Dáil Éireann Debate, Tuesday - 17 May 2016
884. Deputy Richard Boyd Barrett asked the Minister for Health the amount of the health budget he is ring-fencing for the dementia strategy and if he should give an automatic entitlement to a medical card to all dementia sufferers [10417/16]
View answerIn December 2014 the Irish National Dementia Strategy was launched. The objectives of the Strategy are to increase awareness, ensure early diagnosis and intervention and develop enhanced community based services.
The Strategy distinguishes between those Actions that can be progressed within existing resources and others to be addressed as more resources become available. Those identified for first implementation include:
- Clear responsibility for dementia to be assigned within the HSE. A dedicated Office has been established within the HSE to support implementation of the Strategy;
- Clear descriptions of care pathways, and better information and guidance on services to be made available to GPs and to people with dementia and their families and carers;
- A better understanding of dementia, including modifiable risk factors, to be promoted;
- The use of existing resources to be reviewed to ensure that they are used in the best way possible;
- Research to inform the design and delivery of dementia services in Ireland to be supported and given appropriate priority.
The Department of Health and the HSE also agreed a joint initiative with the Atlantic Philanthropies to implement significant elements of the Strategy over the period 2014-2017. This National Dementia Strategy Implementation Programme represents combined investment of €27.5m, with Atlantic Philanthropies contributing €12m, and the HSE contributing €15.5m.
This programme is promoting a greater focus on timely diagnosis of dementia and on the value of early intervention, along with the long-term objective of making people in Ireland generally more aware and understanding of the needs of people with dementia, and of the contribution that those with dementia continue to make to our society.
Key elements of the initiative include:
- the rollout of a programme of Intensive Home Supports and Homecare Packages for people with dementia;
- the provision of additional dementia-specific resources for GPs, who are the critical and initial point of contact with the health system for those with dementia. The resource material will include training materials and guidance on local services and contact points, etc.
- measures to raise public awareness, address stigma, and promote the inclusion and involvement in society of those with dementia.
Progress has already been made on a number of fronts. The HSE has established a central Dementia Office to drive and oversee implementation of the Strategy. Work has commenced on the development of a Dementia Friendly Ireland programme to raise awareness and increase understanding of the condition. Research into the educational needs of GPs and Primary Care Team members is underway, and a body of training will follow when this is complete. Roll-out has commenced of intensive home care packages for people with dementia, and people with dementia have benefited to date.
Under the Health Act 1970, as amended, the assessment of full eligibility for health services (and the issuing of a medical card) is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. If an applicant’s means are above the financial thresholds as set out in the national guidelines, the HSE routinely examines for indications of medical or social circumstances which might result in undue financial hardship in arranging medical services and, exercising discretion, may grant eligibility for a medical card on this basis. There is no automatic entitlement to a medical card for a person with a particular illness or medical condition and this is in accordance with the Health Act 1970.
An Expert Panel was established by the Health Service Executive in 2014 to examine and recommend a range of medical conditions that should be considered as a basis of eligibility for a medical card. A key recommendation of the Expert Panel on Medical Need and Medical Card Eligibility was that a person’s means should remain the main qualifier for a medical card. It is important to note that the Panel concluded that it would not be feasible, desirable, nor ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility.
Nonetheless, the Government approved a range of actions to improve the performance of the medical card system as it is clear that there are people with medical needs and it is important that they should be able to access necessary assistance in a straight forward manner. Greater discretion is being exercised by the HSE as evidenced by the number of discretionary medical cards in circulation, which has increased from about 52,000 in mid-2014 to over 104,000 at the beginning of May 2016.
Following the Expert Panel report, a Clinical Advisory Group (CAG) was established by the Director General of the HSE to provide clinical oversight and guidance to the operation of a more compassionate and trusted medical card system which can strive to ensure that the relatively small percentage of cases requiring the recognition of the burden of a medical condition(s), over and above financial hardship, can be accommodated. The Group is continuing its work on the development of guidance on assessing medical card applications involving significant medical conditions.
