Health (General Practitioner Service) Bill 2014: Report Stage

Amendments Nos. 1, 5, 8 and 9 are related and will be discussed together. Recommittal is necessary in respect of these amendments as they relate to the instruction to committee motion.

Bill recommitted in respect of amendments Nos. 1 and 2.

I move amendment No. 1:

In page 3, line 7, after "years" to insert the following

"; to amend a definition in the Nursing Homes Support Scheme Act 2009;".

The inclusion of the amendment to the Nursing Homes Support Scheme Act 2009 in this legislation has necessitated a change to the Long Title. This is a technical amendment to provide for the Title to be altered in that regard. I, therefore, ask Members to support the amendment.

The Minister of State made a comment in response to the issues I raised during the debate on the instruction to committee motion. He said they did not come within his remit but that he would take note of them. When children with life-limiting conditions are discharged from acute hospitals back into the community, the cheque is paid by the local PCCC manager. Will the Minister of State clarify whether this comes within his remit, given that he is responsible for primary care? My understanding is it does, but I may be wrong. If it does not, does it come within the remit of the senior Minister or the other Minister of State in the Department?

The amendment I have tabled in this grouping is simple and straightforward. Where applicants have been approved under the nursing homes support scheme and it is financially possible to put a package in place to allow them to remain at home with home helps, physiotherapists, occupational therapists and so on attending to them in the community and with the use of technology, this should be facilitated under the scheme. The difficulty is that when a person is unable to remain at home or being discharged from hospital and not fit to return home, he or she should have the option of receiving supports in the community, rather than shoehorning him or her into a nursing home. I expressed this criticism when the 2009 legislation was going through the House.

The amendment is straightforward and would save the Exchequer money. If the supports required for people to remain in their homes when they have been approved under the scheme are available at a lower cost, this should be facilitated and allowed. The Minister of State will argue that the scheme is under review. That is all well and good, but this proposal would save the Exchequer money and improve the quality of life of older people. There would be significant benefits across the board and this could act as a pilot project for the extension of such a service. A small cohort of people would be eligible and the objective of the amendment is to provide flexibility in this regard.

It is all the more relevant and appropriate now because technology has come on in leaps and bounds. Independent Living Ireland has an apartment on Connaught Street in Athlone. I encourage the Minister of State or any other Member to visit. Staff can demonstrate how they use different technological tools to appropriately monitor people with disabilities or older people in their homes to the extent required without going over the top. For example, a monitor could be placed on a kettle to ensure the person was up and moving about. If he or she flicks on the kettle, the monitor indicates that this has happened. Nothing more is needed because they now know the person is up and about. Naturally, such an individual would not be eligible under the nursing homes support scheme. However, if a more cost effective care package using technology to maximise the independence of clients in their homes can be put in place, surely that woud make more sense from a financial perspective, as well as, more importantly, from a community and a quality of care perspective.

The scope of the amendment is limited in that a relatively small number of people would be able to avail of it, but, surely, we should explore such a proposal. It could act as a precursor for its expansion when the review of the scheme has been completed. I ask the Minister of State to accept the amendment now and not to kick the can down the road until the review has been completed. Deputy Willie O'Dea published legislation last week along the same lines as the principle I propose. I hope the Minister of State can accept the amendment which would benefit society as a whole.

I overlooked the fact that we were dealing with grouped amendments and did not refer to amendments Nos. 5, 8 and 9.

We dealt with amendment No. 5 when we took the motion. The nursing homes support scheme is predicated on the principle that applicants must contribute according to their means. The Act provides that assets transferred within the five years prior to applying for the scheme must be taken into account in the financial assessment. This provision does not affect a person's right to sell assets for full market value. It is intended to prevent people from depriving themselves of assets for the purposes of the financial assessment. This is a technical amendment to put it beyond doubt that assets transferred after an application under the scheme is made also come within the definition of transferred assets. It is essential that there be no ambiguity in this regard and I, therefore, ask Members to support the amendment.

I do not intend to move amendment No. 9. The additional amendments to the legislation are relatively minor and, therefore, it would be useful for all concerned to continue to use the current proposed Title. Accordingly, I do not propose to move the amendment.

With regard to Deputy Denis Naughten's amendment, the nursing homes support scheme is being reviewed. The review is considering the balance of funding between long-term residential care and community-based services and the extension of the scheme to community-based services and other sectors. The outcome of the review will inform future policy on community services for older people. The amendment, regrettably, pre-empts the outcome. Timing of the review aside, the term "home care package" is not defined in legislation. The amendment proposes to put the service on a statutory footing, but it does not define the service or set out what it encompasses. This would leave the composition of a home care package open to interpretation and could result in different models emerging.

A further difficulty is that the amendment seeks to amend section 14 of the Nursing Homes Support Scheme Act 2009 which relates to the calculation of the amount of State support under the scheme. At the point this is being calculated, the person concerned has been deemed to require long-term residential care services. Such services are defined in the Act and include 24-hour nursing care. This determination has been made following a care needs assessment and consideration by the local placement forum.

The cost of a home care package to encompass 24-hour nursing would be substantially higher than that of an average home care package. If accepted, the amendment would create a new pathway for accessing home care packages, but would not remove the current mechanism for accessing the service. This would result in a two-tier system whereby people who access home care packages under current arrangements would make no contribution to the cost, while people who access them in the manner proposed by Deputy Naughten would pay a contribution at the same level as those in receipt of financial support under the nursing home support scheme. For those reasons I do not propose to accept the Deputy's amendment.

I am shocked that the Minister of State will not accept my amendment. This review has been going on for more than two years and it will be some time before we see movement on it. My amendment is balanced and fair. A very limited number of people would be able to avail of it, and the Minister of State raised some of the restrictions that will apply to it. If the Minister accepts the principle of this, he will table a re-drafted amendment that will clearly define a home care package. It galls me when Ministers come here and split hairs on the wording of amendments. While I have no difficulty when Ministers disagree with the principle of amendments, I object to their splitting hairs over the wording when they know in their hearts and souls that we on this side of the House do not have the access to the Office of the Parliamentary Counsel the Government side has. We are trying to raise the principle of the issue. I will press the amendment later, and I ask the Minister of State to reconsider his position on it.

Amendment agreed to.

Amendments Nos. 2 and 10 are consequential on amendment No. 6. Amendments Nos. 2, 6 and 10 will be discussed together.

I move amendment No. 2:

In page 3, line 7, after “years” to insert the following:

“to repeal and replace section 8 of the Opticians Act 1956 to provide for the years which are to be election years for the purposes of that Act;”.

The inclusion of the amendment to the Opticians Act 1956 in this Bill has necessitated a change to the Long Title. Amendment No. 2 is a technical amendment to provide for the Title to be altered and I ask Deputies to support it.

Amendment No. 6 relates to the Opticians Act 1956, which regulates the professions of optometrist and dispensing optician. The amendment is to change the election year of Bord na Radharcmhastóirí, the Opticians Board, from 2014 to 2015 and provide that the subsequent election years will be 2019 and each fifth successive year thereafter. The amendment would have the practical effect of removing the requirement to hold elections to the board this year. It would also extend the terms of office of the current members of the board for up to one year until the regulation of the professions of optometrist and dispensing optician has been transferred to the amended Health and Social Care Professionals Act 2005 by the end of this year or early next year. The amendment must be made before the autumn of this year because the Act requires that the elections in an election year be under way by that stage. The alternative would be to hold elections and appoint a new board in 2014 to hold office for a very short period, if at all.

The background to the amendment is the well-advanced proposal to subsume the Opticians Board into the Health and Social Care Professionals Council in accordance with the Government's programme of rationalisation of State agencies. The drafting of the Bill to rationalise the Opticians Board into the Health and Social Care Professionals Council is being finalised and is expected to be published in the coming weeks with a view to its enactment by the autumn of this year. This will pave the way to allow the Opticians Board to be subsumed into the council by the end of this year or early next year. The Bill will provide for the repeal of the Opticians Act 1956, the dissolution of the Opticians Board and the establishment of a new optical registration board to regulate the professions of optometrist and dispensing optician under the 2005 Act. In the meantime, a non-statutory, interim optical registration board has been established to begin the necessary preparatory work, including the drafting of by-laws. The intention is that the members of the interim board will be appointed to the statutory board when it is established, and the statutory board will immediately publish the draft by-laws as part of the required consultation process.

The 2005 Act provides for the statutory regulation of the professions designated under the Act, namely, clinical biochemist, dietician, medical scientist, occupational therapist, orthoptist, physiotherapist, podiatrist, psychologist, radiographer, social care worker, social worker, and speech and language therapist. Regulation under the 2005 Act is primarily by way of the statutory protection of professional titles by confining their use solely to persons granted registration under the Act. The structure of the system of statutory registration comprises registration boards, the committee structure to deal with disciplinary matters, and the Health and Social Care Professionals Council with overall responsibility for the regulatory system. The proposed amendments to the Opticians Act are consequential to its proposed repeal during 2014 or early 2015.

As 2015 is an election year under the Opticians Act 1956, the terms of office of the current board will expire on 31 December this year, and an election will need to be held before 1 December 2014. The proposal is to amend section 8 of the Act to change the next election year from 2014 to 2015. While it is intended that the legislation to dissolve the Opticians Board will be enacted in time to allow the new registration board to be established and make the necessary by-laws before the end of the year, any slippage in an already tight timeline could cause the delayed transfer, possibly into 2015, of the registrants under the Opticians Act 1956 to the new registers to be established under the amended Act. This amendment, by removing the need to hold an election this year, would also ensure the current board would remain in place to continue regulating optometrists and dispensing opticians for as long as necessary into 2015 until the Opticians Board is dissolved and its functions transferred to the Health and Social Care Professionals Council and new optical registration board. Therefore, I respectfully ask the Deputies to support the amendment.

Amendment No. 10 is a technical amendment to provide for a collective citation for the Opticians Acts following on from amendment No. 6, and I ask the Deputies to support it.

Amendment agreed to.
Bill reported with amendments.
Amendment No. 3 not moved.

I move amendment No. 4:

In page 5, to delete lines 33 to 40 and substitute the following:

“(8) (a) The Minister may define the manner in which consultations under subsection (5) are to be conducted and, in doing so, shall have regard to any agreement entered into between the Minister and representatives of relevant medical practitioners relating to the conduct of consultations under that subsection.

(b) The Minister or, as the case may be, the Health Service Executive shall conduct consultations under subsection (5) in the manner defined under paragraph (a) and with such representatives of relevant medical practitioners or otherwise as the Minister or, as the case may be, the Health Service Executive considers appropriate, and nothing in the Competition Act 2002 shall prevent participation by the Minister, the Health Service Executive or any such representative in such consultations, or the communication and discussion of the outcome of such consultations by the representatives with the relevant medical practitioners they represent.”.

Section 5 provides for the insertion of sections 58B and 58C into the Health Act 1970. Section 58C provides that the HSE would be entitled to enter into a contract with any suitably qualified and vocationally trained general practitioner for the provision of GP services to all children aged five years and younger. Subsection (2) provides that the contract shall specify the services to be provided by the GP. Subsection (3) empowers the Minister for Health, with the consent of the Minister for Public Expenditure and Reform, to fix the rate of fees and allowances to be paid to GPs for services provided under these contracts. Subsection (5) obliges the Minister, before making or varying a regulation, to engage in such consultations as he or she considers appropriate. In setting a fee under a regulation, the Minister is required to consider any submissions made and views expressed in the consultations under subsection (7).

Subsection (8), as published, allows the Minister to define the manner in which the consultations are to take place and expressly allows the Minister to consult with representatives of GPs. I propose to amend subsection (8) to ensure the Minister, in defining the manner in which consultations are to be conducted, must have regard to agreements entered into with representatives of GPs relating to the conduct of such consultations. In proposing this amendment I wish to ensure that the framework agreement concluded with the Irish Medical Organisation last month, which I signed on 4 June, will have the benefit of being referenced in law. This agreement with the IMO sets out a process of engagement on all aspects of the general medical services, GMS, contract with GPs, with due regard to the IMO's representative role and within the context of legislation underpinning the introduction of GP care free at the point of access. That engagement with the IMO has begun regarding the draft contract for the provision of services to all children aged five and under.

Under the framework agreement, the IMO can fully represent its members in respect of discussions around all aspects of this draft contract, including fees, and in relation to the GMS contract. As the IMO has stated, this agreement removes major obstacles to engagement between the IMO, the Department of Health and the HSE. The way is now clear for open and constructive discussions regarding primary care, which will lead to an enhanced GP service through universal GP care. The amendment, which I commend to the House, will further serve to facilitate this open and constructive discussion.

I understand the thrust of what the Minister is trying to achieve, the referencing to the Competition Act, and it is worthy of our support. It is crucial that such consultation take place.

I welcome the fact that it has finally got under way. It has been awaited for a long time. I wish the exercise every success. Although there is no difference with regard to what is already provided for in subsection (8) on page 5, the amendment says the Minister shall have regard to any agreement entered into between the Minister and representatives of relevant medical practitioners relating to the conduct of consultations under subsection (5). I am anxious to know if the IMO is the sole representative body with whom the Minister must engage. Does he expect to have to engage with any other representative bodies of medical professions on the matters provided for in the legislation?

I thank the Deputy for the positive remarks at the outset of his contribution and for wishing the exercise success, which all Members desire. The framework agreement I signed was with the IMO. The IMO has been the primary representative body of general practitioners in the State. For that reason, it is proposed to continue that relationship. It is not a relationship in the traditional industrial relations sense which exists between employers and employees. However, it is an important relationship and one which has been in place for many years. It is appropriate that it should continue. Therefore, we had the so-called "talks about talks" with the IMO and have now reached the stage of substantive talks.

The IMO's response to the draft contract that we published in January this year is well known. Its concerns about the nature of the engagement that was being proposed were expressed publicly and repeatedly. We have to a very considerable extent resolved those concerns and the IMO has co-signed the agreement. In fairness to the IMO, as well as expressing its concerns at the time, it made a substantive submission on the contents of the draft contract. Leaving aside the Irish College of General Practitioners, which is the professional body, the IMO was the only organisation that made a submission of substance on the draft contract, albeit objecting to much of its content. At least it engaged at that stage with a submission of substance which can form part of its deliberations with the HSE. That is the basis on which we intend pursuing the matter.

Amendment agreed to.
Bill recommitted in respect of amendments Nos. 5 and 6.

I move amendment No. 5:

In page 7, between lines 1 and 2, to insert the following:

"Amendment of Schedule 1 to Nursing Homes Support Scheme Act 2009

6. Schedule 1 to the Nursing Homes Support Scheme Act 2009 is amended, in Part 3, in paragraph 1, in the definition of "transferred asset", by inserting ", or at any time on or subsequent to," after "5 years prior to".".

Amendment agreed to.

I move amendment No. 6:

In page 7, between lines 1 and 2, to insert the following:

"Election years for purposes of Opticians Act 1956

7. The Opticians Act 1956 is amended by substituting the following for section 8:

"Election years

8. The year 2014 shall not be an election year for the purposes of this Act and the following years shall be election years for those purposes:

(a) 2015;

(b) 2019;

(c) each fifth successive year after 2019.".".

Bill reported with amendments.

Amendment agreed to.

I move amendment No. 7:

In page 7, between lines 3 and 4, to insert the following:

"7. (1) Information in the possession of the Health Service Executive shall be supplied, to such other Minister of the Government who requires and requests it, for the performance of his/her functions.

(2) Notwithstanding any obligation to maintain secrecy or any other restriction on the disclosure or production of information obtained by or furnished to the Department of Social Protection, the Minister for Social Protection shall, at such intervals as are specified by the Health Service Executive, supply to the Executive such information in the Minister's possession which may be required by the Executive when considering eligibility for services under this Act.

(3) Notwithstanding any obligation to maintain secrecy or any other restriction on the disclosure or production of information obtained by or furnished to the Department of Children and Youth Affairs, the Minister for Children and Youth Affairs shall, at such intervals as are specified by the Health Service Executive, supply to the Executive such information in the Minister’s possession which may be required by the Executive when considering eligibility for services under this Act.".

I should have noted at the outset on Second Stage that I have a vested interest in the legislation. Depending on when it is implemented, one or two of my children will be able to avail of its provisions. My older son is five years old in September. I hope that he and many more of his cohort will be able to benefit for a substantial period of time.

My amendment is technical in nature. On Committee Stage, I felt there was a need to tie up some of the loose ends on the sharing of information by Government agencies and Departments. I have made an error in the amendment in that I have not included the Department of Education and Skills, which should be in there.

At issue is the sharing of information among the Department of Social Protection, the Department of Children and Youth Affairs and the Department of Education and Skills. The legislation sets out two tests for eligibility for a doctor visit card. First, the child must be under the age of six years, which information can be obtained easily through the GRO, which is under the remit of the Department of Social Protection. I presume the HSE already has access to that. The more important test is residency in the country. It would benefit PCRS in Finglas if it were able to link in with the database of the Department of Education and Skills to establish whether a child is in school or availing of the ECCE scheme and resident in the State. Of the cohort of children, 97% are availing of ECCE, and school attendance statistics are similar. The Department of Social Protection carries out tests on residency on an ongoing basis.

The Minister of State will probably make the argument that people will be attending their GPs. That is not the case, however. While some children will attend their GPs frequently, I suspect that many will not, particularly after they have had the required vaccinations, as they will not be sick. Children could have left the country. Private patients would not be on a GP's ongoing register for medical cards, which cover approximately 60% of the children we are talking about. The last thing any of us wants is a situation in which we are paying out money for children who are no longer resident in the State.

The Department of Social Protection spends €7.5 million to administer the child benefit scheme annually. It issues 600,000 letters a year, which is enough paper to cover the pitch at Croke Park two and a half times. That does not include postage stamps and envelopes. It costs money. Each year, the control section of the Department of Social Protection recoups €75 million in child benefit payments, a substantial amount of which relates to children who are not resident in the State. Their parents have PPS numbers and may be in receipt of other social protection benefits, but they have emigrated while the money continues to be lodged in a bank account. Under the child benefit scheme, once a child reaches school-going age, he or she must be attending school to be eligible for a payment. That is not enforced, which is a significant part of the problem. Another problem is that the letters must be issued in respect of children under the age of five. GPs must certify that the child is still resident in the State.

Rather than issuing 600,000 letters annually through the Department of Social Protection and having the Department of Health issue payments to GPs through the HSE and PCRS for children who are no longer resident in the State, I propose amendment No. 7.

I propose the amendment to link the sharing of information between the Department of Social Protection, the Department of Children and Youth Affairs and the Department of Education and Skills so there is a sharing of data on the residency of the children. The information the PCRS has will assist the Department of Social Protection in ensuring child benefit is not paid to children not resident here. The same is true of information held by the three Departments, which will benefit PCRS in making sure it is not paying GPs for children in cases where the GPs may not know the children have left the country.

We had a problem in the past whereby the Exchequer paid GPs for people who were dead. It was a big scandal a number of years ago and we do not want to create another anomaly in legislation and another loophole that sees valuable resources and taxpayers' money being spent on children who are not resident in the country. I urge the Minister of State to accept the amendment and to ensure the sharing takes place.

The furnishing of personal data to and by the HSE is adequately provided for by section 8 of the Health (Alteration of Criteria for Eligibility) Act 2013, which was passed by the Houses last year. The 2013 Act provides for the exchange of personal data between HSE, the Revenue Commissioners and the Department of Social Protection for specific purposes with a view to ensuring public services are delivered as efficiently as possible to those who have an entitlement to such services. Since implementation of the legislation, the HSE has exchanged relevant personal data with the Revenue Commissioners and the Department of Social Protection for the purposes of assessing or reviewing eligibility for services provided under the Health Acts.

The preparation of the 2013 legislation involved extensive consultation with the HSE, the Revenue Commissioners, the Department of Social Protection and, in particular, the Office of the Data Protection Commissioner. Under the legislation, the HSE is obliged to be mindful of its responsibilities to protect the rights and privacy of individuals in accordance with the Data Protection Acts 1988 and 2003. A primary objective of public service reform is to integrate services with a view to providing better services to citizens and greater efficiency for the State. Co-operation between public bodies at national and local level is one of the key pillars to the achievement of this objective. In this context, the Department will continue to support the HSE in its exploration of opportunities to exchange data with public bodies, with a view to ensuring public services are delivered as efficiently as possible and, with regard to what the Deputy seeks, to those who have an entitlement to such services. That includes the question of ordinary residence because a person who is not ordinarily resident in the State is not entitled to the service we are dealing with.

Consideration of proposals to include other relevant bodies within the legislation can be entertained in the future if it becomes necessary and if a case is made. The HSE can identify other agencies with which datasharing is appropriate but it has not done so as yet. If such circumstances arise and the HSE identifies another agency or body in respect of which it seeks data exchange, we can address that with legislation.

In those circumstances, I do not propose to accept the amendment. Adequate provision has been made in legislation introduced only last year in respect of the sharing of information and data. It is appropriate that there should be sharing and exchange of data although that has not been the case in the past. It is easier to do now in terms of developing technologies and it is appropriate to do so. In respect of children under six years of age, where there is a non-active medical card, and where the service has been extended to children under this legislation, the same processes apply. Where there is a non-active card for a period of time, it triggers a probity exercise by the PCRS in respect of searching out the circumstances of the non-active card. Deputies are aware that there is a probity exercise ongoing in respect of medical cards and querying the continuing eligibility of persons with medical cards. It is being assisted by the measures introduced last year with regard to data sharing. We are alive to the issue raised by the Deputy but it is not necessary or appropriate to amend the legislation in the manner proposed. We will keep the matter under review and the HSE should do likewise with regard to any necessity that may arise in the future to add any new agencies or bodies to those currently comprehended by the datasharing arrangements.

I am disappointed by the response, which is basically suggesting that when we find there is a problem and when we find we are paying GPs for children who are not in the early childhood care and education scheme or not in school, we will return to the House for legislation. That is closing the door when the horse has bolted and I am trying to pre-empt that. There is an effective database within the Department of Children and Youth Affairs and an effective and comprehensive database in the Department of Education and Skills. The sharing does not take place with the Department of Social Protection. By linking the two Departments with the PCRS, one third of the children granted eligibility in this legislation can be monitored on an ongoing basis as to their residence in the country without having to go through a probity exercise and without having to send out 600,000 letters on an annual basis to see if the children are resident. We will not have to go through the probity exercise in respect of non-active cards because we will be able to check through the Department of Education and Skills and the Department of Children and Youth Affairs that the children are attending school and availing of the early childhood care and education scheme. Rather than all that we have done over the past number of years to close the door when the horse has bolted and where there are loopholes in respect of the nursing home Act, only when someone may be able to avail of the loophole do we decide to close the door rather than dealing with this at the initial stage and ensuring that the three databases are linked so that only eligible children and those legitimately entitled to cards receive them in the first place and retain them.

I have no objection in principle to the thrust of Deputy Denis Naughten's amendment. He proposes something we wanted to see, covering a range of areas. Rather than Departments operating in silo fashion, we should have joined-up Government. It is another practical example of an area with a myriad of benefits. It concerns not only the elimination of those who should not be entitled to what the Bill plans to provide. There might be any number of other areas in which positives could accrue. We should not be resistant to propositions. There are no defensible objections to what the Deputy is proposing to achieve. It merits the Minister of State reconsidering and, for those reasons, I record my support.

I support the amendment proposed by Deputy Denis Naughten. As Deputy Ó Caoláin stated, it makes good sense and what makes good sense is capable of being enacted in law. Where housekeeping arrangements are clear, unambiguous and fair in the context of what is being attempted to achieve, it should be introduced.

As was said, the Department has excellent resources and people who can put the principle we are attempting to achieve in nice, clear and unambiguous terms. It is worth doing that at this stage.

I do not propose to say much more other than that much of what the Deputies want to see in place is in place and was passed in the Houses last year in the first of the two pieces of legislation dealing with alterations to eligibility for those over 70 years. The Houses passed legislation then which broadly facilitates what the Deputies seek.

Deputy Denis Naughten has indicated that his amendment does not include the Department of Education and Skills-----

That was an error.

I am not criticising the Deputy. I am simply saying his amendment would not achieve much of what is being argued for if we passed it in its current form, notwithstanding its intent. Also, last year when the legislation was being passed, there was extensive contact and discussion with the Data Protection Commissioner because of the real concerns in respect of personal data and information. All Members will understand and appreciate this. Those concerns cannot always be the decisive issue, because public policy questions interact with the issue of protection of private data. I would not be in a position to proceed with this amendment in circumstances in which we had not at least gone through the process of engagement with the Data Protection Commissioner in respect of the implications under the Data Protection Acts, and for the other reasons I have given.

I understand and appreciate what the Deputies are saying, but I believe we are covered substantially by what we did in the legislation last year. However, this is not and cannot be a closed issue forever. The issue may well be raised again in future legislation. If we believe we need to improve the data protection systems we have in place, we can do so then.

I am disappointed that the Government is not prepared to accept the principle of my amendment, which is that the HSE, through its office in Finglas, should have, if required, access to the database held by the Department of Children and Youth Affairs and the Department of Education and Skills in regard to children under the age of six years who are attending either the education system or the preschool system. This covers one-third of the children who will be provided with eligibility under this proposed medical card scheme. The parents of some 60% of these children do not have a medical card. These children are not frequent GP attenders, because their parents cannot afford to fork out €50 or €60 on a GP. Many of these children will end up with non-active cards over a period. I know from my family - I have four small kids - that it is not often that I go to the GP with them; therefore, their cards could very well be non-active. Why, therefore, should we place a responsibility on the HSE to send a probity form which will need to be returned, either by the GP or by the parent, when a request could easily be made to the Department of Education and Skills seeking information on whether Johnny Murphy or whoever is attending school? Why can the Department not be given his age and PPS number and asked whether this five and a half year old is attending school? Then, at that stage, we could go through the probity process if required. This would be preferable to creating more paperwork such as that in the Department of Social Protection, where some €7.5 million is spent on administration of the child benefit scheme. Not all of that paperwork relates to control, but some 600,000 letters a year go out to parents in regard to this scheme, bringing in savings of €75 million a year.

There is a problem currently, but by sharing information across Departments, we can ensure those who are legitimately entitled to a service can get it. We can ensure children under the age of six years who are resident in this country can get the service and that we do not pay GPs for children who are no longer resident here because their families have been forced to emigrate. These families are now living in Australia, Canada, the United States or the United Kingdom, yet GPs in some parts of the country will still be paid for these children until somebody cops on that they are no longer resident in the country. This will then involve a paper trail to try to find out when they left the country and to try to recoup the payments from the GP. We are back to the old policy we had where we were paying GP fees for medical cards for patients who were dead.

We have an opportunity here to close off a potential loophole. I urge the Minister of State to think about this. His colleague gave a commitment this morning that another emergency piece of legislation relating to medical cards is to come before the House next month. I urge him to return to the House next month with an amendment that will deal with this issue. I ask him to commit to the House that he will do this.

Amendment put and declared lost.
Bill recommitted in respect of amendment No. 8.

I move amendment No. 8:

In page 7, between lines 3 and 4, to insert the following:

“Amendment to the Nursing Homes Support Scheme Act 2009

8. Section 14 of the Nursing Homes Support Scheme Act 2009 is amended by the insertion of the following subsection:

“(4) Where a person is offered State support under subsection (1), such person shall, as an alternative to that support, be entitled to request and be offered a home care package if such home care package meets the person’s care needs and is less costly than the long-term residential care service.”.”.

Bill recommitted in respect of amendment No. 10.

Amendment put and declared lost.
Amendment No. 9 not moved.
Bill reported without amendments.

I move amendment No. 10:

In page 7, between lines 7 and 8, to insert the following:

“(3) Section 7 and the Opticians Acts 1956 and 2003 may be cited together as the Opticians Acts 1956 to 2014 and shall be construed together as one.”.

Amendment agreed to.
Bill reported with amendment.
Bill, as amended, received for final consideration.