Vol. 607 No. 5
97 Mr. Hogan asked the Tánaiste and Minister for Health and Children the number of the 30,000 medical cards which she announced in November 2004 for 2005 which will have been delivered by 2005; and if she will make a statement on the matter. [28918/05]
114 Mr. Gilmore asked the Tánaiste and Minister for Health and Children the reason none of the 30,000 additional medical cards promised by her in November 2004 have yet been issued; if she will review eligibility limits for medical cards; and if she will make a statement on the matter. [28791/05]
126 Mr. Gilmore asked the Tánaiste and Minister for Health and Children the number of medical cards issued in June 1997, June 2002, June 2004 and the latest date for which figures are available; if the Government will honour the pledge in An Agreed Programme for Government to extend eligibility to bring in another 200,000 persons; and if she will make a statement on the matter. [28792/05]
144 Mr. Sherlock asked the Tánaiste and Minister for Health and Children when the long promised general practitioner cards will be issued; if all industrial relations issues arising from the card have now been resolved; and if she will make a statement on the matter. [28790/05]
I propose to take Questions Nos. 97, 114, 126 and 144 together.
In January 2005 I increased the income guidelines used in the assessment of medical card applications by 7.5%. In June it was apparent that the effect of rising income in our successful economy meant that the target of 30,000 additional medical cards would not be achieved. At this time I simplified the means test for both medical cards and GP visit cards. It is now based on an applicant's and spouse's income after income tax and PRSI and takes account of reasonable expenses incurred in respect of rent or mortgage payments, child care and travel to work. This is much fairer to applicants.
I announced on 13 October 2005 that the income guidelines for both medical cards and GP visit cards would be increased by an additional 20%. This means the income guidelines are now 29% higher than this time last year. This substantial increase in the assessment guidelines will allow many more people to visit their family doctor free of charge. I urge people to apply straight away for these important benefits. I understand from the HSE that issues raised by IMPACT and SIPTU, which represent HSE staff assessing applications, have been addressed.
The HSE has advised my Department that in the period from January to September this year, nearly 150,000 new medical cards were issued while just over 145,000 were withdrawn for various reasons, including death, income changes and data updates. Many people have benefited by getting a medical card for the first time in 2005.
A simple comparison of the 1997 to 2005 figures does not take account of the fact that over 104,000 invalid cards have been removed since that time following concerns which arose about inaccurate GMS lists. If allowance is made for the effect of this necessary exercise, there has been a net increase over the period of 10,000.
My Department and the HSE will continue to monitor the number of cards issued. The Government's commitment in the programme for Government to extend eligibility for medical cards will be kept under review in the light of other competing service priorities, available resources and the graduated benefits approach which I introduced with the GP visit card.
I would like the Minister to give a commitment on a few issues regarding the doctor only medical card and the full medical card. The doctor only medical card which is being introduced along side the full medical card is being seen as a means to give some help to those at the margins of entitlement to a medical card. Currently 1.1 million people have a full medical card and many of those patients are concerned that the Minister will try to substitute the full medical card with the doctor only medical card. Will the Minister draw up a minimum number of the population who will be entitled to a full medical card?
I would also like the Minister to clarify a statement I believe she made. She said a family comprising a mother, father and two children with an income of €850 per week would be entitled to a doctor only medical card. That would not seem to gel with the information I am getting from some of the local HSE offices when people apply for medical cards. The Minister is being a little generous and is including every entitlement going. She should make it clear that the income threshold is not €850 per week because many people will believe they are entitled to doctor only medical cards if they earn less than €850 per week which is, of course, far from the case.
Will the Minister give a commitment that full medical cards will not be substituted with doctor only medical cards in the years ahead because of this policy?
It is true that somebody in those circumstances, depending on their outgoings, can qualify for a medical card. For example, the basic income is €266.50 per week with a child dependant allowance of €76, child care expenses of €220, housing or mortgage payments of €190 and travel to work of €50. We gave a number of examples last week and published the data. The whole purpose is not to have a percentage of the population on medical cards but to try to ensure whatever resources are available are targeted at those who need them most.
Incomes have risen very sharply in this economy in recent years. In fact, official data are way behind what is happening in the real economy. Although 150,000 new medical cards have been issued this year to date, there was not an additional net 30,000 because many people fell out of the net due to income or otherwise.
The doctor only medical card is an initiative to have a graduated level of benefit. By providing doctor only medical cards, it allowed us to give the card to four times more people than if we stayed with the traditional medical card. I have always been a fan of graduated benefits. It means that families on low enough incomes and, in some cases, on modest gross incomes, depending on their outgoings, will not be afraid to go to the doctor because of the resource implications. In fact, the Deputy advocated such a proposal previously. Many general practitioners felt this would be a good idea, which I believe it will be.
There is no intention to substitute the traditional card with the doctor only card. We want to maintain the current regime where those on the lowest incomes, social welfare recipients, those over 70 years of age and people with particular difficulties get the full medical card and where the next layer, depending on income and particular circumstances, will get the doctor only medical card.
Does the Minister share my view that those who need the medical card the most are children and that if she wants to make a real difference in regard to health care not only in the current situation but as an investment into the future, she should address the needs of children now? Will she indicate if she has considered, proposed or has argued for at Cabinet the extension of full medical card cover to all children under 18 years of age and if not, will she explain why?
I am not a great fan of universal payments to everyone regardless of means because that hits those who are not as well off unfairly, that is, if relatively rich people get the same benefits as less well off people.
That is what has been done for the over 70s.
When one applies something universally to a class of individuals — in this case, children — it can be unfair on others because one has a finite amount of resources. All the evidence suggests that the medical need is greatest among lower income families in particular. That is what we are doing with the traditional medical card and the doctor only card. Given that we increased the income guidelines by 20% last week, since this time last year, the income threshold has gone up 29%. There is a further 25% top up for the doctor only card. That should include a whole host of people who heretofore had to pay to go to the doctor. It is a welcome measure and we should review it as time goes on.
I accept the Minister's point that it is lower income families who need these cards the most. However, does she not accept the reality that there are many families on what would be regarded as moderate incomes who, because of their commitment to the workplace, namely, two earning parents, the outlay on child care, mortgages and other such expenses, which were not all together reflected even in the new configuration she announced last week, face hardship and that children suffer in such circumstances? I do not believe the Tánaiste can universally apply her earlier response and claim children are not suffering as a consequence. They are suffering and the only way to ensure all children are adequately catered for and that we invest in the health of the nation is through the extension of full medical card cover to all children under 18 years. Will the Tánaiste accept this proposal?
I do not accept this because using gross income is not a fair way of calculating entitlement. That is why there are deductions for tax purposes, such as PRSI, travel-to-work, mortgage repayments and child care. For example, a single mother with one dependent child can earn more than €584 a week and still get a full medical card depending on her outgoings. Travel to work could cost €40 a week and child care €100 a week. These can be added to her income when she is assessed for a full medical card. The new assessment mechanism will help us to target both the full and doctor-only card to those who need it most.
Having heard the Tánaiste say she does not believe in universal benefits, was the reason she supported the over-70s medical card scheme to attract votes in the last general election? She seemed to be overriding her natural inclination against universal benefits. The Government promised 200,000 medical cards. When will we get them?
There was a commitment on medical cards in the election manifesto of my colleagues in Government. We will get more than 200,000 medical cards with the doctor-only cards.
When will we get them?
We must become less fixated with numbers and target the needs of families, children and the elderly. The way the Government is doing this, particularly discounting income outgoings, will ensure many people who traditionally would not have qualified because of their gross earnings will now come into the medical card net with either the full or doctor-only card. The doctor-only card meets the needs of a substantial number of people, particularly those with children. They want to be confident that if a child is sick they can get the opinion of the doctor without worrying about costs. Often in such cases, no follow-up medication is required.
Older people have greater health needs than younger people. However, the costs of the over 70s has been high. Issues have arisen in the context of re-negotiating the GMS contract. Some elderly patients are worth more than others to particular doctors. It must be asked——
The Tánaiste did the deal. Where was she then?
When we introduced the doctor-only card, no special deal was done with Deputy Twomey's colleagues, notwithstanding the fact that it was sought.
A certain form of statistical discrimination was introduced into how people were treated if they had a medical card.
Question No. 98 has been called. It is not in order for the Member to speak.
98 Mr. Rabbitte asked the Tánaiste and Minister for Health and Children the steps she will take following the recent revelations that it will be 2006 before an estimated 180,000 children in the State will be able to get the booster vaccinations they require to protect them from a bug which can cause a lethal form of meningitis; and if she will make a statement on the matter. [28812/05]
168 Dr. Twomey asked the Tánaiste and Minister for Health and Children when the booster vaccination in the second year of life to prevent haemophilus infection will be introduced; and if she will make a statement on the matter. [28954/05]
188 Dr. Twomey asked the Tánaiste and Minister for Health and Children when the Health Service Executive took delivery of the Hib booster vaccine and when vaccination will begin; and if she will make a statement on the matter. [28955/05]
I propose to take Questions Nos. 98, 168 and 188 together.
Haemophilus influenzae type B is a bacteria that can cause serious infections in humans, particularly in children, but also in individuals with a weakened immune system. Haemophilus influenzae type B bacteria is one of six haemophilus types. It can cause several diseases such as otitis media, or bacterial or viral infection of the middle ear, meningitis, pneumonia, septicaemia, epiglottitis septic arthritis, cellulitis and osteomyelitis. Known as Hib, it lives in the nose and throats of humans and is transmitted from person to person through respiratory droplets or contact with respiratory secretions. The bacteria may be carried around in the nose and throat for a short while or for several months without causing symptoms, in an asymptomatic carrier.
Is this a medical lecture?
In some individuals, particularly those most at risk, Hib will invade the body causing invasive disease.
The Hib vaccine was introduced into Ireland in 1992 and since then babies have been routinely immunised at two, four and six months of age. There was a dramatic decrease in the number of Hib cases from 100 per year in the late 1980s to ten cases or less by 2002. Although a slight increase in total Hib diseases has been seen since 2003, the total number of cases in children under 15 years has only increased slightly. There were seven cases in 2002, ten in 2003, nine in 2004 and 11 up to September of this year.
Most of the cases were in non-vaccinated children up to 2004. The priority was to improve the vaccination uptake. A recent cause of concern has been the steady increase in the number of children developing Hib disease despite full vaccination, referred to as the Hib vaccine failures. From 1996 to 2003, one to four children each year developed Hib despite full vaccination. This rose to six in 2004 and there have been ten cases this year to September.
The national immunisation advisory committee has been keeping the position under review. A letter on 28 July recommended that the Department implement a catch-up campaign for children from six months to four years of age as soon as possible. In addition, the advisory committee will recommend a booster dose of Hib vaccines as part of the primary immunisation schedule in the planned new additions to the guidelines. The Health Service Executive announced on 20 September that it made the introduction of a campaign an urgent priority. It will commence its introduction as soon as possible.
The campaign is due to be launched in November 2005. It will be implemented on a phased basis over six months, phase 1 to cover children aged one year and not yet two years, phase 2, children aged two years and not yet three years, phase 3, children aged three years and not yet four years. Children becoming 12 months of age during the campaign will also be offered the vaccine. A portion of the vaccine has already arrived and will be distributed to general practitioners.
An initial letter will be forwarded to general practitioners in the coming week advising them of the phased implementation. Further letters will issue at the commencement of each phase of the campaign. A letter will be issued to all parents and guardians of children in each of the phases inviting them to attend for vaccination. Information leaflets for parents and health professionals have been compiled and will be circulated prior to the commencement of the campaign. Public awareness initiatives will also be organised at the commencement of each phase of the campaign.
I thank the Minister of State for his comprehensive reply, much of which was not requested. It was an interesting lecture in the background to the issue. Can I have the attention of the Minister of State?
The Deputy had and has my undivided attention.
While 48,000 doses of the booster vaccine will be available this October, 180,000 children need it. The immunisation committee is concerned by this. It wrote to the Department in July but this is the amount we are informed about now. Rather than concentrating on extraneous items, how soon will those 180,000 children be provided for? Has the Health Service Executive received the additional funding of €10 million needed to protect these children? The Minister of State is aware the issue received much media attention because a child died.
Correspondence was written on 28 July 2005 and the Chief Medical Officer in the Department received it on 3 August 2005. The Department then took the matter up with the national director of population health in the Health Service Executive, referring to the recommendations of the national council and requesting that appropriate action be taken to provide an effective level of community protection. On 16 August 2005, the assistant director of population health to the Health Service Executive wrote to the Department and confirmed the Health Service Executive was keen to implement the recommendations and that planning for this had commenced on 6 September.
The Department reaffirmed to the Health Service Executive that the allocation of resources for this priority public health initiative was a matter for the Health Service Executive having regard to its contingency fund and the 2006 Estimates process. The executive announced on 20 September 2005 it had made the introduction of the campaign an urgent priority and will commence its introduction as soon as possible. This is the history of the Department's involvement in the matter. I have outlined the basis of the campaign which will be launched in mid-November and will be on a phased basis of six months, starting with the relevant categories of children.
There are 48,000 doses available now. Within the six months of the campaign, will full cover be provided and accessed by the children in question? Is that what the Minister is saying? A campaign can be many things. I am asking about the release of vaccines.
As I understand it a portion of the vaccine has already arrived.
Is that the 48,000 doses?
Yes. The rest is ordered.
When will it come? That is not much comfort to those not among the 48,000 to receive the vaccine.
The purpose of the six-month campaign is to cover all the relevant categories.
Campaigns are one thing. I asked about the delivery of vaccines. There are problems with vaccines in other areas. All I want to know is when the Government will have the full complement.
I will have to communicate with the Deputy on that matter. I do not have details of when particular consignments of vaccines will be delivered.
I would be grateful if the Minister of State would.
The Minister of State has issued a tender for the vaccines. There has been the usual delay of 25 days, although it might have been 52 days had it been a normal tendering process. He has not, therefore, taken ownership of even one of the vaccines yet. That is the problem. A great deal of misleading information has been given. The long story the Minister of State told leading up to this gives a good indication of what is happening.
The Health Service Executive had no intention of purchasing any of these vaccines in 2005 because of a lack of funding. The Minister of State's chronology explains what went wrong. There was a public outcry before 20 September and then suddenly the HSE announced it would get the vaccines as soon as possible. Even up to ten days before that it had no intention of doing so. I know because I was on a radio interview with the same person from the HSE who said the executive did not have the resources for that year. When the publicity built up the resources suddenly became available. That is the truth.
The nub of the question is when the Minister of State will take delivery of the vaccines. Protracted negotiations have meant there are no vaccines to give to children who are most at risk from the disease this winter. They need a booster in their second year. The history of what happened is not important. We just need to get the vaccines and start vaccinating children, especially those who are most vulnerable in this winter season.
I provided full information to the House on the question in so far as I could. I do not believe the content of an answer in those circumstances should be the subject of the kind of criticism the Deputy initially made. The purpose of answers to parliamentary questions is to give information to the House and that is what I did. It was certainly not an attempt to obscure any issue. The Deputy is wrong to suggest that no vaccine has arrived yet. My information is that a portion has already arrived and the balance will be delivered early next year.
Is the Minister of State saying that the 48,000 vaccines are in the cold chain at this moment, ready to be delivered to doctors' surgeries to give to children?
A portion of the vaccine has already arrived in the country and will be distributed to general practitioners. That is what I am saying to the House. The balance will be delivered in the spring. I gave the full history of correspondence between the relevant national council, the Department and the HSE which shows that decisions were not taken on foot of any radio discussions the Deputy might have been involved in.
It was not just me. I was told in a radio interview there were no resources this year to implement this programme. There was a complete U-turn within two weeks.
As the correspondence makes clear, the HSE is provided with a contingency fund. It plans from year to year and takes part in an Estimates process every year. As the Deputy is well aware, the sum voted to that body is very substantial and gives it some creative choice to meet emergencies that arise. That is why we have a Health Service Executive. I have no evidence that at any stage funds available to the HSE were insufficient.
Written Answers follow Adjournment Debate.
