I am aware of the policy recommendations to which the Deputy refers, which cover a range of health issues. The Deputy is aware that the national anti-poverty strategy, NAPS, targets to reduce health inequalities were included in the Government's review of the NAPS — Building an Inclusive Society — and have subsequently been subsumed into the national action plan against poverty and social exclusion 2003-05. This latter plan is now an EU requirement under the Lisbon Agenda. The targets to reduce health inequalities have been taken on board in the national health strategy, Quality and Fairness — A Health System for You. They cover both health status issues, such as reducing differences between socio-economic groups in premature mortality, as well as health care issues such as improved respite care for people with disabilities. A range of initiatives are under way to implement the targets and my Department has forwarded a report on these to the Office for Social Inclusion for inclusion in its annual report. I understand this report will be published in November by the Minister for Social and Family Affairs who has lead responsibility for the NAPS.
The latest information on medical card coverage is that for September 2004. There were 768,895 cards, covering 1,151,106 persons, or 29.39% of the population, in existence at that time. It should be noted that the upward trend in the population may marginally affect the 2004 percentage over time. The Government is fully committed to the extension of medical card coverage, as set out in the health strategy. This will focus on people on low incomes and will give priority to families with children, particularly those with a disability. The timing of the introduction of the extension will be decided having regard to the prevailing budgetary position. In addition, the Department of Health and Children is committed to the preparation of new legislation to update and codify the entire legal framework for eligibility and entitlements in regard to health services.
The policy of my Department with regard to the care of older people is to maintain them in dignity and independence in their own homes for as long as possible, in accordance with their wishes. Numerous research studies have shown that the vast majority of older people have a preference to remain living in their own homes for as long as possible rather than moving into long stay residential care. My Department has been encouraging the Eastern Regional Health Authority and the health boards to develop personal care packages for older people as an alternative to long stay residential care. Personal care packages are specifically designed for the individual concerned and could possibly include the provision of a home help service, home subvention payments, arrangements for attendance at a day centre or day hospital and other services such as twilight nursing. Personal care packages allow older persons the option of remaining living in their own homes rather than going into long stay residential care. In addition, the authority and the health boards provide respite care for older people, a service which is seen as an integral part of the community support services which are being developed to support older people living in the community.
In line with a Government decision, an expenditure review of the nursing home subvention scheme was undertaken by the Department of Health and Children in association with the Department of Finance. The review was carried out by Professor Eamon O'Shea and the objectives of the review were,inter alia, to examine the objectives of the nursing home subvention scheme and the extent to which they remained valid, to assess the service delivered and to establish what scope, if any, existed for achieving the programme objectives by other more efficient and effective means. Professor O’Shea’s report, Review of the Nursing Home Subvention Scheme, was launched in June 2003 simultaneously with the Mercer report, Study on the Future Financing of Long-Term Care in Ireland, which was commissioned by the Department of Social and Family Affairs.
My Department has established a working group comprising all stakeholders to review the operation and administration of the nursing home subvention scheme following on from the publication of the O'Shea report. The purpose of the review is to develop a scheme which will be transparent, offer a high standard of care for clients, provide equity within the system to include standardised dependency and means testing, be less discretionary, provide both a home and nursing home subvention depending on need, be consistent in implementation throughout the country and draw on experience of the operation of the old scheme. The working group has received both oral and written submissions from a number of interested parties. Issues such as how the scheme is administered are being examined as part of the review.
The expert group on mental health policy was established by the Minister of State, Deputy Tim O'Malley, in August 2003, to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. The future direction and delivery of all aspects of our mental health services, including those referred to by the Deputy, will be considered in the context of the work of the group. It is expected that the expert group will report in 2005.
The Child Care Act 1991 has been fully implemented since the end of 1996. Section 11 of the Children Act 2001, establishing the special residential services board on a statutory basis, was commenced in November 2003. Sections 2 and 3 of the Children Act 2001, concerning family welfare conferencing, special care and the regulation of private fostering, were commenced towards the end of September 2004. Approximately €230 million has been invested in the development of child welfare, protection and family support services since 1991. Further development of child care and in particular family support and early intervention services will be considered in the light of any additional resources available in 2005.
With regard to respite care, there was an increase of 255% in the number of people with disabilities, an additional 445 people, who received service based respite care between 2001 and 2002, the latest year for which figures are available.
The health promotion unit in my Department is leading a wide range of strategic initiatives in areas such as smoking and alcohol — lifestyle issues which are related to many non-communicable diseases, for example, cardiovascular disease and cancer. Work on smoking cessation in recent years has resulted in a 1% drop in the prevalence of adult smoking per year. Advertisements on public awareness of passive smoking, on foot of the workplace smoking ban, started during 2004. These advertisements direct smokers to the national smokers quitline where they receive support in their efforts to quit smoking. The strategic task force on alcohol, STFA, has published two reports, the second of which is being brought to Government. The two reports contain approximately 100 recommendations involving many different sectors, target groups and environments. The health promotion unit will build on these and other strategic initiatives in the coming year.
The four key principles underpinning the Government's national health strategy — Quality and Fairness, a Health System for You — are equity and fairness, a people-centred service, quality of care and clear accountability. The health service reform programme is the framework for the modernisation of the health service and the achievement of the goals and objectives of the health strategy. The annual report of the Department of Health and Children sets out progress over 2003 in respect of each of the 121 action points contained in the health strategy action plan. To date, work has commenced on 88% of the 121 actions set out in the strategy.
The Minister for Health and Children convenes a national consultative forum on an annual basis to comment on progress in the implementation of the health strategy, emerging trends and future priorities, including the health reform programme. It is intended to convene a meeting of this forum next month.