Adjournment Matters

Long-Term Illness Scheme

Senator Marie Moloney

I thank the Minister for staying on. He has had a very long afternoon here and has given comprehensive replies to all our questions. I felt it was more appropriate to raise this matter with him through an Adjournment debate rather than to bring it up during the statements. I refer to the i-port Advance medical device. There is no need for me to tell the Minister what it is with his background in medicine, but for the record of the House I should explain that this is a cannula device that is attached to a child. It administers the insulin shots for them via this port. The port is replaced every three days. Its use results in injections and skin piercings being reduced from 120 per month to just ten. It is revolutionary and has been in use in America for years. It was introduced in Ireland on 1 June but it is not covered under the general medical services, GMS, scheme or the long-term illness scheme. It is very expensive to buy, costing about €200.

Just a few moments ago, the Minister referred to health insurance covering the cost of items. Health insurance in Ireland does not cover pump training, insulin pumps or i-ports. There is a device called a continuous glucose monitor, CGM, which can be attached to the body. It takes a reading every five minutes and transmits that information to an external device. This is excellent for keeping a close eye on blood glucose levels. In the United States, insurance companies cover the cost of these, but in Ireland they can only be obtained through a hospital and they are expensive, so the HSE only gives them out on a loan basis, for a week, to check blood glucose patterns. I understand there is a petition going around by parents, especially for children with type 1 diabetes, for this i-port to be included in the GMS or the long-term illness scheme as are other diabetic services. It would reduce the discomfort and pain that children get from injecting their skin up to four times a day or 120 times a month.

Minister for Health (Deputy Leo Varadkar)

I wish to thank the Senator for raising this important matter. At the outset I think it is important to state that decisions on which medicines and appliances are reimbursed by the taxpayer, are not political or ministerial decisions. They are made on objective scientific and economic grounds by the HSE. The HSE has statutory responsibility for decisions on pricing and reimbursement of medical appliances under the community drug scheme in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. The HSE received an application for the inclusion of the i-port Advance injection port to its non-drugs reimbursable lists on 1 July 2014. This application is now being considered in line with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.

I understand that the i-port device is an injection port through which injectable medication can be given. It can be worn for up to 72 hours thereby reducing the number of injections required for those on multiple daily injections. The device should lessen the burden of daily injections and improve quality of life for patients which would be particularly beneficial for people with type 1 diabetes. The development of such innovative products and the obvious benefits the i-port may provide are welcomed. Nonetheless, the HSE must consider a wide range of criteria when assessing an application for a new product on the reimbursable list. In addition to the health needs of the public, the HSE will consider issues such as the effectiveness of the product, the proposed cost, the benefits, side-effect profile and risks of the product as well as the resources available to the Executive.

An expert group has been convened to assist the HSE in their consideration of this product. It is being led by the clinical lead for the national clinical programme for diabetes. The group has been tasked with assessing the clinical evidence to support the use of the product, to consider if the product is appropriate for reimbursement under the community drugs schemes and to assist in determining the value that the innovation presents. Its work will aid the HSE in its decision-making process. I want to assure the Senator that both the HSE and I fully understand the concerns of patients regarding the availability of this product. However, the HSE has a responsibility to undertake rigorous assessment of all applications for reimbursement so that decisions around the funding of products are clinically appropriate, fair, consistent and sustainable.

Senator Marie Moloney

I am glad to see that the device is being considered under the Health (Pricing and Supply of Medical Goods) Act 2013. The Minister might give an indication of when he expects a decision to issue on it or when the expert group will report back. As he will appreciate, parents know this device is available. I understand that it is being used in some of the hospitals, that they are giving it out in the clinics. Parents would wish to have anything that would make it easier and less painful for their children, but it comes at a cost and a lot of parents simply cannot afford it. Again we have the "chequebook rule", where people who have the money can purchase a device or treatment while people who do not are under pressure. No-one would want to see a child suffer just because the parents cannot afford the device. Considering that all things for diabetics do come under the long-term illness scheme, I would appreciate if the Minister might get a report back from the expert group at some stage, although I understand he does not have a say in the decision.

Deputy Leo Varadkar

I do not have a timeline for Senator Moloney but I will certainly check on it to see whether there is a timeline for it.

I conducted a quick research check before responding to the debate. Unfortunately, I have not been able to find a significant amount of research on it, although there is one paper which suggests that, while there is no statistically different improvement in HbA1c in outcomes in the sense that a port and a pump work equally well, the use of a port is less expensive. The small bit of research that I managed to find seems to suggest that it would be cost effective but, as I stated, it would be inappropriate for me to be making these decisions. What is really required is that the National Centre for Pharmacoeconomics, NCPE, and the HSE national drugs committee, which is made up of doctors, specialists and persons with the correct economic expertise, make these determinations, and I hope they can in this case, sooner rather than later.

Senator Marie Moloney

I thank the Minister.

Medical Card Applications

Senator Martin Conway

I also thank the Minister for staying on to take this Adjournment matter.

In the past number of months, taking a holistic view on it, our experience in dealing with the medical card primary care reimbursement service, PCRS, staff has improved. However, this case is an example of how matters were and how they should not be. I would not normally put a medical card application down as an Adjournment matter, but the applicant is suffering from considerable anxiety because of being moved from Billy to Jack and told one thing by one group and something else by another. Ultimately, the message from different staff within the PCRS system is conflicting. My office has been dealing with this application on a daily basis. My secretary would speak to one person and get one set of recommendations in terms of what is required, and having put the necessary paperwork together, then would be told that something else entirely is required.

There seems to be a breakdown in communications between the PCRS and the Revenue Commissioners, particularly when it comes to the Revenue website and for the self-employed who submit self-assessment. Apparently, when one makes a self-assessment, one is issued with a letter of acknowledgement which is considered a receipt but for some reason, the PCRS is of the view that a completely different documentation is required. Even the Revenue staff are baffled because such a document, for which we have been asked on behalf of these clients, does not exist.

Ultimately, I need somebody senior in the PCRS to take this file and resolve it for me. In my view - the financial statements are there to back it up - the person is entitled to a medical card but is being delayed because of bureaucratic non-engagement and, perhaps, through no fault of anybody, misunderstanding. It is merely one of these cases that is going on for months and it needs to be resolved.

Deputy Leo Varadkar

The Senator will be aware that in accordance with the relevant health legislation, full eligibility for a medical card is awarded where a person cannot arrange GP services for himself or herself and his or her family without undue hardship, having regard to his or her financial circumstances.

It is important to clarify that, under the Health Act 1970, as amended, the determination of an individual's eligibility for a medical card is the statutory responsibility of the HSE. Under the legislation, it is clear that there is no role for the Minister for Health in assessing an individual's medical card eligibility. Furthermore, under the Health Act 2004, as amended by the Health Service Executive (Governance) Act 2013, the Minister for Health may not give a direction to the HSE relating to a decision concerning the eligibility of an individual.

By way of assistance, Senators may be aware that there is a dedicated PCRS contact service for Members of the Oireachtas. This service deals specifically with queries about medical cards and GP visit card. The details of the contact service have been issued to all Members of the Oireachtas and I would be happy to forward the details to Senators, if they so wish.

On the case to which the Senator refers, I believe it would be inappropriate to discuss the family circumstances and their financial details in public in the Seanad. However, I can advise the Senator that medical card applications are considered by the HSE in a fair and equitable manner on the basis of an assessment of the applicants' means, by reference to the HSE's national assessment guidelines and in accordance with the health legislation.

The HSE has, however, discretion to grant a medical card in circumstances where there is undue hardship in the arranging of medical services. For example, if an applicant's means are above the financial thresholds set out in the national guidelines, the HSE examines for any indication of medical or social circumstances, which might result in undue hardship in the arranging of medical services. In order to fully take account of all the relevant circumstances that may benefit an applicant in the assessment, a range of information and documentation must be provided, as outlined on the application form.

The HSE makes every effort to provide a person with sufficient time to renew his or her eligibility. Where a review form is returned, but not fully completed by the expiry date, it is HSE policy to extend the eligibility for a reasonable period of time until the review is carried out and a final decision made. I understand from the HSE that in this case some information is outstanding.

Finally, I can advise the Senator that medical card holders who engage with the review of their medical card eligibility will not have their eligibility withdrawn before the review is complete.

Senator Martin Conway

I note the reply. Of course, one would not discuss a specific case particulars on the floor of the House. This is an example of where the system still is not working. The information requested has been provided but yet it is deemed not acceptable, although Revenue cannot understand what is acceptable because what is deemed to be acceptable by the PCRS does not exist in the eyes of Revenue. That has also been backed up by the client's accountants.

I like to deal with matters in a positive manner. I would be happy if the Minister gave a commitment that he would request a senior person in the PCRS to deal with this file - not direct him or her as to what to do - and to iron out the crinkles that exist.

Deputy Leo Varadkar

If the Senator contacts my private office later in the week I can undertake to have a senior person examine the file. As the Senator accepts, I cannot direct him or her to provide a medical card.

Register of Electors

An Cathaoirleach

I welcome the Minister of State, Deputy Coffey, to the House for the third matter.

Senator Katherine Zappone

I welcome the Minister of State. I ask him to outline what the Government is doing to raise awareness and to encourage citizens to register to vote ahead of 25 November, which is the voter registration deadline for the marriage equality referendum in 2015. It is essential to encourage citizens to register to vote and to vote, especially in light of the alarmingly low voter turnout figures from recent by-elections, for example, with only 34% of the electorate voting in Dublin South-West. I especially hope to hear what the Government is doing to ensure that young people are fully aware that they must act now to secure their vote in the marriage equality referendum next year. One in three between the ages of 18 and 25 are not registered to vote and eight out of ten young people did not vote the last time we held a referendum.

This upcoming referendum is an opportunity to end the disconnect between politics and the younger generation caused by decades of failure to deliver real political reforms. Getting young people energised and involved in the democratic process is one of our greatest challenges and the only path towards a health vibrant society. The current citizen movement signals that people need and want to be included in public decision-making in a meaningful way so that they can use their voices to shape the type of Ireland they want to live in, and I applaud civil society for its powerful efforts to encourage people to register to vote in time.

The Gay and Lesbian Equality Network, the Irish Council for Civil Liberties and Marriage Equality Ireland have joined together to launch the Yes Equality campaign to encourage people to register to vote this November. The Union of Students in Ireland and SpunOut.ie have also launched their information campaigns.

The Government and political parties cannot shirk from their responsibilities so what I expect from the Government is at least to match this civil society effort. As the Minister of State is probably aware, the system to register to vote also needs to be reformed. We need to have a centralised system that is up to date, streamlined and easy to use. The procedures vary from one county council to another which leads to confusion and frustration among potential voters attempting to sign up to the electoral register. We also need to have a centralised online voter registration system. Some county councils have this but there are significant inconsistencies between councils. It is too late for this referendum but we should have this debate and I hope to hear an update from the Minister on this issue at some point. Time is running out and the Government should make every effort to get the message out to young people that there are only three weeks left in which to register to vote in the marriage equality referendum 2015. Particular emphasis should be placed on areas like Dublin South-West where, compared with the national average, a higher percentage of the population is under 25 years.

Minister of State at the Department of the Environment, Community and Local Government (Deputy Paudie Coffey)

I thank Senator Zappone for raising this important issue which I am taking on behalf of the Minister, Deputy Alan Kelly.

Voter registration is an important and fundamental part of our electoral processes and the annual register is prepared at this time of year. I welcome the effort of civil society, as outlined by the Senator. It is important that all sectors in society engage with the democratic process. I welcome the opportunity to outline to the House what measures my Department is taking in this respect.

By law, the preparation of the register of electors is a matter for each local registration authority. It is their duty to ensure, in so far as possible and with the co-operation of the public, the accuracy and comprehensiveness of the register. Local authorities have undertaken extensive voter registration campaigns over the years, with assistance from my Department, to ensure the electoral register is as up-to-date and as accurate as possible. Senators will be aware the draft register of electors is published annually on 1 November. Between that date and 25 November, the draft register is on display in local authority offices, post offices, Garda stations and the offices of county registrars. The public are encouraged to check the register during this time. Where new registrations or corrections to existing registrations need to be made, the public are encouraged to notify their registration authority. The process culminates in the publication of a new register on 1 February in the following year. That new register comes into force on 15 February and is used for all elections and referendums held during the following 12 months.

My Department supports an annual voter registration campaign during the period for displaying the draft register, which is between 1 and 25 November. The key message to members of the public each year is to value their vote and to take the necessary steps to ensure they are registered to vote and that their registration details are in order. People can do this by checking with their registration authority or online at the website, www.checktheregister.ie.

The following measures are being taken by my Department this year to promote voter registration. Ten thousand posters were printed and posted last month to registration authorities, Members of the Dáil, youth organisations, third level student bodies and multicultural groups. Registration authorities were asked to arrange to have these posters displayed in post offices, public libraries, Garda stations, courthouses, local authority offices and other suitable locations. Advertisements were placed last week in national daily newspapers and in other newspapers, including Seachtain. Online advertisements will be appearing on popular websites on a staggered basis during November. The home page of the Department's website will draw attention to the timelines for voter registration. The posters and the advertisements in each case encourage people to engage with the voter registration process by checking the draft register to ensure they are included it if they are over 18 years of age and that their details are correctly recorded.

I hope people will respond to the registration campaign during this time. It is important that all eligible voters are enabled to vote when elections or referendums occur. To do this they must be registered. Inevitably, some will not vote or will forget to vote. These voters will still have the opportunity to apply for inclusion in the supplement to the register for a period of time in advance of the holding of any elections or referendums.

I thank Senator Zappone for raising awareness of this matter. I agree it is essential and important that anyone entitled to vote is registered to vote. In my experience over many years, the local authority registers have contained inaccuracies and omissions. I repeat that anyone entitled to vote should register and exercise his or her vote if at all possible.

Senator Katherine Zappone

I thank the Minister of State for his response. I am somewhat heartened by it. I agree with him that it is good to identify these issues now. The draft registers are on display in local authority offices and people are encouraged to inspect them. The different measures identified by the Minister of State are helpful to know. I was with members of the Union of Students in Ireland last evening to promote the issue in Galway. I know that they will be happy to hear that the Minister of State is engaged in this process. We should encourage members of the local authorities to hold events, for example, or to reach out beyond the advertisements and other initiatives. I hope they will do so. We are all keen to have the citizens engaged in the referendum, whichever way they vote, but they cannot do so if they are not registered. I thank the Minister of State for outlining the measures in his response to the matter I have raised.

Deputy Paudie Coffey

I thank the Senator. I reiterate that, by law, the local authorities are the responsible authorities for voter registration. I am sure the Senator's experience is the same as mine in that some local authorities are better than others in this regard. I call on local authorities to use the resources available to them to ensure in so far as possible there is awareness about voter registration in their respective areas. I accept the Senator's point about the importance of political parties, those in civil society, students' unions and anyone else with an active interest engaging proactively with our democracy. To do so they must be registered to vote. The issue raised by the Senator is timely. I support her in her efforts to raise awareness. It is important that everyone entitled to vote exercises their vote. Some may wish not to exercise their vote but that is their right also. I thank the Senator for raising this important issue. I hope some members of the media are listening to this debate because they have a role to play in raising awareness.

Employment Rights

Senator Fidelma Healy Eames

I welcome the Minister, Deputy Richard Bruton, to the House. I am grateful that he is here to take this Adjournment matter as the senior Minister in the Department.

My case is the need for the Minister for Jobs, Enterprise and Innovation to consider the poor prospects of agency workers who exist on week-to-week contracts and how he can improve their lot. It is in everyone's interest that workers are happy and that people stay working. We do not want to make welfare attractive or to create a welfare trap. The Minister will know that I have a long record in supporting work and employment and in supporting multinational companies as well as small local businesses.

I was quite stunned when I heard of some of the conditions under which agency workers are employed. I will document some of them for the Minister. Agency workers are employed by an agency and not by the company directly, although they work in the company. The main kernel of the problem is that they work on week-to-week contracts and are paid on a scale ranging from the minimum wage to a little more than €10 per hour. One worker met me to describe his plight. He earns approximately €21,500 a year but his biggest problem is that he is employed on a week-to-week contract. He is not a baby; he is 39 years of age. He would like to get married but he cannot even qualify for a credit union loan. He cannot get a car loan or a mortgage because of the lack of job security in the contract. He has no benefits in terms of sick pay or a pension. Others mentioned to me that some agency workers are on a week-to-week contract for up to three years without any definite contract duration. That is quite a long time. They are the issues I would like the Minister to address in terms of legislation he is planning to bring forward and guidelines he can issue to agencies. Is he examining lengthening the week-to-week contract, even to three to six months, which would be helpful? In some cases agency workers' wages have been reduced from €10 an hour to the minimum wage.

This policy of low pay is a big issue. This individual pointed out to me that, under the budget, he will get an extra €3 a week, but that will not make any sizeable difference to his life. I reiterate that the biggest problem is the week-to-week contract because, to use that individual's words, he feels "it is messing with people's lives". He cannot get a mortgage, a car loan or a credit union loan. He said: "my head is exploding as I want out of here but where else can I go - I want to work - but into another agency job". It is desirable that the weekly contracts be extended to short-term contracts, for example, up to six months, which would give workers the ability to plan ahead. This would be good for companies too because they would be able to plan ahead. If there is better morale among the workers, it will improve spirits in the company. While it is somewhat nebulous, one can always recognise good worker morale and good spirits in a company.

The perception is that the law suits companies and the Government backs it. We all need employment and I support jobs, growth and the growth of GDP, but workers' rights and dignity matter too. If lengthening the duration of contracts is not examined, the danger is that it could make welfare attractive, and creating a welfare trap is the last thing we would wish to do.

I have many more examples. Another one is that after the deduction of PAYE tax, PRSI, the universal social charge, the property tax and with the water tax that is being introduced, there is very little left to live on and that all that is left to tax now is the air. I am not being sensational about this but my fundamental question to Minister is what he can do and, more important, what he will do to improve workers' conditions and contracts for agency workers. The attributes of the agency worker are just as important to the company as those of the permanent worker. We are very lucky to produce creative and flexible people and, above all, people who want to work on low wages. I await the Minister's reply.

Minister for Jobs, Enterprise and Innovation (Deputy Richard Bruton)

I thank the Senator for raising this issue. There is no doubt that pay and conditions form a continuing issue to which my Department gives very careful attention. One of the first things we did on entering Government was to increase the minimum wage, which had been reduced under pressure in the previous negotiations with the troika. We restored that minimum wage. We have also been implementing a wide range of reforms in the wage-setting area where we have sought to re-establish the system of joint labour committees and the registered employment agreements which were struck down by the courts. Specifically, in regard to agency workers, we introduced the Protection of Employees (Temporary Agency Work) Act 2012, which provides that agency workers must receive equal treatment in regard to the pay they receive with the permanent workers in the same company. That has been a very important measure and it was backed by an EU directive but had not been implemented in Ireland. That gives protection to agency workers.

Clearly, we are concerned about what are called zero-hour contracts. In our new agreement for the second phase of the programme for Government between the Taoiseach and the Tánaiste, a study of zero-hour contracts is being undertaken. The position of zero-hour contracts is somewhat different in Ireland from the UK, where this has been a centre of very considerable concern, in that people here who are required to be on-call have some protection from the Organisation of Working Time Act, which provides that they will have to be paid for 25% of the period during which they are on call. I think that is a provision under section 18. They have to be paid for 15 hours or 25% of the time whichever is the lesser. There is a protection there.

Employment law does not seek to regulate the duration of a contract but it provides that people who are on contracts enjoy the same access to employment rights, holiday entitlements and so on as any other worker. I do not think the State can start insisting on the duration of a contract because inevitably people set contracts depending on the scale of the projects they are working on and it is not possible to require companies to have contracts of a certain duration. Clearly, agency working, and temporary working generally, is a feature. It should never be a major part of the workforce but there are employees it suits and employers it suits who have seasonal fluctuations whereby they can arrange some of their production on this more flexible arrangement.

We have introduced a large number of changes. We are establishing a commission on low pay and the newly appointed Minister of State in my Department, Deputy Gerald Nash, will steer that legislation through. It will come to the House in due course and it is his intention to appoint an interim commission on low pay. There has been such a body in the UK and by common acclaim it has done a good deal of valuable work in understanding the process and making sure that the both the employment opportunity and the need for protection of people in low paid positions would be balanced. We have a programme of work in terms of examining the zero-hour contact and the establishment of a commission on low pay. We have implemented legislation on agency workers and are bringing in the REA legislation. We have a good suite of protections in place. I am always open to looking at amendments in our legislative framework but the emphasis in recent years has been to consolidate legislation following a number of court decisions that undermine the existing approach. I hope those comments have addressed some of the Senator's concerns.

Senator Fidelma Healy Eames

If the Minister or I were employed on one of these week-to-week contracts, we would not be able to plan our lives. What comfort can he give me to pass on to the considerable number of the workforce - 150,000 people - employed as agency workers? I look forward to the establishment of the commission on low pay. I could just as easily be talking on behalf of the employers' side or the small business sector but my job is to represent whatever concerns are put forward. How can these workers plan ahead? How can they borrow a penny? What can the Minister say that could help? Would he consider, for example, requesting companies, through legislation, to set the duration of contracts according to the length of a project?

Deputy Richard Bruton

In this area we must provide legal protections that are general in their application. Not all agency workers are low paid - some agency workers are quite highly paid and in some professions working through an agency gives higher pay. As Senator Healy Eames rightly says, some agency workers are vulnerable to being treated very badly. That is why we passed legislation in 2012, which I brought through the House, requiring equal treatment in relation to pay and basic working and employment conditions. That is in effect since 5 December 2011. It requires that people who are brought in through an agency on a temporary basis be treated identically to the full-time staff of the same company.

Senator Fidelma Healy Eames

Not in terms of pay.

Deputy Richard Bruton

Yes, in terms of pay. Pay is defined as basic pay-----

Senator Fidelma Healy Eames

I heard the Minister.

Deputy Richard Bruton

-----and pay in excess of the basic pay in respect of shiftwork, piecework, overtime, unsocial hours worked or hours worked on a Sunday. It covers the pay element, but it does not cover pensions, and those sorts of-----

Senator Fidelma Healy Eames

Or sick pay.

Deputy Richard Bruton

Or sick pay. However, this is an arrangement whereby these people are working on a short-term agency basis. That does not suit everyone but it does suit some people and we are seeking to recognise that this is a flexible option that suits some people and some employers but one cannot demand of an employer who has a temporary assignment that it will endure. They often do not know how long demand will be such that-----

Senator Fidelma Healy Eames

I understand completely.

Deputy Richard Bruton

We can only provide a general provision, as we are doing, but we are different from the UK in that where people are required to be available they are guaranteed the 25% or 15 hours even if they do not work. We are looking again at the zero-hours contract. I will ensure that the officials in my Department who are initiating that study of zero-hours contracts will look at the sort of cases that Senator Healy Eames has raised and will factor those into that study.

By and large, however, we have put in new protections for the very type of worker that Senator Healy Eames is concerned about. We are looking at the issue of low pay, if such people are on low pay, and we are looking at zero-hours contracts. Across the spectrum of issues the Senator has raised, if we have not already implemented change, we are actively looking at areas where we could improve the environment. At the same time we recognise that there is huge pressure. With 21,000 people emigrating from Ireland and 11% unemployment, one must balance any measure taken on one side with the need to create employment on the other. One of the things that has been seen in the past few years is that this recovery started with largely part-time working and shorter duration contracts. In the past 12 months, all of the employment growth is in full-time positions. As recovery has taken hold, we have seen what were short-term opportunities becoming more established in duration and people getting into a better position to plan their future. Agency working is just one element but it is being regulated in a way that we believe is bringing greater fairness into the environment.

The Seanad adjourned at 6.55 p.m. until 10.30 a.m. on Wednesday, 5 November 2014.

Seanad Éireann debate - Tuesday, 4 Nov 2014