I welcome the opportunity to speak on the issue of fibromyalgia. I would like to begin by acknowledging the seriousness of fibromyalgia and the personal challenges that people with this condition encounter in their daily lives. There are many symptoms of fibromyalgia. They tend to vary from person to person. The symptoms can come and go over a period of time. The main symptoms of fibromyalgia include pain, extreme sensitivity, stiffness, poor-quality sleep, cognitive problems, headaches, irritable bowel syndrome and depression-like symptoms.
The exact prevalence of fibromyalgia in Ireland is not known, but it is estimated to affect approximately 2% of the population and nearly one in 20 people across the globe. Anyone can develop fibromyalgia, although the condition typically affects more women than men. While in most cases fibromyalgia occurs between 30 and 60 years of age, it can develop in people of any age, including children and the elderly.
The exact cause of fibromyalgia is unknown, but it most likely involves a variety of risk factors working together which can either make fibromyalgia more likely or act as a trigger for the condition to emerge. These include physical trauma, psychological trauma, a viral infection or depressive illnesses. Research into people with fibromyalgia has identified several physiological changes in the way their body functions. These include disturbed pain messages, low levels of hormones and sleep problems. What causes these changes in the first place and how exactly this causes fibromyalgia is still not clear.
Fibromyalgia is a difficult condition to diagnose as there is no specific test for it while its symptoms can replicate those associated with other conditions. There is no cure for this condition as its cause is unknown. A GP will diagnose fibromyalgia based on having a typical mix of symptoms and ruling out any other conditions that could be causing these. Once all other conditions have been considered or ruled out, there are two criteria which can be used to confirm a diagnosis of fibromyalgia. If symptoms fit within these criteria, it is likely a person will be diagnosed with fibromyalgia.
As fibromyalgia has several different symptoms, no single treatment will work for all symptoms and for all patients. It is, therefore, likely the person will need to try a variety of treatments to find the best approach that suits them. This will normally be a combination of medication and lifestyle changes. As well as medications that may involve pain medications and antidepressants, other treatment options can be used to help cope with the symptoms of fibromyalgia. These include exercise, cognitive behavioural therapy, psychotherapy, relaxation techniques, physiotherapy and psychological support. For most people, the symptoms of fibromyalgia are permanent, although they can vary in severity and frequency.
The overarching principle governing the planning and delivery of health services and supports for individuals with conditions such as fibromyalgia is that they should be integrated, as far as possible, with services and supports on a whole-of-population basis. Given the complex and diverse symptoms associated with fibromyalgia, treatment involves a combination of medicines, therapies, counselling and lifestyle changes. In line with the vision set out in Sláintecare, the Government’s aim is to ensure all citizens, including those suffering from fibromyalgia, can be offered the right care in the right place at the right time. Those with fibromyalgia should be supported in their local community wherever possible.
To facilitate this, the Government is committed to the expansion of primary care. This is reflected not just in the roll-out of primary care centres across the country but also in the increased funding provided for primary care services. An additional €50 million has been allocated to primary care in 2019, an increase of 6.1% on the 2018 budget. This additional resourcing will enable a range of measures to be advanced, including the recruitment of additional therapy staff such as physiotherapists and occupational therapists who can play an important role in supporting those with fibromyalgia.
I acknowledge the concerns raised by those with fibromyalgia that their expenditure on the medicines they need may not be covered by the public health service. In particular, I know there have been calls to include fibromyalgia as a specified condition under the long-term illness scheme. These requests have been considered carefully but there are no plans to extend the scheme at this time. However, it is proposed the scheme will be included as part of a review of the basis for existing hospital and medication charges to be carried out under commitments given in the Sláintecare action plan. While I understand this news will be disappointing to some, it should be remembered that there are several arrangements which provide patients with protection from excessive medicine costs. Those with fibromyalgia have benefitted from Government action in this area alongside others with long-term conditions.
The Government has lived up to its commitment in A Programme for a Partnership Government to reduce medicine costs for individuals and families. Those suffering financial hardship may be eligible for a medical card. In accordance with our overall eligibility framework, this decision is not based on a particular illness, but rather on the overall financial situation of an individual and family. Legislation allows for the HSE to exercise discretion in awarding medical cards in certain circumstances where an applicant exceeds income thresholds. The total number of medical cards issued as of 1 February 2019 was over 1.5 million. The Government has also ensured thousands of families, whose income levels are just above the thresholds for receiving a medical card, can avail of free GP visits by providing them with a GP-visit card. Over 500,000 people now hold such a card. The revised income thresholds which came into effect from 1 April will ensure more people will benefit from this support.
The Government has also significantly reduced the cost of medicines by reducing the annual required co-payment under the drugs payment scheme and reducing prescription charges for medical card holders. The maximum monthly amount that anyone is required to pay for their medicines under the drugs payment scheme is being reduced this month from €134 to €124. A similar €10 reduction was also applied in 2018. This means the annual financial burden on the average person who spends more than €124 a month on drugs has been reduced by €240 in less than two years.
We have also ensured prescription charges have been reduced in each of the past three years. The culmination of these reductions means that since 2017, co-payments in the community drug schemes have been reduced by 40% for over 70s medical card holders, 20% for medical card holders under 70 and 14% for drug payment scheme members.
The Government is determined to extend free healthcare to more people and reduce costs to others. However, it is doing this in line with the Sláintecare goal of universal access rather than targeting particular illnesses and conditions. I would, therefore, urge all those with fibromyalgia to check their eligibility for the GP-visit card at medicalcard.ie and apply for the drugs payment scheme at their local health office or through the mydps.ie website. It is my sincere hope that as many people as possible with fibromyalgia benefit from these measures.
Disability services provided by the HSE focus on enabling people with disabilities their full potential, living ordinary lives in ordinary places as independently as possible. The overarching principle governing the planning and delivery of services and supports for adults and children with disabilities is one of mainstreaming and inclusion. People with disabilities should be integrated, as much as possible, with services and supports for the rest of the population. The Government’s agenda in this regard is set out in the current national disability inclusion strategy which was launched by the Minister of State, Deputy Finian McGrath, in July 2017. The strategy takes a whole-of-Government approach to improving the lives of people with disabilities, as well as aiming to create the best possible opportunities for people with disabilities to fulfil their potential.
Our current health policy promotes a non-condition specific approach to disability service provision, based on the needs of the individual rather than the provision of services based on a specific disability diagnosis. I appreciate that for people living with this condition, there are many challenges. However, measures and supports are available. I am interested in hearing the view of Deputies on this matter.