Seanad Éireann debate -
Tuesday, 28 Mar 2017

Vol. 251 No. 1

Health (Amendment) Bill 2017: Second Stage

Question proposed: "That the Bill be now read a Second Time."

Minister of State at the Department of Health (Deputy Finian McGrath)

It is my pleasure to introduce this Bill to the Seanad. 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 would be a priority for the partnership Government. In our programme, we committed to extending the entitlement to a medical card for all children in receipt of the domiciliary care allowance. This initiative was subsequently announced as part of a range of health measures in budget 2017. The 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 will see the prescription charge reduced for medical card holders who are over 70 years of age and their dependants.

The legislation has two primary purposes. First, it will ensure that all children for whom a domiciliary care allowance payment is being made will be eligible for a medical card. Up to now, more than 9,800 of the 33,000 children for whom an allowance payment is made have not qualified for a medical card. The Bill will ensure that all 33,000 children will be eligible. This scheme will be operational from 1 June, with the 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.

Second, it will reduce the prescription charge for medical card holders aged 70 years or older and their dependants. The charge will be reduced to €2 per prescription item, with a monthly cap of €20 for an individual or family. This targeted measure will benefit nearly 390,000 over 70s and their dependants. It is expected to save this group in the region of €10 million in 2017 and €12 million in a full year. Senators will note that this reduction was implemented on an administrative basis from 1 March. The HSE issued a circular to pharmacies setting out the reduced charge and process. I will take this opportunity on the Minister’s behalf and mine to thank the HSE and pharmacies across the country for their swift implementation of this measure.

In addition, I stress the importance of delivering the Bill in March in order to place this important measure on a statutory basis.

I ask for the support of Senators in achieving this benefit for all of our older citizens.

Senators will be aware that I have long been a supporter of and campaigner for the rights of all people with disabilities, so it was extremely important that A Programme for a Partnership Government contained a commitment to provide medical cards to all children who qualify for a domiciliary care allowance payment. Children in receipt of the domiciliary care allowance payment are children under the age of 16 who 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 very serious disability is a most difficult, stressful and worrying time and dealing with a diagnosis can at times require every ounce of strength from parents and guardians. That is why we are committed to ensuring that all children for whom a domiciliary care allowance is made will have access to a medical card. Provision of a medical card will undoubtedly relieve some of the financial burden these families have experienced over many years. By virtue of having a medical card, these children will now be eligible for the following services free of charge: inpatient and outpatient hospital care; GP care; prescribed drugs and medicines, subject to a co-payment; dental and aural services; and aids and appliances. In addition, parents and guardians will 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. In other words, it makes their lives much easier. I appreciate this was a burden and the outcome was often uncertain. 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.

To ensure that all families are treated equally, where there is one child or a number of children in a family in receipt of domiciliary care allowance and the payment is made to the same parent for each child, the legislation allows that the prescription cap of €25 per month will apply. The Government is committed to reducing the cost of medicines for Irish patients, and this includes reducing the prescription charge 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 was set in 2013. It reduces the cost of the GMS 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. While the Act provides for groups to be exempted from the charge, it does not allow the charge to be varied for a particular group. The Bill identifies the over-70s as that group and provides 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 and over have higher medication requirements than the general population. Patients over 70 make up just under 20% of the medical card population but receive nearly half of the drugs dispensed under the scheme. The average number of items dispensed per person over 70 is seven compared with two items per person under 70 so it is fair and just to use the resources available this year to reduce the cost of medication for this group. This is part of building a just and inclusive society. Accordingly, budget 2017 announced a reduction in the prescription charge for medical card holders aged 70 and over and their dependants. The reduction is 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 will now outline the main provisions of the Bill. 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, namely, children in receipt of the domiciliary care allowance. Section 3 amends section 59 of the Health Act 1970 to provide that persons over the age of 70 years and their dependants will benefit from a monthly maximum prescription charge. The monthly limit of €20 is provided for in section 4 of this Bill. Section 3 also provides that, where a child, or a number of children in a family, have full eligibility for a medical card solely for the reason that they are in receipt of the DCA payment, the monthly maximum prescription charge of €25 will apply.

Section 4 amends section 59 of the Act by inserting a new section, section 59A, into the Act to allow for the variation of prescription charges and monthly expenditure cap for medical card holders over 70. 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 when making such regulations. Section 5 states the Short Title of the Act and includes a standard provision relating to commencement of the provisions of the Act.

This Bill is all about looking after some of the most vulnerable in our society - children for whom a domiciliary care allowance payment is made and people over 70 years of age who have a medical card. By providing all children for whom the domiciliary care allowance is paid with eligibility for a medical card, the Government is addressing an anomaly where a substantial cohort of children, in the region of 9,800, were considered to need ongoing care and attention substantially above that required by a child of the same age but did not qualify for a means-tested or discretionary medical card. Providing these medical cards will help to alleviate the stress and anxiety of parents and guardians who are dealing with the medical costs associated with a child’s disability. It is very difficult so this is a major assistance to these families.

The provision in the Bill to reduce this charge for people over 70 is the first step - and only a first step - in implementing the Government’s commitment to reduce the prescription charge for medical card holders. It is targeted at the medical card holders facing the greatest burden of the charge and it is right and just that, within the constraints we face, this group of patients receive the earliest relief from the total charge.

I am very pleased to bring forward this legislation. It is our obligation as representatives of the citizens of Ireland to look after those who need it most.

Senator Gerry Horkan

I welcome the Minister of State to the House. I will be speaking on behalf of my colleague, Senator Swanick, who is unfortunately unable to be here today.

I welcome the opportunity to speak on the Bill as it was a specific commitment in Fianna Fáil's 2016 general election manifesto. Fianna Fáil supports this Bill which provides a medical card for all children in receipt of the domiciliary care allowance. We are also committed to the removal of prescription charges on a phased basis so we welcome the reduction for the over-70s.

In the Dáil and Seanad during the term of the previous Government, Fianna Fáil was to the fore in highlighting the Government's targeting of people on discretionary medical cards, especially from 2012 to 2014. I appreciate the Minister of State was not part of that Government. The subsequent U-turn and climbdown by the Government was testament to the strength of our opposition on this issue. More can be done, especially for children with disabilities, which is why we included a proposal in our 2016 general election manifesto to provide a medical card for all children in receipt of the domiciliary care allowance.

At the moment, there are around 10,000 children - the Minister of State referred to 9,800 - who receive the domiciliary care allowance but are not in receipt of a full medical card and are forced to pay for medical care that is not covered by this scheme. The Bill will provide all 33,000 domiciliary care allowance recipients with full eligibility for a medical card. While this is very welcome, will the Minister indicate the timeline for the roll out?

We also made it a provision in the confidence and supply agreement with Fine Gael that the more humane system for discretionary medical cards that was put in place prior to the election would be fully maintained after polling day. It remains imperative that we ensure that those experiencing financial hardship due to very serious illnesses will receive a discretionary medical card. We should never forget the appalling denial and deceit from the then Government over discretionary medical cards in 2013 and early 2014. It is extremely regrettable that thousands of families across the country were put through the stress and hardship of having their medical cards withdrawn before the Government finally saw sense in mid-2014. For two years the Government ignored the issue and denied there was a deliberate policy to cut discretionary medical cards. It was only in the wake of public outrage and backbench panic that it finally acted. Fianna Fáil will continue to ensure that the more compassionate and humane approach to medical cards is sustained.

The programme for Government also contains a commitment to request the clinical advisory group on medical cards to examine the guidelines for the awarding of discretionary medical cards to patients undergoing treatment for cancer. That is something we welcome and on which we want to see action. As the Irish Cancer Society has pointed out, many cancer patients and their families face a financial crisis while they are going through their treatment. The 2015 report, the Real Cost of Cancer, showed how a significant number of patients face a severe drop in income while at the same time running up extra bills on a range of items such as home heating, parking, child care, travel, prescription charges, hospital stays, over-the-counter drugs, consultant visits, dental care, physiotherapy and clothing and personal care. A medical card is designed to be available for those who are suffering financial hardship as a result of their illness, and from the Irish Cancer Society's research, we can see that more than 20% of survey respondents who applied for a medical card after their diagnosis did not get one.

I welcome the changes to prescription charges in 2011. The then Minister for Health, now Senator James Reilly, declared his intention to abolish prescription charges. However, within 18 months he performed a spectacular U-turn, trebling the 50 cent prescription charge to €1.50 and in budget 2014 he compounded his hypocrisy by adding another euro to the charge. That was a deplorable breach of faith by the then Minister and has taken hundreds of millions from the most vulnerable in society. The increase in prescription charges is having a disproportionate impact on fixed-income groups, in particular pensioners. Fianna Fáil is committed to the abolition of prescription charges on a phased basis as the cost makes it prohibitive for people to access medication.

Health care professionals have consistently described the charges as short sighted, potentially resulting in more people having to be hospitalised when that could have been avoided through primary care, which ultimately only increases the cost of health care for the State. The Government claims it is seeking to help low and middle income families. However, medical card holders who by their nature are some of the most disadvantaged in society are still paying up to €25 a month for vital medicines.

When the provision of medical cards is discussed, the issue of free GP care always comes up. Fianna Fáil is committed to making primary care stronger and embedding it as the first point of contact in health care. We want to expand GP care on the basis of income rather than age, yet at the moment nobody in government or opposition can definitively say how much that would cost. We must bear in mind how the original estimate for free GP care for the under-sixes doubled following the agreement of a contract with GPs in April 2015. Therefore, before we proceed any further in that regard, Fianna Fáil wants to see a GP contract in place which has general practitioners on board for universal GP care.

The Bill is a welcome measure for those in need. However, we must ensure the smooth passage of the Bill through the legislative process so that those measures can be put in place without further delay. I will withhold my congratulations at this point until all recipients of the domiciliary care allowance receive their medical card.

Senator Victor Boyhan

I welcome the Minister and thank him. I know his absolute commitment to this matter. I have three points and four questions for the Minister. First, we know the Bill is to provide for an automatic entitlement to a medical card for those in receipt of the domiciliary care allowance. The Minister also intends to reduce the prescription charges for medical card holders aged 70 years and over, and their dependants. That is clearly the objective of the Bill.

I received some correspondence and a copy of a press release on budget 2017 issued on 11 October 2016 by the spokesperson for Age Action. The commentary was as follows, namely, that prescription charges had increased more than 500% since they were introduced and that older people are more likely to have multiple prescriptions so were particularly affected by a tax that targets the poor and the sick. They are the words of Age Action, not mine. Age Action welcomed the reduction in the prescription charges which the Bill will bring about, but it cautioned that not all older medical card holders would benefit equally from the cuts. It concluded by saying that the reduction in the cap on the "sick tax", as it described it, announced today was good news and Age Action hopes it is a step in the right direction to its abolition. It cautioned that lone pensioners would not benefit greatly as they are unlikely to be paying more than €20. I will circulate the views of Age Action in case the Minister is not familiar with them.

I wish to focus on four questions. The first is what will happen to a recipient of the domiciliary care allowance, DCA, medical card once he or she turns 16 years of age. I would like the Minister to tell us here. I have my own views but I wish to hear what the Minister has to say.

The second question is what bearing the United Nations Convention on the Rights of the Child have on the Bill. I know the Minister and his officials have considered the issue. I looked at some correspondence in the Library today on the matter.

The third question is what entitlements, if any, do recipients of the DCA have in relation to medical cards.

The fourth question is what plans there are to continue to reduce or remove prescription fees for medical card holders over 70 years, or to reduce or remove prescription charges for medical card holders under 70 and their dependants. I accept the Minister referred to some of those issues in his concluding remarks. Furthermore, a number of organisations which represent older people, such as Age Action, welcome the reduction in prescription fees provided for in the Bill but have made a further call for the complete abolition of prescription charges for all those over 70 years. I would like the Minister to give a detailed response.

Senator Colm Burke

I welcome the Minister, and I very much welcome the Bill. I was worried when I listened to Senator Horkan of Fianna Fáil because he was so negative I thought the Bill was being introduced to abolish the charges. I reassure him that the purpose of the Bill is to introduce medical cards for people who are in receipt of the domiciliary care allowance. A significant number of people will come into the scheme. More than 33,000 people are currently in receipt of the domiciliary care allowance. My understanding is that approximately 9,800 of them currently do not have medical cards and they will have an entitlement as and from 1 June. I very much welcome that.

It is important that we give support to families who have an extra struggle. Many families have a significant struggle despite the income they receive. This is a really welcome development and the Minister should be thanked for his considerable commitment to people with disabilities. The Minister for Social Protection has also ensured the measure would be introduced.

When we bring forward proposals, it is important that we look to the long term and what we can roll out in the coming years. My colleague asked what would happen when a child reaches the age of 16. That is a very valid question. As recently as last Saturday, I met a family whose child had just reached his 18th birthday and he no longer had an entitlement to respite care. That was a major concern for his parent. I had a long conversation with the parent who outlined that the child is very good in every respect but has an intellectual disability and requires 24-7 care. The parent said that when the child was under 18 and in receipt of respite care, she slept for a full two days because it was the only break she had as she has to look after her child night and day. That is an issue of concern. I welcome the proposal in that regard and I welcome the Bill. It is long overdue. It will help people who previously had to fight tooth and nail to try to get medical cards on discretionary grounds but were not successful and now they no longer have to fight that battle.

There are mixed views on the prescription charge. On the one hand, we are one of the highest consumers of medication according to the OECD.

At present, we are spending about €2.6 billion - not million but billion - per annum on medication and prescriptions. Therefore, the questions must be asked as to whether all the medication is necessary and if there is a better way of dealing with it. The previous Minister, Senator James Reilly, introduced the scheme on generic drugs but I wonder how successful are we in that area and whether we need to do a lot more work. By saving money through the use of generic drugs and lowering the use of medication and drugs, we can use that money to provide additional services. We sometimes seem to forget that. I refer to a lady with a child over 18 years of age who cannot get respite care. If we could save €50 million in the cost of medication, that €50 million would go a long way to helping parents with children over 18 years of age who want to get respite care. It is something we need to consider when we look at issues such as this about long-term planning. I can see where people are coming from on the question of prescription charges but I can also see that we need to do more work on making information available so that people can see that using generic drugs is the same as using the patent drug but also that the use or over-use of some drugs is not wise. This is something we need to work on. If we announced a scheme in the morning where people could surrender any unused or out-of-date drugs, we would fill a lot of bins and containers with medication that could be disposed of. Many people would be embarrassed if they checked their medicine cabinets and saw what they have stored that is really out of date and has been there not for a month, two months, a year or two years but a very long period of time and has not been disposed of. We need a major education programme.

Anywhere we can save money in one area of health, without anyone being at a disadvantage, is of benefit to the people who have a disadvantage, particularly for those with disabilities and for elderly care. We need to work on this.

I congratulate the Minister of State on this. This Bill has the support of everyone in this House and, hopefully, it is just another step in helping families and people who have disabilities to get the same advantage as anyone else. I welcome the Bill and thank the Minister of State for bringing if forward.

Senator Máire Devine

As others have done, I begin by acknowledging the work done by Our Children's Health, which has been at the forefront of this issue and has worked tirelessly to bring this question to the fore so that it gets the attention it deserves. It is a road to providing a first-class health system for all and I welcome it. Mobilising over 65,000 people to sign a petition in order to get medical cards for seriously ill children is no mean feat and I highly commend the tireless work of a campaign that is primarily run by three men on a voluntary basis - kudos to them. It is that type of activism, commitment and community duty that will change Ireland for the better.

I welcome this legislation, as I am sure all Members of this Chamber do. If enacted quickly and efficiently, this legislation will make a positive difference to many people in the Republic. Its primary purpose is for medical cards for children with domiciliary cards and the secondary purpose is for the lowering of prescription charges. Primarily, it is about the lives of children such as Louise, Isabella, Aoife and Laura, whose stories I read on Our Children's Health's website. Their struggle and their families' resilience in the face of unimaginable difficulties, coupled with the administrative hell, is beyond belief. I can barely imagine the reality of a very sick child where every day is filled with new challenges, heartache and worry. These brave and admirable parents have no respite. They care for their children out of love and their sheer armour of resilience that cannot be commended highly enough.

It cannot be the case that the weight of administration piles on their shoulders. When a child is sick, a parent needs, and is desperate, to be at home with him or her rather than chasing forms and phoning departments chasing a card that would ensure care. We cannot and should not take that time away from them. Therefore, it is our obligation to ensure access to medical cards is granted easily and as quickly as possible for families.

The negative impact on families' mental health from waiting for access to services is well demonstrated when we meet people in constituencies. The families and parents are burned out. Members can imagine the burn out which I often talk about among the nursing staff within our chaotic system, but imagine the burnout from 24-7 care, without respite care and with continuous responsibility. I have seen the stress, the anguish and the tears of parents. People have come to me, have dumped big plastic bags filled with forms and have asked me to please figure it out for them as they have been on to departments trying to figure it out and beg for a medical card. They have told me that they cannot wait on the phone with no one responding to try to access what is right for their child.

We cannot lump on the additional financial stress of the medical care and jumping through bureaucratic hoops. I am happy we can alleviate some of the financial barriers to medical services with medical cards but the HSE needs to confirm that this legislation and the process of accessing these cards will be quick and easy. There should be ample staff so that the families can have a one-stop-shop, a point of contact to apply to should they have any problem applying online. It should be quick and easy so that we steal no more time from them.

This brings me to a point to note. It is stated that these families will gain access to medical cards in June 2017, so that is in three months' time. Will there be any flexibility in the interim for those who so desperately need access to health care now? While two or three months may seem like a short amount of time, it is not to families struggling to navigate a health system and jump through hoops in order to receive health care for their beloved children. It is my belief, and that of my party, that all children on the island of Ireland should be valued. This should happen today; let us not wait until June.

I welcome this Bill as a move in the right direction to end the two-tier health system and move towards a system where every person - child, man or woman - who needs health care can avail of it. Every person deserves to live in a society that supports them and helps them in whatever way it can when they are sick, rather than in a State that tries to scour every penny from sick people who maybe too tired to fight for it.

This legislation is a start. At the very least, it grants medical cards to almost 10,000 children who deserve them. It is paramount that a public awareness campaign be launched so that every one of those families does not have to search for information regarding their medical cards. It is of upmost importance that this legislation be introduced with the necessary resources and personnel so that there is minimal to no waiting time for families. Time is more precious than we know in these circumstances. We need to do everything not to take any time away for unnecessary bureaucracy and red tape. I echo the questions posed by other Senators. What happens to a child after he or she reaches 16 years of age? What are the plans then?

I concur with Senator Colm Burke's point that the overall aim should be to reduce the prescription, and the use and perhaps abuse, of medications in this country. We need to look to training GPs, public health nurses and front-line workers. It has been done very successfully in the prison system here where benzodiazepines are no longer prescribed or tolerated. It has become accepted and they are no longer used. We need to work towards that as a society.

Senator Maria Byrne

I welcome the Minister of State and the proposals before the House today.

I welcome the domiciliary care allowance and the proposal to bring almost 10,000 extra children into the category in receipt of medical cards. I have been involved with one or two families that were just over the threshold in the past and know the pain that they went through. I compliment the Minister of State and the other Ministers with responsibility for health for having the foresight to take this on board. One particular family has two other children as well and were in negative equity. They went through considerable pain. Their daughter had severe difficulties and disabilities. They did everything and are still doing everything. It is going to be a great relief to many families, and especially to the almost 10,000 children who are now going to qualify from, I think, 1 June. Am I right in saying that?

Another area that I would like the Minister of State to look at is whether an allowance could be given to families who have children with severe disabilities and who also have other children, maybe younger or similar in age. Perhaps the Minister of State could look at providing an allowance in the future towards their child care or whatever. Even though the medical card is going to go a long way to help relieve the pressure for these families, they go the extra mile when they are blessed with children with severe difficulties and perhaps leave themselves short of things to make sure their child has the best of everything. We have to think of the other children that are in the family as well. I would like the Minister of State to look at whether anything could be put in place, be it child care relief or whatever.

I welcome that the prescription charges for over-70s are being reduced. I have had many people visit my office. Even though I know they were on a cap of €25, some of the older and vulnerable people, especially those on basic pensions, found it very tough going. I welcome that it has been capped at €2 per item and €20 per person over 70 and his or her dependants. Some people worked and contributed all their lives, but some of them who are only on basic pensions found it very tough going. While we are talking about people who oversubscribe to drugs, I met some people who were not even fulfilling their full prescription on a monthly basis. They were leaving some of the drugs behind. They were necessary drugs in some cases because of people's conditions. All these allowances are going to help children under 16. I ask the same question as other colleagues in this regard. What happens once they reach 16? I also ask about the help that is being given to over-70s.

Senator Gerald Nash

I welcome the Minister of State.

This is very good news and it is a credit to the Minister of State and to the Minister, Deputy Harris, that they ensured that this provision was contained in the programme for Government. They wasted little time in bringing the legislation forward and resourcing it through the Estimates in last year's budget to allow this measure to become a reality for many families across the country who need it. It is good to see that there is one Minister of State in the Independent Alliance who is prioritising the work in his Department. He might have a word with his colleague, the Minister, Deputy Ross, later on.

Deputy Finian McGrath

About what?

Senator Gerald Nash

He might ask him to take some interest in the bus dispute and the provision of public transport. In fairness, I know that the Minister of State is extremely committed to his own brief and has a long track record of campaigning in this area. It would be appreciated if he could use his good offices to make common cause with the Minister, Deputy Ross, and see if he could express the same interest in his brief that the Minister of State expresses in his own.

We have all dealt with heartbreaking issues in our constituencies over the years. I have been a public representative for 18 years in total. I have been a councillor, Deputy, Minister and Senator - the whole gamut. There are still a few positions that I would like to occupy at some time in the future. In any event, this issue has been deeply frustrating for everybody in public life. They deal with heartbreaking cases involving constituents who simply cannot access the type of support they need when they have children with severe disabilities because they did not meet very tight eligibility criteria to qualify for a medical card. This is €10 million well spent and I want to commend the Minister of State again. It will give peace of mind to children and families right across the land. It shows what we can do with a relatively limited amount of money. We can give that peace of mind and certainty to people who did not previously have it.

This legislation involves a registration system rather than an application system. That is welcome because this will ensure that the process will be expedited for those who qualify. It appears to be quite straightforward but we can never assume that administrative processes will be as simple as they initially appear. We do not want to be dealing with some of the difficult cases in our constituencies that may arise where somebody has been overlooked or has had difficulty when the system goes live on 1 May, only for it to turn out that that person does not receive his or her card by 1 June. I apologise for missing the Minister of State's earlier introduction and remarks. He may have addressed that issue, but we need to be very clear on the process that is in place. I suggest that there be direct communication with the families concerned with regard to data sharing with the Department of Social Protection and indeed the HSE and the Department of Health to ensure that everybody is covered, included and involved, and that everybody who is entitled to a medical card gets it.

I will also ask, and I am sure there is a reason for this, why this is limited to children under 16 who received a domiciliary care allowance and their families, and not children under 18. That might be something that could be considered. I understand that Senator Boyhan may have raised that issue. The problem with regard to the age of adulthood is common across the system, as is the question of when people are entitled to services and so on. The Minister of State might refer to that in his response.

It is good to see a reduction in the prescription charge for single items for those who are over 70 and indeed a reduction in the monthly cap. It is a welcome development and should make a difference, particularly for those who are dependent entirely on the State pension, notwithstanding that it is good to see that the value of the State pension has been increased on a couple of occasions over the last few years. The research shows that older people, particularly those who are struggling, and less well-off socio-economic groups sometimes make choices when it comes to paying for medicines. We do not want to preside over a situation where that choice involves buying food or stretching their medication against medical advice. It is good to see that that is being reduced. I hope to see it being reduced further as resources permit over the next years.

Senator James Reilly

I welcome the Minister of State. I am sure it is pleasing for him to be the bearer of good tidings, as this Bill is.

It is always a challenge to rear children, but I think parents of children with disabilities face additional challenges and those with special needs more so. To be able to give some comfort with regard to medical care costs and the medical card scheme is something that I truly welcome. It is only right and proper that, as our economy recovers, those who are most vulnerable should be the first to benefit. It fits in with the general theme of trying to bring the medical card scheme and free primary care to all our citizens.

This is another step along the road.

Primary care is the most cost-effective and closest to home service. It has been an abiding principle that the patient should be seen at the lowest level of complexity which is safe, timely, efficient and as near to home as possible. Sadly, because of the financial position we found ourselves in, many services were cut and, indeed, rather than remove services, charges were increased through the prescription charge. I am delighted that this charge has been reduced in two ways - first, by reducing the per item charge and, second, by reducing the monthly cap. This will also help many in our society who are elderly or vulnerable and who are on multiple medications.

I echo Senator Colm Burke's comments on the waste that occurs under the medical card scheme. I recently encountered somebody who was terminally ill and who did not have a medical card. On his passing, there were boxes of medications he had ceased using, which were still in date. If I brought them to certain pharmacies, I would be told they could not re-sell them because they were in somebody else's possession and they could not guarantee their propriety and safety. This is our health service and it belongs to us all. It, therefore, behoves us all to be mindful of waste, including doctors, nurses and patients, in respect of medications we no longer use. I would love to see more empowerment of the patient to say to the doctor, "I am not using that so please do not prescribe it", or to say to the chemist, "Please do not dispense it". I have numerous experiences of opening a wardrobe only for a raft of medication to fall out, much of it out of date, because people believe that because the doctor has prescribed it, they should accept the prescription silently. Doctors, patients and pharmacists need to join together to avoid this waste. It is particularly prevalent in certain areas and we all need to guard against it.

I welcome the legislation, which is another step along the road to providing free GP care for the entire population, and I congratulate the Minister of State and the Minister on it.

Senator Jerry Buttimer

I welcome the Minister of State to the House and I thank the Minister for Health for the initiatives contained in the Bill. The Bill is a positive development, which is about looking after those who are most in need and ensuring ease of access, as the Minister said in the Dáil, for people who require health care. This means that people with disabilities will be empowered to ensure they are respected by our health system and those on the domiciliary care allowance will automatically qualify for a medical card.

When I was chairman of the Joint Committee on Health and Children, Senator Colm Burke and others were members, and we met representatives of Down Syndrome Ireland and other groups. They expressed constant worry about being able to access health care. The legislation removes the worry and stress associated with reams of papers needed to apply for services. The Minister of State will have a legacy in this regard, which will not be forgotten, nor will his approach to this. I appreciate the work he has done so far in office. I have always found him to be about the person with special needs and ensuring there is a commitment to care for them. The increase in money available to the Government means we must ensure there is increased and targeted investment in our health system. Senator Colm Burke highlighted the issue of waste and mismanagement and so on, but the money expended on our health system must be targeted at the people who require access and treatment.

As Leader, I was happy to facilitate the Minister and the Minister of State in respect of the introduction of the Bill and I thank Members of Opposition parties and the Independent groups for their co-operation in this regard. The Bill will be passed by the end of the month, which is important. This is a good day for families of children and young adults with disabilities. We must ensure that our disability policy is overarching because it is easy to forget people in our health system. A significant burden has been experienced by some people who have tried to access funding for aids and appliances, or gain access to therapies or to even to be assessed not only during the recession but during times of plenty when the world was awash with money and the then Governments could spend whatever it wanted. Waiting times were long and worries were experienced even during those times. In crossing the threshold from recession to recovery, the burden in respect of respite care and day care must be lifted. Earlier, Senator Coghlan raised the issue of the mental health facility on Mill Road, Killarney, and pointed out that there are still gaps that need to be bridged, not only in funding but also in staffing. This is the same in Cork.

I welcome the reduction in the prescription charge per item and the monthly cap for the over-70s. All of us who are engaged in constituency politics and who meet members of our community every week know they live in fear of not having the money to buy tablets and so on. As we move towards universality in our health care system and free GP care, I hope the threshold for the over-70s will be eliminated because that is a source of concern.

Today is a stepping stone but we should recognise we have a journey to travel in regard to our disability sector. I am more confident than I have ever been, with the Minister of State at the helm, that we have someone who understands and who will work with all of us to deliver change. Like him, I am committed to this sector. There needs to be a change in the way services are delivered by the HSE. The Government provides the money but the HSE administers the funding and I hope that will change.

I am delighted to have had the opportunity to contribute. Many of us worked to ensure the Bill would come to pass during the previous Dáil and I thank the members of the previous Oireachtas health committee for their work. I commend the Minister of State and the Minister on the work they have done. Today is a good day for the families of children and young adults who require this legislation.

Minister of State at the Department of Health (Deputy Finian McGrath)

I thank all Senators for their valuable contributions, support and positive criticism and new ideas. This is an important Bill. Its provisions will be a welcome development for two groups of people who have additional medical needs - children with disabilities in receipt of the domiciliary care allowance and those aged over 70 and their dependants. Children in receipt of the domiciliary care allowance have a severe disability and require ongoing care and attention substantially over and above that required by children of the same age. The legislation will mean all children in respect of whom a domiciliary care allowance payment is made will automatically qualify for a medical card and, therefore, will no longer be subject to the medical card means test while in receipt of the allowance.

As I stated earlier, I fully recognise the added stress parents and guardians are faced with when dealing with a difficult diagnosis. For many it is their first time to seek assistance from the State. Providing an automatic medical card to these children will reduce the uncertainty and anxiety they face in accessing the services required, as well as lessening the financial burden associated with managing their child's disability. I understand the new scheme will be live from 1 June and that the parents and guardians of those children who do not hold the medical card will be able to pre-register with the HSE from 1 May. The Senators are correct we need to get this message out to the families.

Another of the Government's commitments is to reduce the cost of medicines for Irish patients. Budget 2017 included a commitment to reduce the prescription charge for medical card holders aged over 70 years of age and their dependants. This legislation addresses this issue. I welcome the introduction of this measure as it will provide some relief for those aged over 70 and their dependants. In general, those aged over 70 have higher rates of medicine usage and therefore are most impacted by the prescription charges.

Senator Horkan stated more can be done, and I accept the point, but it is a start. He also spoke about the timeline, which is to roll it out on 1 June. He also raised a very important issue, about which I feel very strongly myself. This is cancer and the debacle people face when they are under severe pressure. I agree with the Senator and we will push it. Another important issue he raised is primary and GP care and services in the community. Recently, I met a group of GPs in my office who made this point. They strongly emphasised the GP contract and the ethos of primary GP care as a major start in developing a health service. These are the ideas I have and these are the ideas I will implement.

Senator Victor Boyhan spoke about our senior citizens and the issues raised by Age Action, and we will need to deal with these. He mentioned the cap with regard to lone pensioners. He also asked about what will happen to 16 year olds. At present, there is a half rate domiciliary care allowance payment. These children will receive full medical cards. Between 16 and 18 years of age those with a recognised disability will receive medical cards, and this is something I want to push. I emphasise that while we are doing these reforms my objective is to ensure every child in Ireland with a recognised disability or long-term illness gets a medical card. These are the types of changes I want to implement. Senator Boyhan mentioned the United Nations Convention on the Rights of the Child. He also asked whether we have plans for those aged under 70. We have many plans but we have not developed them yet and I will come back to Senator Boyhan on these issues.

Senator Colm Burke raised a number of important issues. One of these, about which I feel very strongly, is respite care for children aged over 16. As Minister of State I have been going up and down the country meeting families. They seem to be grand with respite for children aged up to 16 but then it disappears for a while. I am determined to push respite services. In 2017 I plan to ensure we will have 41,000 day respite sessions and 2.7 million home support hours for 7,500 people. There are gaps in the system and we need to focus on this issue.

Senator Máire Devine spoke about the campaign group Our Children's Health. I know the group, which has been campaigning for many years. I acknowledge its contribution to the debate. Its objective is the same as mine, which is to ensure children with disabilities and sick children get their rights. The Senator also strongly emphasised the importance of community action. What saddens me about modern society is there is not enough community action. We need more community action coming from people on the ground. When I go to second level schools and meet transition year students I am always blown away by how interested they are in current affairs, human rights, disabilities, having a proper country and honesty in politics. There is a buzz in classrooms throughout the country but when they reach the age of 18, 19 or 20 we seem to lose them. We have a job as politicians to develop this. We must also highlight and publicise the difficulty in accessing medical cards and services.

Senator Byrne spoke about the pain of families and asked whether we could examine other ideas and allowances. We must look at this. In this year's social care and disability service plan we are looking at these issues. We managed to obtain approximately €16.2 million for a plan to develop home support for these families who are under severe pressure. We must look at other ideas and I intend to do this as part of my ministry. I also intend to work very closely with the Ministers, Deputies Leo Varadkar and Simon Harris. The Minister, Deputy Varadkar, has many ideas in social protection to assist families.

Senator Nash spoke about the process and direct communication, which a number of other Senators also mentioned. He stated we must ensure nobody is left out and that everybody is covered, and that we should keep an extra eye out for less well sections of society.

Senator Reilly mentioned the additional challenges for families of people with disabilities. He has been a long-time campaigner, when in government and as a Member of this House, of the idea of cost-effective primary care and free GP care to reduce costs and reduce issues in our accident and emergency departments and hospitals. The general practitioners I met last week also emphasised this point. We all speak about the fact the health service is short 3,000 beds but they argued if they had proper funding and support for primary and GP care and early intervention services there would be less need for beds in hospitals. This is a cost-effective argument to which I listened.

Senator Buttimer spoke about the most needy and access. As long as I am Minister of State, my focus will not be on the HSE, the Department of Health or myself but on the person with the disability. I want to design services around people with disabilities.

I accept the point that some people might consider the reduction in prescription charges to be modest, but given the resources available in the health system it was considered the most effective use of these resources to apply the reduction to the cohort of the population. I am happy to note this measure was implemented on 1 March.

I thank all Senators for their support of this important legislation. I will come back to them with details and more up to date information on some of the points which I did not get to. We are reforming the disability allowance as well as the domiciliary care allowance and the Senators will need to be updated on this. I thank them for their contributions and I look forward to further examination of the Bill on Committee and Report Stages.

Question put and agreed to.

An Leas-Chathaoirleach

When is it proposed to take Committee Stage?

Senator Colm Burke

On Thursday.

Committee Stage ordered for Thursday, 30 March 2017.

Sitting suspended at 6 p.m. and resumed at 8.30 p.m.