Dáil Éireann Debate, Wednesday - 25 June 2014
5. Deputy Thomas Pringle asked the Minister for Health if he will reconsider extending the long-term illness, LTI, scheme list; if he will establish a review to ensure that all those who have an illness that is long term are eligible for the LTI scheme; and if he will make a statement on the matter. [27108/14]
View answerThis question relates to the necessity to review the long-term illness scheme and add to the list of conditions-----
I am sorry I did not hear that.
-----that are covered under the scheme. I think it came in in 1970 and needs to be reviewed. There are many lifelong conditions from which people are suffering and they need the assistance of the scheme.
The long-term illness, LTI, scheme was established under section 59(3) of the Health Act 1970. Regulations were made in 1971, 1973 and 1975 specifying the conditions covered by the LTI scheme. The conditions covered by the LTI scheme are as follows: acute leukaemia; mental handicap; cerebral palsy; mental illness in a person under 16; cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; Parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. There are no plans to extend the list of conditions covered under the LTI scheme.
My Department is currently reviewing the operation of the LTI scheme. It is expected that this review will be completed later this year. However, there are no plans to review the scheme along the lines of the current work of the expert panel recently established by the HSE to review eligibility for medical cards.
Under the drug payment scheme, no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines. Of course, the introduction of that scheme post-dates the LTI scheme.
In addition, people who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the HSE may take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP-visit card, which covers the cost of GP consultations.
I think there is a need to extend the scheme. There are a number of conditions, including Crohn's disease and colitis where people have lifelong conditions involving ongoing medical costs. It is strange to see the HSE recommending that people should apply for a discretionary medical card given the fiasco of the past couple of years with discretionary medical cards. The long-term illness scheme would provide relief for those many people. There are also people with dementia and Alzheimer's disease who have ongoing costs that could be covered by the scheme if the scheme was brought up to date and modernised. It would be of great benefit to those people. Rather than having to put them through the process of being means-tested through the medical card system, their conditions could be looked at and the benefit from the scheme could come from there. It should be reviewed and the list of conditions should be increased.
The very real situation faced by people, mentioned by the Deputy, who have a long-term illness or medical condition and are above the means-test limit for a medical card, will be addressed in the new policy shift signalled by the Minister, Deputy Reilly, and the Government last week, which is based on a review by an expert panel, and a paper and decisions in Government later this year. This will address the very real issue, on which I agree with the Deputy, faced by people who, although they are above means-test limit for a medical card, have a continuing medical condition requiring access to services. That is precisely what we are doing in respect of the decision the Government has made. The Government will certainly revert to the Oireachtas in due course as to how that will be addressed. I suggest to the Deputy that will cover in large measure the issue he is raising. Rather than adding new illnesses to the LTI scheme - nothing has been added to that since 1975 - let us now look to what the Government has determined which is to see how best to incorporate into the GMS persons who although they are above the income limits, perhaps in some cases substantially above the income limits and in many cases not so much above the income limits, but still have a medical condition or illness which is a problem for them. That is the real difficulty we have been struggling with in recent months and the Government made clear decisions last week on a policy shift there.
I ask the Minister of State to clarify if the expert review will consider a long list of illnesses or the medical need of a person when deciding. If it looks at a list of illnesses, it may result in illnesses being left out and people will be outside the system as happens with the long-term illness scheme. Will it look at the medical need of a person rather than having a prescribed list of conditions?
The expert panel has been formed under the chairmanship of Professor Frank Keane. The panel contains an extensive number of experienced health professionals. We will leave the work on determining whether it is lists or conditions to that expert panel in the first instance. As I understand it - I do not want to mislead the House - I believe the terms of reference are currently being determined for the expert panel. Perhaps we will be in a position to report back to the House in due course as to the precise terms of reference. I think I am right about that. It is an important piece of work for the expert panel to address and it will do that. There is an undertaking that work will be completed by September.
