Health (Amendment) Bill 2017: Committee and Remaining Stages

Question proposed: "That section 1 stand part of the Bill."

I welcome the Minister to the House. A Minister of State from his Department was here the other day and I asked two questions about this legislation. They are very important points and I was not quite satisfied when I reflected on his contribution. I want to raise these two issues now. They relate to section 45 and the anomaly with a 16 year old and an 18 year old. I asked then what will happen to a domiciliary care allowance, DCA, recipient's entitlement to a medical card once that person turns 16 years of age. We know the story. People are not automatically entitled to it at 16. They go and must apply for a medical card. It is not always automatic and it might not happen. There were previous papers, in fairness, and I give credit to the research done by the Oireachtas Library and Research Service. It did a very comprehensive digest on this Bill. It raises a number of questions and highlights the following:

Once a child turns 16 years however, their entitlement to a DCA payment ends. At this point the recipient is permitted to apply for Disability Allowance instead. Unlike the Domiciliary Care Allowance payment, Disability Allowance is a means tested payment. However, there is no automatic entitlement to a medical card for recipients of Disability Allowance. Former DCA recipients will not be permitted to retain their automatic entitlement to a medical card.

Former domiciliary care allowance recipients will not be permitted to retain their automatic entitlement to a medical card. That is the first point.

I then went on to ask what bearing this Bill might have on the UN Convention on the Rights of the Child. As part of this process, a review group was set up and it reported on the domiciliary care allowance scheme in 2012. The group produced a number of background papers on the matter. It expressed concern, made a number of strong recommendations and reached a consensus that it should be pushed up from 16, as it currently stands, to 18 years of age. The group found that this anomaly, inherent in the system, may lead to some ambiguity and confusion going forward.

I do not want to go on because I have made my point. It is a matter of serious concern and these benefits need to travel with the illness and the condition rather than with the person, the status of his or her parents or the family income. There is an anomaly there and I really just wanted to flag it. I am well aware of the Minister's serious commitment in this area. What is the Government's intention here? It could be argued it is a social protection measure or issue and that it is a matter for that Minister, Deputy Varadkar. Either way, I would appreciate it if some institution of government could address this anomaly. I look forward to hearing the Minister's considered views on this matter.

I thank Senator Boyhan for raising a very valid point. The Senator has alluded to the fact that the domiciliary care allowance scheme is run by the Department of Social Protection. He is quite right that there have been a number of reports on it, including the Ita Mangan report which was an excellent body of work that recommended extending the domiciliary care allowance to people up to the age of 18, if they wished. However, as the domiciliary care allowance is paid at a lower rate than the disability allowance, it is important that there would not be any adverse consequences for anybody with a disability. The consideration of that issue is a matter for the Department of Social Protection.

What I am doing with the legislation before the House today is aligning the domiciliary care allowance with the medical card. If the Department of Social Protection decides to extend the domiciliary care allowance scheme further, this legislation will extend further. The medical card scheme, for the purposes of this legislation, is aligned with the domiciliary care allowance scheme. However, it is important to note that as the domiciliary care allowance payment ceases when a child reaches the age of 16, it would be necessary at that stage for an application to be made for a medical card. Up until that point, there will be no reviews and there will be an automatic entitlement to a medical card for everybody. However, at the age of 16, the normal medical card procedure will kick in. The HSE has assured me that it has a process in place to manage such applications so that families are notified well in advance of the child's 16th birthday in order to ensure continuity. Obviously the normal rules of medical cards will apply, which are not solely financial or means tested but also have a discretionary element.

There is a broader need to align social protection schemes with health schemes. Indeed, I and the Minister for Social Protection will be launching some policies relating to how health and social protection interact in terms of persons with disabilities who are working. The point that Senator Boyhan makes merits further consideration but under this legislation, eligibility for the domiciliary care allowance is linked directly to the medical card. People beyond the age of 16 can apply for a medical card in the normal way.

Question put and agreed to.
Sections 2 to 5, inclusive, agreed to.
Title agreed to.
Bill reported without amendment and received for final consideration.
Question proposed: "That the Bill do now pass".

I am not sure of the protocol here-----

The Senator may speak to the Bill.

I welcome the passage of this Bill which we have spoken about at length in Seanad Éireann. I commend the Minister for getting the Bill through all Stages in this House and hope there will be no delay to its enactment. While it is not directly related to this legislation, there is a protest taking place outside Leinster House today marking the tenth anniversary of Ireland's signing of the UN Convention on the Rights of Persons with Disabilities and seeking ratification of that convention. I would ask that such ratification becomes the Government's next priority. I recognise that this Bill is a step towards disability-proofing our society but would ask that the Government would prioritise the ratification of the aforementioned UN convention.

I thank the Minister for being here and thank both him and the Minister of State at his Department, Deputy Finian McGrath, for bringing forward this legislation. It is an extremely important development and more than 9,800 children will benefit directly. I agree with Senator Boyhan that the issue of raising the age limit for the domiciliary care allowance from 16 to 18 must be examined. If that does happen, we must make sure that those over 16 will not be disadvantaged. This is an important step in making sure that families who have to deal with all of the extra work and responsibilities to make sure that every possible service is available to their child or children are helped along that road. I very much welcome the legislation.

I welcome the Minister to the House. As other speakers have said, this is a very welcome development and the Minister and his team are to be congratulated on it.

I join others in asking the Minister to comment on the ratification of the UN Convention on the Rights of Persons with Disabilities. I understand, having spent some time in the Department of Justice and Equality, that it is not an easy process. The way that the Government addresses such issues is to put all of the legislation in place first and then to ratify the convention. I ask the Minister to comment on that, given the day that is in it.

Fine Gael and the Labour Party worked very well together in government on certain issues, including in the health sphere, where we managed to introduce free GP care for every child under six. It is disappointing that this was not rolled out for a wider age cohort. Given that this is a welcome move that benefits children with a disability, I ask the Minister to comment on the Government's plan to roll out free GP care to a wider age group. I congratulate the Minister and his Department on a job well done with this legislation.

I welcome the Minister to the House. We were both members of the Dublin Mid-Leinster health forum a long time ago, when we were both councillors. Indeed, Senator Devine was a member of that forum subsequently. It is great to see this Bill pass. I spoke on it at length on Tuesday. It represents progress and I welcome it. I agree with Senators Devine, Ó Ríordáin and others that it is important that the Minister would address the matter that is the subject of protests today. There was a very interesting presentation on the matter in the AV room yesterday, led by Senator John Dolan, and it would be timely for the Minister to say a few words on it today.

I thank all Senators on all sides of this House for their support, not just for the legislation itself but also for its speedy passage, which is really appreciated. When one is in a minority Government bringing legislation before either House of the Oireachtas, one relies upon support from a variety of parties. The fact that such support has been received in both Houses is a testament to our common goal here, which is to right a wrong. That wrong is the fact that almost 10,000 children who are in receipt of the domiciliary care allowance did not have a medical card. More importantly, 33,000 children who are in receipt of the domiciliary care allowance, even if they did have a medical card, were subjected to reviews which were bringing significant hardship, stress, frustration and worry on their families.

This Bill has been long sought by a number of incredible groups who deserve acknowledgment, particularly Our Children's Health, which campaigned tirelessly and put this issue on the political agenda for all of us in the run up to the last general election. It is an issue that all of us picked up the baton for and committed to doing something on. It was certainly a priority for me and for the Minister of State, Deputy Finian McGrath, when we came into office, to get this legislation over the line. I am very pleased that it has now passed all Stages in the Dáil and Seanad. It will now go to the President for signature and be passed into law. By 1 June, all children for whom a domiciliary care allowance payment is made will have automatic eligibility for a medical card. The HSE will put in place both an online and paper registration system which will be activated from 1 May.

Let us not forget that this Bill also reduces prescription charges for those over 70 who hold a medical card. This will be of significant benefit to many families in terms of their monthly prescription charges. That is something that I hope we can build on further in future budgets.

I pay tribute to my Department and thank my officials, Mr. Tom Monks and Mr. Daniel Sheridan, and all of those in the Department and the HSE who worked very hard on putting this legislation in place as quickly as possible.

I acknowledge that Senator Ó Ríordáin did considerable work on the issue of free GP care. Contrary to what I read in the newspapers, I remain absolutely committed to the introduction of free GP care. However, I remain committed to it in the same manner that the previous Government did, namely, it is subject to a negotiated agreement with GP bodies. As Senators know, we have begun the GP contract negotiations. It is very important that we have buy-in and understanding from our GPs and ensure we have the capacity within general practice. This legislation extends entitlement to a group based on need. I absolutely wish to see free GP care for all children, but it needs to be done in the context of the GP contract.

I assure the House that the UN Convention on the Rights of Persons with Disabilities is absolutely a priority for me and for the Minister of State, Deputy Finian McGrath, who is leading this effort across Government. Senator Ó Ríordáin gave a very honest and fair appraisal of the approach being taken by successive Governments and Departments. We want to put all the legislation in place so that Ireland does not just sign on the dotted line, but signs on the dotted line in a meaningful way. Some legislative work remains to be done in this regard. This remains a priority for the Government as it is for people on all sides of this House.

I again thank the Seanad for its consideration of this important Bill. I have no doubt that it will make life a little easier for significant numbers of families with children with disabilities and a significant number of our older people as well.

Question put and agreed to.