Minister will see that those who need Orkambi will get it. Regrettably, diabetes in children is also a serious problem. There are breakthroughs, however, such that parents or whoever cares for children will not have to carry out the prick test, often in the middle of the night, which is stressful and annoying. People will look for the new method to be approved by the Department or the Health Service Executive, HSE.

It is welcome that the prescription charge is coming down. We acknowledge that we introduced a charge of 50 cent. When it went to €2.50 it caused hardship, as I saw among older people in my family. Those on the basic pension had to cut back because the telephone allowance and other allowances went. There are more costs for those people. When the prescription charge went up it imposed a huge burden on many. It is coming down a little but we must work to reduce it further. We have to be fair to all in respect of health. Equality and fairness are important.

We have to be radical, whether in government or in opposition. We have to have bold initiatives, new ideas and new ways to tackle the health service difficulties in this country. Unless we do that the problem will get worse in ten or 15 years time. There is a huge budget but it needs to be better managed and we need to make sure there is equality and fairness in the system for all.

I welcome the parents who are watching this debate at home. They cannot be here because they are caring for their children. I also join the Minister in acknowledging the very good work done by Our Children's Health, which has fought tirelessly. I am very proud to be one of its supporters. It deserves credit for bringing this about because it was only through its hard work that the matter got the attention it deserves.

I welcome this legislation and hope we will be in a position to expedite its passage as well as ensuring the provisions of the Bill take effect as quickly as possible. This is not the first time today that the Minister and I have had a conversation about how quickly things should happen. This is one of those rare occasions when peace and unanimity will break out in this Chamber because we are all agreed that this measure is important, necessary and should be taken quickly.

Last year the House passed a Sinn Féin motion calling for all children in receipt of the domiciliary care allowance to get an automatic entitlement to a medical card. I am concerned, however, to read in the legislation and the accompanying press release that parents will not be able to use the new medical card until 1 June 2017, almost a year since that motion and further on from commitments made in manifestos. It is important that as we discuss this Bill and the welcome provision regarding medical cards we remember that for thousands of families in the State there is no respite. They have sick children who need care and access to services and they have to battle every single day for their children. They have waited a long time for this legislation. They welcomed the programme for Government commitments, the words of the Minister following the passage of the motion last year and the budget 2017 commitment but as they welcomed all of these milestones they still wait for their medical cards. Last July the Minister said:

I will act and we will act, as I hope will all Members, with a sense of urgency. The money will be put in place in the budget in October and we will move forward with the legislation. There are parents currently sitting in the public gallery. These, and the parents of 11,000 other children, will receive an automatic entitlement to a medical card early in 2017. That is acting immediately and urgently.

Unfortunately, however, it is not early 2017 when they will get it. The first of June is the middle of 2017. What was the delay in drafting the Bill and introducing it to the House when the money was put in place in the budget? Why is it June 2017?

It is a blot on our society that for so long we have had a system that withheld medical cards from children with severe disabilities or life-threatening or sometimes terminal conditions. It is a cruel society that perpetuates a system that tells the parents of a child with such a disability and illness that granting or continuation of a child's medical card depends on those parents jumping through a lot of bureaucratic hoops. Access to quality health care should be a right and not a concession to be granted, withheld or withdrawn by any Government, Minister or civil servant. The provision to grant children in receipt of the domiciliary care allowance a full medical card is acknowledgement of this fact. We need to end the two-tier health care system and move towards a system where every person, child, man or woman who needs health care can avail of it.

I am not alone in having sat down with families to help them work their way through the myriad forms and proof needed to apply for a medical card. Those people tell us, as legislators, to do whatever is necessary. Those 9,800 families who will benefit from this legislation can tell us at first hand that the process is both cruel and degrading.

In addition, it happens at a time when parents are least able to handle dealing with bureaucracy. When one's children are sick, one wants to be at home caring for them. The last place one wants to be is standing in a queue to photocopy one's P60 for the third, fourth, fifth or sixth time. Parents who have gone through this would advise us to forget about requiring people to get P45s, P60s, PAYE balancing statements, bank statements, evidence of mortgage payments and everything else that goes along with the current approach. When a person's illness or disability has been confirmed and a medical need has been established, the State should do everything in its power to help and support him or her. However, as the Minister knows, that has not been the case. Many hurdles are put in the way of parents of children with disabilities at the precise time when they are least able to deal with any of those hurdles.

When this House debated a Sinn Féin motion on this issue last year, I told the Minister about baby Réiltín, who was a very sick little girl. I had spoken to baby Réiltín's mother, who was facing a bureaucratic nightmare involving mountains of paperwork. I am a mother but I do not presume to have any monopoly on sympathy, experience or anything like that. After my daughter was born and when she was still small, I would not have been fit to write my own name, never mind fill out all the paperwork baby Réiltín's mother had to go through. Thankfully, she got her medical card very soon after her case was discussed here. The current system is not right. It is cruel. We need to move towards a system that shows respect, decency and compassion to people who are sick and who need to use our health service. We have to put an end to the disturbing and insensitive practice that requires people with life-limiting illnesses and permanent disabilities to respond to review after review, despite the ongoing progression of their illnesses and the reality that there will be no recovery for them. Some people with terminal illnesses cannot get medical cards. As the Minister knows, there is no such thing as recovering from a terminal illness.

The Minister might argue that my criticism of the delay in this legislation and the wait for the day when it will come into operation and parents will be able to use these medical cards is an example of the Opposition playing politics on a positive news day, but far from it. The importance of a medical card, in terms of the quality of life and quality of care given to children, cannot be fathomed by those of us who are fortunate to have good health and no caring responsibilities. The delay in bringing this long-promised proposal to fruition is having a real impact on people's lives. I remind the House that medical cards cover the cost of things like GP visits, medication and aids and appliances. It can cause grave hardship for someone to be dealt the blow that he or she, or his or her child or loved one, needs a range of aids or medicines to deal with a diagnosis. This is in addition to the difficulties associated with the illness or disability itself. These circumstances can be absolutely catastrophic for the mental well-being of those involved. It can be nearly impossible for someone who is unable to get a medical card because his or her household is on or just over the income threshold to get access to these services. The drawn-out wait for these services piles more worry and pressure on families that are already heading towards breaking point.

The medical card is a passport to gaining automatic access to a range of community-based and primary care services. This is a particularly challenging position to be in if one has a complex condition requiring ongoing multidisciplinary support in the community. As the Minister knows from his meetings with representatives of Our Children's Health, the medical card process is torture in slow motion for worn-out parents. It involves constant form-filling and endless reviews, rejections and appeals. Although this proposal will go live in June, the parents to whom I refer would like it to be a matter of urgency tonight. Will there be any flexibility in the interim period to enable the 9,800 children involved to access the services, aids, appliances and supports that come with a medical card? In light of the stated aim and purpose of the legislation before the House, I ask the Minister to give a commitment that he will ensure these children are able to get the medical services they need while their parents wait for the official date of 1 June 2017.

What is the reason for the difference between the figure presented last year and the figure presented last week? The Minister advised us last July that 11,000 children would be affected by this Bill, but he has said today that the correct figure is 9,800. Where have the other 1,200 children and their families gone? Is it the case that having fought tooth and nail in the interim period, they have received medical cards? Has the wait been too long for some of these very sick children? I would also like to ask about the operation of the scheme. Will the Minister confirm that when parents register for the scheme online, by means of a paper-based form or otherwise, there will be no delay in issuing medical cards? There should not be any slippage between saying it in here and making it a reality for parents as they watch the postbox. Will the Minister ensure the necessary resources and personnel are in place to process these registrations as quickly as possible? He must ensure no further unnecessary ordeal is visited on these families by further bureaucracy or delays in processing their medical cards. Similarly, I urge the HSE and the Department of Health to ensure a high-profile public campaign is launched.

This legislation is welcome. We need to ensure the smooth passage of the Bill through the legislative process so that these measures can be put in place without further delay. That will be the true measure of the success of this initiative. The Minister will forgive me if I withhold my congratulations until the 9,800 children he mentioned receive their medical cards.

I warmly welcome the Second Stage debate on the Health (Amendment) Bill 2017, which provides for two key advances in health care delivery, each of them potentially leading to greater or even more important developments in the provision of health care in this country. First, the Bill provides for the automatic granting of a full medical card to every child in receipt of domiciliary care allowance. This will have a welcome impact on the lives of 9,800 children and their parents when it comes into effect on 1 June 2017. The second measure will have a small but welcome impact on the monthly budgeting of households of citizens over the age of 70, and their dependants where applicable. Both of these measures were promised in the programme for Government. I welcome the presentation of this Bill and its implementation that will follow its successful passage through these Houses. The granting of a full medical card to all children in receipt of the domiciliary care allowance is an important step. I hope it will lead to a universal health care system in this country that is free at the point of delivery and is paid for through direct and fair taxation.

Domiciliary care allowance is a monthly payment that is made in respect of children up to 16 years of age who have severe disabilities that require continuous care and attention over and above what a child of comparable age would normally require. Some 33,000 parents are currently receiving domiciliary care allowance each month. More than 20,000 of their children already have medical cards. This Bill will extend that entitlement to almost 10,000 children whose parents are in receipt of domiciliary care allowance but who have not qualified for medical cards to date. All children whose parents are in receipt of domiciliary care allowance will now qualify for a full medical card, irrespective of family means.

I have been advocating the extension of medical card entitlement to all such children for a long time. This has been a core proposition in a series of Sinn Féin election manifestos and in our alternative budget proposals. In December 2015, when I was still my party's health spokesperson, I introduced our new health policy document in which we urged that this critical advance be made and undertook to introduce it if we were in government. When I did so, I was mindful of the needs of severely challenged children and their parents. I was particularly mindful of the case made by the Our Children's Health campaign group, which was launched in May 2014 by families affected by illness and disability with first-hand experience of the struggle to secure and retain medical cards for their children. Its primary aim is "to ensure children with serious medical need are no longer subjected to the crude, unfair, lengthy and frustrating means test in order to be considered for a medical card".

The campaign has condemned the onerous application process, the exclusive focus on financial hardship and the failure to take account of medical need and the impact of a serious medical condition on a child and its family. Our Children's Health has argued:

We cannot continue to have a situation whereby children with the most serious medical need coming from ordinary families with modest incomes and huge outgoings remain ineligible. This is simply wrong and unjustifiable.

Sinn Féin has long argued that the Department of Social Protection's domiciliary care allowance, operated until 2009 by the Health Service Executive, provides an example of an assessment model on which a new medical card eligibility test could be based in that it is independent of both financial means and diagnosis titles. Eligibility would be based on reaching a threshold of care needs.

The horror stories of seriously ill children being refused medical cards and the lengths to which distressed parents have been forced to go to apply for medical cards have continued to this very day. Today is but a start and stepping stone towards a universal health care system, as I stated. The Government must introduce and implement a schedule for the extension of full medical cards to people with serious illness and disabilities without a means test, and not only focused on the primary measure in this legislation. The Government is extending a full medical card to every child qualifying for the domiciliary care allowance and, despite the long years lost, I say "well done". I mean that sincerely. I also say with great sincerity that the Government should now take the next steps.

We should legislate for a distinct new medical need ground for eligibility for the medical card with an associated application route, using the domiciliary care assessment framework as a model. That is an assessment involving the establishment of a threshold of medical need and not tested against a household's financial means or diagnosis titles. We should then invite applications to this distinct application process for a card that would be reviewed at intervals informed by the recommendation of the medical assessor. This new route would be open to applicants of all ages but any child who has been granted the domiciliary care allowance would gain the card automatically, as we are providing for now. Medical cards awarded on this new ground would not be impacted by changes to employment status or income. This is essential as otherwise the medical card system will continue to trap people with disabilities in unemployment and poverty. This would initially result in a further 14,500 cards meeting the health care needs of a further cohort of deserving people challenged by disability and serious medical needs on top of the 9,800 additional cards provided for in terms of the domiciliary care allowance. Ultimately, all of this should lead to universal health care.

In the last couple of minutes remaining in my slot I will address the second matter the Bill provides for, the reduction in prescription charges for medical card holders over 70 years old. I remember very well being a health spokesperson before my very able and esteemed colleague arrived. She has been performing this role with great verve and capacity over the past 12 months. I remember very well being on these benches when the Minister's predecessor, the deputy leader of Fine Gael, was an Opposition spokesperson on health, as I was myself. Prescription charges were introduced at 50 cent and that was the position when the Minister's party went into Government in 2011. Senator Reilly, then a Deputy, was an able spokesperson on health in opposition and I will not go further than that. Like any of us here in those days, he articulated fierce opposition to prescription charges and not just for those aged over 70. However, as the record shows, Fine Gael and Labour introduced a fivefold increase in this charge from 50 cent to €2.50. All these years later, the Government has decided to reduce the charge by 50 cent but only for those aged over 70. What of everyone below 70 years of age, who must continue to pay €2.50 per item up to a €25 maximum per month? Why not extend this reduction to all medical card holders and why not remove the charge entirely? We should be done with it, as the former Minister and deputy party leader, Senator Reilly, so strenuously argued for here in this Chamber not all that many years ago. I encourage the Minister to do it.

We will support the passage of this Bill in the hope that it will be followed by the further steps that can and should be taken, bringing us ultimately to the introduction of a national health care service across our land. I use those words with purpose. That is a worthy goal and a real and proud legacy for all of us to leave for future generations. If the Minister says he will do it and he means it, we will work with him every step of the way.

I will also support the Bill as it is the start of progress. Reducing the prescription charge from €2.50 to €2 for those aged over 70 years and capping it at €20 per month is a start, although a very small start. When this prescription charge was introduced in 2010, it was 50 cent and it was meant to reduce unnecessary taking of drugs where people were getting drugs under a medical card and not using them. The 50 cent charge was a disincentive to asking a pharmacist for drugs. However, as time passed, the charge went from 50 cent to €2.50. If memory serves correctly, the Fine Gael Party campaign in the 2011 general election said the party would abolish the prescription charge but when the now Senator James Reilly came into ministerial office, he increased it incrementally, year on year, until it reached the level of €2.50 per item. That is a substantial burden on patients where it was not that people were getting unnecessary medication, but they stopped getting necessary medication. That had untold consequences for the health service as people not taking their medication ended up in hospital. Although it was set up as a deterrent, it ended up being a method of revenue collection, which amounted to a negative health policy.

It is good that this is being reversed and, as the Minister notes, it will apply first to those who use medication most, those over 70 years old. The €2.50 charge is substantial for any patient on a medical card, which they have because they have been means tested. This is not a wealthy cohort of society but these people are being charged €2.50 for each item. There are people under 70 years who are not getting their medication because of the charge for prescriptions.

The Minister referenced generic drugs and the savings they bring to the health service. There is a caveat in that generic drugs may have equal bioavailability but they do not have equal constituents. Many patients suffer side effects from generic drugs and 10% of hospital admissions are related to iatrogenic illness, meaning it is caused by side effects of drugs.

It has increased since generic drugs were introduced. They are not equivalent and many people suffer side effects. One patient of mine went through investigations for nine months before it was eventually discovered that the medication he had been prescribed, in a generic manner, on discharge from hospital was not the same medication as he received when he entered hospital. He had a substantial illness because of it. I could cite many other cases.

I commend the Minister for introducing the domiciliary care allowance measure. It is a very progressive provision. However, as Deputy Billy Kelleher said, these are people who should have had a medical card long before now. When I worked as a GP, it never ceased to amaze me when I wrote prescriptions for people with substantial disabilities and they told me they had no medical cards. It was unbelievable. Although it is late, it is very welcome.

Disabilities put substantial pressure on patients, children and their families. There is a substantial unmet need among people with disabilities. This will address some of it. There is financial stress involved in looking after a person with disabilities. Access to aids and appliances was a huge barrier for people with disabilities. Not only could they not get drugs, they could not get the aids and appliances they needed to help them cope with their disabilities. Disability is a long-term condition; it does not come and go. Obliging patients to go under constant review to retain their medical cards up to now was unjust.

The Minister's policy on medical cards must also be reviewed. We have discussed it at length at the Oireachtas Committee on the Future of Healthcare, where we are trying to devise a system which is fair, equitable and based on need rather than the ability to pay. We must address all these issues regarding medical cards. Discretionary medical cards are also a major issue as is the granting of medical cards to patients who have cancer. One has to be terminally ill with cancer in order to get a medical card, and that is very unjust.

I too am pleased the Bill has been introduced. My colleagues and I made this a very high priority, as did Fianna Fáil in the discussions for Government. It could not come too soon. It is well overdue. I welcome the opportunity to speak on the Bill. During the previous Dáil, the Technical Group, of which the Minister of State, Deputy Finian McGrath, and I were members, tabled a motion to improve auxiliary care services in 2012. The motion called on the Government, among other things, to reform the domiciliary allowance system immediately by returning the administration of the system to the Department of Health where it belonged and insisting medical assessors were competent to assess the medical information submitted and were on the relevant specialist register, for example, paediatrics or child psychology. It is very important. There is nothing worse than parents of sick children who live with them 24/7 and who want the best for them to have them assessed by people who do not understand the difficulties, issues and intricacies of their conditions. Deputy Michael Harty would understand it far better than I.

We asked that all decisions on domiciliary care allowance applications and existing claims be made by child protection or disability social workers. We also asked that domiciliary care allowance applicants and recipients be given access to all documentation held regarding their claims upon request and within a reasonable timeframe. There have been serious blockages, delays and stifling and frustrating of applicants. It is part of what the HSE is good at.

The Bill will provide children with disabilities who are in receipt of domiciliary care allowance with automatic entitlement to a medical card. It is a major step and was badly needed and I compliment the Government on it. However, like other speakers said, we will be policing it day by day. We cannot have any more delays. It has to happen. It is already years too late. Under the former Minister for Health, now Senator James Reilly - "Calamity James" as I used to call him - HSE officials were writing to parents of sick children, even children with Down's syndrome, to ask whether they still had the condition. The Minister of State, Deputy Finian McGrath, knows all about it. How hurtful and unfortunate it was. Are the people who sent these letters heartless, illiterate or what to send such heartless, uncaring letters?

The Bill follows on from a commitment made in the budget in October 2016. The Bill will benefit more than 9,000 children who are not eligible for a medical card. My late brother was a paediatrician of renown in Tipperary. Like Deputy Michael Harty, he was astounded to see people come into the surgery who did not have medical cards and who had to fight tooth and nail for them. All the Deputies have constituents who are seriously ill with cancer and all kinds of illnesses who are begging, striving, scrounging, scraping, filling in forms and putting in this and that claim to get a medical card. Once they have a serious illness, they should be entitled. The frustration and stress is enough to make them sick, never mind affect them when they are under serious threat and trying to recover.

The parent or guardian of a child in receipt of domiciliary care allowance but who does not have a medical card will register for the scheme online or through a paper form. Many people in rural Ireland cannot go online. They have no line to go on, because we have no broadband. For a child who is currently eligible for a medical card, discretionary or otherwise, and is in receipt of the domiciliary care allowance, the HSE will automatically issue him or her with a medical card. I will believe it when I see it. All those measures are very welcome, even if they are coming five years after the motion by the former Technical Group was proposed. It is better late than never: do not look a gift horse in the mouth. It has to happen and I am holding the Minister of State, Deputy Finian McGrath, responsible. He recently came to Tipperary with a colleague of mine offering this, that and the other to very sick children. I will hold him accountable for that too. We need it to be delivered. We need the Minister of State in the Cabinet with his Independent colleagues. Along with the Minister, Deputy Shane Ross, and the Minister of State, Deputy John Halligan, he was part of the Technical Group in 2012. Put your money where your mouth is. We expect delivery. We cannot have these sick children or their parents waiting any longer. The parents become ill themselves due to the trauma and stress.

I supported the prescription charge of 50 cent for reasons to which Deputy Michael Harty and others alluded. However, the HSE saw that it was working well and decided to multiply it. All the HSE seems to do is bleed people for money.

I fully support the Bill, which will allow for some the provisions of budget 2017 to be introduced. I fully support the provision of a medical card to all children in receipt of domiciliary care allowance. Domiciliary care allowance is granted to children aged under 16 years with a severe disability who require ongoing care and attention substantially over and above the care and attention usually required by a child of the same age. Children in receipt of domiciliary care allowance are some of the most vulnerable children in our society and it is only right that we provide them and their families with as much assistance as possible.

More often than not, a child who qualifies for domiciliary care allowance also has complex medical needs and, therefore, parents are burdened with high medical bills. The introduction of medical cards for all children in receipt of domiciliary care allowance, regardless of means, will be a great relief to many parents and families. In line with this, I urge the Government to introduce medical cards to all adults diagnosed with cancer. I ask that the Minister make this his priority in the next budget. In the past year, I have come across numerous constituents, many of them just over the income threshold, who have been diagnosed with cancer and who are struggling greatly to pay for their medical bills. At a time when they are at their weakest and trying to fight this awful disease, they are burdened with trying to fill out paperwork and prove their eligibility for a medical card. This causes extreme stress and undoubtedly interferes with their recovery. We all have people calling into our constituency offices with serious cancer issues who have been refused a medical card. It could not be more heartless in a desperate time for these people.

I fully support the reduction in prescription charges for medical card holders over 70 years of age. It is great to see a reduction of 50 cent per item down to €2 and the maximum monthly cost reduced by €5 down to €20 per person or family. It is a positive step towards eliminating the charge in the future, for which I commend the Government. The reduction shows the Government's support for one of the most vulnerable groups in our society and it will, no doubt, reduce elderly poverty.

I too welcome the Bill to ensure children who are in receipt of the domiciliary care allowance receive a medical card automatically.

It is well known that parents with responsibility for a very sick child, who will be sick for many years, have enough to do and have other problems to get over every day, when they are landed with this noose around their necks. Why has this measure taken so long since it was announced in the budget so many months ago? Those people have been looking forward to this since. I hope there will not be much further delay and it can be progressed as soon as possible.

The reduction in prescription charges is also very welcome. As Deputy Michael Harty has said, many people had to forego some medication because they could not afford the charges. When we talk about medical cards there are many issues that need to be resolved, but there is one issue in particular I have come across many times. It is where many people do not apply for a medical card until they get sick or until the day they go into hospital. Panic sets in because they know they do not have the funds to pay the hospital. They fill out their card application form and send it away. In due course, they get their card, but they may have already left the hospital two or three weeks prior to receiving the card. They are billed by the hospital and they must pay that bill, even though they subsequently receive the medical card.

I am asking for this matter to be reviewed. If a person is entitled to the card then it should at least be in force from the day a person applies for it, or maybe even further back. People do not expect to get sick and they do not take the precaution of looking for the medical card even though they are entitled to it. As many people do not do this, I ask that the matter could be looked at to see if some fairness could apply to those people. I have been involved in a number of cases where people had to pay the hospital and there was no way in the world could they get out of it. They actually had to borrow money from the credit union to pay the bills.

My next point is possibly unrelated to the topic we are speaking about. I am aware that the Kerry Cork health link bus, which takes people to Cork University Hospital, is on the road every day. The bus needs to be replaced. The operator needs to buy another bus but must pay VAT on the new bus. This is very unfair and I say to the Government it is collecting enough VAT from every other person in the State so please do not charge those people who provide a service that takes patients for cancer treatment to Cork, or to any other hospital. People should not have to pay for VAT on a vehicle such as this. I ask that this could be looked at to ensure the matter is addressed. It is very unfair. The Kerry Cork health link bus provides a great service for people who do not have a car or cannot drive a car themselves. I ask that the matter be looked into and addressed appropriately.

I invite Deputy Bernard J. Durkan who proposes to share with Deputy Peter Fitzpatrick.

Deputy Peter Fitzpatrick will go first.

I am delighted to be able to speak to this very important Bill. I have been in constant contact with my colleague, the Minister for Health, Deputy Simon Harris, since he first announced last year that he would be bringing this Bill before the House. It will provide all children in receipt of domiciliary care allowance an automatic entitlement to a full medical card. There will now be a clear entitlement for those children to a full medical card. The Bill will also reduce prescription charges for medical card holders who are aged over 70 years and also for their dependants.

On numerous occasions in the past I have said in this House and in the media that I firmly believe that any child in receipt of domiciliary care allowance must get a medical card automatically and without delay. I am in constant contact with my constituents from all over County Louth and I assure Deputies that the introduction of this legislation will be a huge relief for them. They will no longer have to go through the whole means tested route in order to get a medical card to which they should be entitled. The whole application process of providing family financial information, expert and medical reports and additional supporting information was, and is, a terrible burden on parents when all they were seeking was a medical card for their child. It beggars belief that up to now a child could receive domiciliary care allowance but in some cases was refused a medical card.

I will now turn to the current application process for a medical card. The system is too cumbersome and bureaucratic. It is one of the issues that my constituency office in Dundalk spends most time dealing with. The application process takes far too long. I also have many difficulties with the procedure of assessing medical evidence. I have lost count of the number of times an application has been refused yet is granted on appeal. This extra time is another period of worry and stress for the applicant, when it is clear from the medical evidence provided that the person is entitled to a medical card. I know that in the past the Minister has raised questions around the process and he has stated publicly that there are limitations to the system. He has also stated that the Committee on the Future of Healthcare will examine the matter and will play a key role in any future changes to the system. I hope the Minister will look at this aspect of the medical card process and that in the near future we will see a simpler and more transparent system of assessing medical card applications.

I was amazed to find out that currently one in three children in receipt of domiciliary care allowance does not hold a medical card. How could this have been allowed to happen for so long? It is not right that these children were not automatically given a medical card. In my constituency work in Louth I, like many of my colleagues, see on a daily basis the challenges faced by parents in looking after a child with a severe disability. I agree with my colleague, the Minister, Deputy Simon Harris, when he said recently that in many cases parents who applied for domiciliary care allowance had never before requested help from the State for their child or children. It is important that we recognise this fact and make people aware of the sacrifices these families make on a daily basis. We must fully support parents of children with disabilities in order that they can access the services required to ensure their quality of life is improved.

We must use an improving economy and the improving tax receipts to benefit all in society. Some 12 months ago the electorate told Deputies that we must improve public services as a priority. We must invest more in the health, education and social welfare systems. I believe people would prefer to see increased spending on public services as opposed to tax cuts. These extra resources must be spent on those who need it most. I am particularly pleased this measure is finally getting approval from the House. There is no doubt that those children and their families who are in receipt of domiciliary care allowance not only deserve a full medical card but should always have been automatically entitled to it.

I am delighted that the Minister has brought this Bill to the House but I hope this is only the start of new measures. I would like to see a more simplified process introduced for medical card applications, particularly for those with strong medical evidence to back up their claim.

I will outline the main features of the Bill for the benefit of those who have been following this topic. The Health (Amendment) Bill 2017 will provide all 33,000 children who are in receipt of domiciliary care allowance full eligibility to a medical card. Parents will be able to apply for medical cards on behalf of the child or children from 1 May 2017 and the medical card will be available to use from the 1 June 2017. With regard to changes to prescription charges the Bill will reduce the cost of a prescription from €2.50 to €2 per item and will cap the monthly amount at €20, which was previously €25. This reduction was introduced on 1 March and will benefit 390,000 people.

I had the pleasure of welcoming the Minister, Deputy Simon Harris, to the Louth County Hospital in August 2016. The Minister was very impressed with the hospital, its staff and the services it provides to the community. During that visit the Minister indicated that he intended making the minor injuries unit accessible to all children over the age of six years. Currently the unit will only treat children aged 14 years and over. Perhaps the Minister will confirm a timeframe for this change which would allow all children over the age of six years to be treated in the minor injuries unit at Louth County Hospital.

Like other speakers, I am delighted to have an opportunity to speak on this important legislation. It is one of the first occasions in recent years that it was possible on the basis of the sacrifices made-----

To live up to their promises.

The social dividend has arrived, the Deputy will be glad to know. Huge sacrifices were made by many people in this country for many years. It is good to see they were not in vain and there is at least some recompense at the end of the day, some recognition for the sacrifices they made and some preparation for the next phase of health provision for the next generation.

For the 8,700 individual families who will receive the medical card, it is a great boon for them and something they deserve. One has only to go through the various appeal processes for domiciliary care and for medical card applications, as we all have, to understand the degree to which a small thing can make a huge difference to people who are faced with the kind of difficulties they have to face in regard to special needs and the costs that go with that. We should pay tribute to the parents and families who had to undergo a long series of difficulties in recent years while waiting for this change.

I compliment the Minister of State for bringing the legislation before the House and for giving recognition to those people who have been in that situation for a number of years. Like Deputy Caoimhghín Ó Caoláin, I have been around for a year or two years and, indeed, the other Opposition spokesman, Deputy Billy Kelleher, is in the same position also. It is very easy when one is in opposition, of course.

Hear, hear. That is right.

It comes so easy to have the resolution to every problem. We are all human beings and we all have the interests of our constituents at heart. Unfortunately, it is not always as easy as it looks from that vantage point. At last and at least, in this particular situation, we now see some recognition of the things we would like to do when in opposition, and we have an opportunity to have some little influence of a positive nature on the well-being and livelihood of families who are dependent on what we do.

Deputy Michael Harty and others made reference to the administration of the medical card system. I accept it leaves a lot of room for improvement, although I am not criticising anybody, one way or the other, except to simply say this. If a person is suffering from a serious illness, he or she has enough problems in his or her life without having to get proof in written or graphic form to say, "Your end is nigh", or words to that effect. That should not be the case. It should be a simple thing to be able to say, within reason, that this person deserves a medical card because of his or her situation and illness. I know the HSE will say to us there is no automatic right to a medical card because of the seriousness of the illness. However, there is always discretion and one can always use common sense to come to a conclusion that it is in the interests of those in receipt of medication or of surgery, instead of having to wait what could be a huge length of time to them. We should always remember, when wearing the other person's shoes, that to those who are in pain or in doubt about their health, and those with a serious health problem, even a short time is much more magnified and serious, and has a much more debilitating effect on them.

I hope that, in the context of the reforms that are taking place, which are of a positive nature, we can do something about this issue. This is particularly the case in regard to the spot checks where the person's card is due for renewal and they get a form to tell them, "It has come to our attention your circumstances have changed", when no such change has taken place. Every Member of this House knows this, and we have all dealt with such cases. When it is pursued further, we find it is a spot check. If there is a spot check for that purpose, the simple thing would be to do the spot check first without taking away the medical card and leaving the person waiting. The obvious thing is to leave the person in possession of their card. All we do is create unnecessary hardship for people in those circumstances.

This is a positive move which I welcome. The House will not be surprised when I reveal I intend to vote for the Bill. I congratulate the Minister of State for the work done. We hope this is the first of many items of recognition for the people who are deserving in our society, given we did not have a whole lot to give them in the past few years.

On a point of order, I point out that Deputy Bernard J. Durkan has eight minutes left, for fear he was not aware of it.

The Deputy does not normally need encouragement.

I am always willing to oblige.

Is cosúil go bhfuil an díospóireacht ag teacht chun deiridh. Is mór an trua é nach raibh níos mó Teachtaí i láthair chun páirt a ghlacadh sa díospóireacht.

I want to warmly thank Deputies Bernard J. Durkan, Caoimhghín Ó Caoláin, Billy Kelleher and all the other Deputies for their contributions to the Second Stage debate on the Health (Amendment) Bill 2017. The Government is committed to delivering on the aims to increase access to safe, timely care, as close to patients’ homes as possible, as set out in A Programme for a Partnership Government. Let us remember it is a partnership Government. The Independent Alliance is making a very positive contribution in regard to these issues, including this legislation, domiciliary care allowance and the prescription charges, on which we had a major input.

The Bill has two parts, first, to extend automatic entitlement to a medical card to all children in receipt of domiciliary care allowance and, second, to reduce prescription charges for medical card holders over 70 years and their dependants. This is a positive development. It is a good news story and it is doing something for the members of society, particularly the weaker sections of society. As Members know, children who are in receipt of domiciliary care allowance are children under the age of 16 years who are considered to have a severe disability and who require ongoing care and attention substantially over and above that required for a child of the same age. Many families are in that position - I understand the figure is in the region of 9,800. This new legislation will mean that all children in respect of whom a domiciliary care allowance payment is made will automatically qualify for a medical card and, therefore, no longer be subject to the medical card means test at any point in the future while in receipt of domiciliary care allowance. This is a positive and constructive development but it is also a major step in regard to the rights of all people with a disability. That is part of my project in regard to services for people with disabilities.

We recognise the added stress that parents are faced with when dealing with a difficult diagnosis. For many of these parents, it is their first time seeking assistance from the State. I hope, by providing an automatic medical card for these children, it will relieve some of the financial burden these families face and provide easier access to the health services their children need. This is a positive development because we need to ensure the weaker sections of society are protected. Like many of my colleagues who spoke in this debate, I believe that is a core ambition and should be a core value of anybody who is elected to the Houses of the Oireachtas.

While we are discussing domiciliary care allowance and other services for people with disabilities, I want to note that the social care disability services plan for 2017 represents a historic investment in disability services after many years of cuts to services. For example, following my negotiations with the HSE for the disability sector, in budget 2017 we will be spending €1.688 billion, an increase of 6%, on disability services.

What does this mean for the person on the ground? It means 8,400 residential places, 182,000 respite overnights, 1.4 million personal assistant hours for 2,400 people, 24,800 day places, 41,000 day respite sessions and 2.75 million home support hours for 7,500 people.

Another issue that came up when I took office was that every single year we had a crisis in dealing with emergency cases. I have managed to secure €16.2 million to support 395 people. The breakdown means that there has been the provision of 185 new emergency places, 210 new home supports and respite for emergency cases. There is to be €10 million for New Directions which includes school leavers and which will support 1,500 people.

The House is aware of the move from congregated settings. There will be €100 million for a capital programme over five years. That means that this year 223 people will be moved to community living and that 50 additional homes will be purchased. I mention those issues because they are very relevant.

Another issue that is very relevant with regard to the disability service plan is what came up earlier today about the Grace case - the issue of protecting vulnerable people. Earlier in the debate I did not have the opportunity to highlight the services that had been put in place in the past few years. We now have a national policy on safeguarding vulnerable persons at risk of abuse. We have an excellent national safeguarding committee, with an independent chairperson, Ms Patricia Rickard Clarke. We have also seen the national quality improvement programme, the national volunteer advocacy programme and the establishment of a family working group with Inclusion Ireland, an organisation that works with people with disabilities. What is more important for families is the appointment of a confidential recipient, Ms Leigh Gath. Through these measures, we are trying to ensure protection through the disability services.

Another of the Government's commitments is to reduce the cost of medicines for Irish patients, who have been hammered in recent years by high costs. As stated, this includes a reduction of prescription charges for medical card holders. Budget 2017 included a commitment to reduce prescription charges for medical card holders aged over 70 years and their dependants. This issue is addressed in the second part of this legislation. While the prescription charge was introduced in the Health (Amendment) (No. 2) Act 2010, the Act does not allow it to be amended for a particular group. This Bill identifies the over 70s, for whom it provides for a lower charge and for their dependants. After all, it is a small way of saying, "Thank you," for the services and taxes they have paid during the years to the State, particularly during tough times. I am happy to note that this measure has been implemented on an administrative basis since 1 March 2017 and will benefit approximately 390,000 people. However, I stress once again the importance of delivering on this legislation to place the measure on a statutory basis. I ask all Deputies to continue their support for this important legislation. I look forward to further constructive examination of the Bill on Committee Stage.

Question put and agreed to.
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