Seanad Éireann díospóireacht -
Wednesday, 15 Feb 2006

Vol. 182 No. 17

Adjournment Matters.

Medical Cards.

Ms Tuffy

My question to the Minister of State concerns a particular case of a married couple. The husband is in receipt of an old age contributory pension, and claims qualifying adult allowance for his wife. Their joint income is €298.80. In October they qualified for the medical card, under the medical card income guidelines. It has come to my attention that because of the budget increases, that couple may be over the income limit for the medical card as they are now in receipt of a total income of €322.10. Will the Minister of State clarify the position? Does he analyse the situation in the same way? It is a matter of concern. A few months ago, when the income guidelines were announced, the couple qualified for the medical card. However, the social welfare increase made a couple of months later means they are outside the income limits.

Since formulating the question, I examined this issue and found other incidents where people qualified for the medical card or the GP visit card on a social welfare income in October 2005 but, following budget increases, are now outside the income guidelines. A married couple aged under 65 years, where the husband is in receipt of an invalidity pension and claims qualifying adult allowance for his wife, had a total income of €264.30 before Christmas. That brought them within the medical card income guidelines limit of €266.50 for a married couple up to 65 years. The new social welfare rates introduced in the budget mean their income is more than the medical card income limits as they are in receipt of €293.50. That is made up of €171.30 for the claimant and €122.20 for the qualifying adult.

Another example is a married couple aged between 66 and 69 years where the husband was in receipt of the old age non-contributory pension and claiming qualified adult allowance for his wife. That is made of €166 for the claimant and €109.70 for the qualifying adult totalling €275.70. That would leave them under the medical card income guidelines of €298 for a married couple aged between 66 and 69 years. However, with the new social welfare rates following the budget, the claimant will have an income €182 and the qualifying adult will have an income of €120 totalling €302. That brings the couple over the medical card income limit.

I am concerned, although some people might be within the guidelines because they might have receipts which they could include in their application for the card. However, some people might not have those receipts and within two months, they will find themselves outside the income limits for the medical card. Surely the Government should now increase the income limits as a matter of urgency. Am I correct in my analysis of the position or am I missing something? Is there any way around this?

Minister of State at the Department of Health and Children (Mr. S. Power)

I thank Senator Tuffy for raising this matter. The determination of eligibility of applicants to medical cards is a matter for the Health Service Executive, HSE, as provided for under the provisions of the Health Act 1970. Since 2001, persons aged 70 and over have an automatic statutory entitlement to a medical card. In all other cases, medical cards are issued to persons for whom, in the opinion of the executive, the provision of general practitioner medical and surgical services for themselves and their dependants would prove unduly burdensome. In assessing applications, the HSE has regard to the financial circumstances and medical needs of the applicant.

Income guidelines are used by the executive in determining eligibility. They are not statutorily binding and in cases where a person's income exceeds the guidelines, a medical card may still be awarded if the executive considers that his or her medical needs or other circumstances would justify this. In the past, the Department of Health and Children has requested that increases in social welfare payments would not adversely affect the eligibility to medical cards of people in receipt of such payments. I understand from the HSE that it has been established practice for many years that anyone whose income was solely derived from social welfare sources would qualify for a medical card.

Furthermore, in December 2005, the Department asked the HSE to take account of the welfare, taxation and other changes announced in the budget in the operation of the income guidelines and to identify any changes which may be required in order to ensure that medical cards and GP visit cards will continue to be available to those who need them. In this regard, the HSE has indicated it is completing a review of the guidelines and expects to be in a position to make a recommendation in the near future.

The Senator will be aware the Tánaiste and Minister for Health and Children has made significant improvements to the way in which an applicant's eligibility for medical cards and GP visit cards is assessed. From 1 January 2005, the income guidelines were increased by 7.5% and significant rises were also made in the allowances provided for dependent children.

In June 2005, the Tánaiste 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. On 13 October 2005, the income guidelines for both medical cards and GP visit cards were further increased by 20%. This means the income guidelines are now 29% higher than at the end of 2004. It will also be noted that income guidelines used for the assessment for GP visit cards are 25% higher than those used for medical cards.

The Health Act 2004 provided that the HSE has responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Given this, I would be happy to request the executive, on provision of the relevant details as outlined by Senator Tuffy to investigate and report directly to the Senator in respect of any specific cases which she raised.

Employment Support Services.

Mr. Bannon

I welcome the Minister of State and thank him for taking this important matter on community employment mainstreaming. I ask him to provide us with an update on funding for community employment project staff on whom the Irish Wheelchair Association relies for the provision of care and driving personnel for core and essential services within its resource and outreach centres in 62 locations nationally.

I have received many representations on this issue, particularly in the run up to and since the last budget, asking that I raise the issue of funding for community employment project staff. The Disability Act was passed in the last 12 months. It claims to protect and develop services for people with disabilities. It is unsatisfactory that the most vital and basic services are being delivered by community employment participants. As the Minister of State knows, the Irish Wheelchair Association relies on community employment schemes to provide care and driving staff to core and essential services in its resource and outreach centres in 62 locations nationally serving approximately 3,000 people weekly.

I acknowledge the great work of community employment schemes. They have played a major role in the development and provision of services for the disability sector in several areas over many years. The Irish Wheelchair Association also acknowledges this. However, use of community employment is no longer sufficient or appropriate to those very necessary services and the quality and number of participants available to community employment is threatening the ability to continue to deliver this service. That has been highlighted to me in clinics over the past few months by people involved in the Irish Wheelchair Association. I cannot overstate the importance of addressing this issue and I hope the Minister of State has good news for me.

Last year the Irish Wheelchair Association and the Disability Federation of Ireland made a joint presentation to the Joint Oireachtas Committee on Health and Children. As a result of this presentation, we were guaranteed the situation would be prioritised and a budget submission was made to the Minister outlining the possible solutions to guarantee core funding for the critical positions. They also presented their concerns to Ministers and Members of the Oireachtas.

We continue to get representations on this issue. On behalf of the Irish Wheelchair Association and people with disabilities, I appeal for funding on an incremental basis to secure staff and services beyond 2006. I would welcome a favourable response from the Minister of State who is trying to do his best in this area. I hope funding will be put on a firmer footing in the years to come. Community employment schemes have done a good job and many services have been provided but there has been much insecurity. It is important funding is available on a permanent basis.

Mr. S. Power

I thank Senator Bannon for raising this matter. It gives me the opportunity to clarify the position in regard to the employment of staff by the Irish Wheelchair Association. I am replying on behalf of my colleague, the Tánaiste and Minister for Health and Children.

In the Estimates for 2006, significant additional funding totalling €100 million has been included for the improvement of health services for people with disabilities. As part of this provision, funding of €10 million has been made available to address core underfunding and core staffing issues in services provided by the non-statutory sector. The Health Service Executive has been asked to allocate this funding on an equitable basis, having regard to the needs of people with disabilities. I expect the executive's consideration of these needs will take into account any urgent case for funding of necessary services which may be made by the Irish Wheelchair Association.

In this connection, I am aware that the Irish Wheelchair Association is highly dependent on community employment schemes to provide services to people with disabilities. This means there is a regular turnover of highly experienced, well trained and committed staff when their stints on community employment schemes expire. For agencies such as the Irish Wheelchair Association which have a significant involvement in community employment schemes, there can be particular difficulties associated with the lack of eligible participants, difficulties in recruiting people of the required calibre and problems associated with training participants who must then leave the schemes after a defined period, resulting in the need on the part of the agency and service user to recruit and train all over again.

If the association is of the view that such services should be fully funded by the Health Services Executive instead, it should make this case directly to the executive. It will then be a matter for the HSE to decide on the level of priority to be given to this funding application, taking into account the advice of the regional co-ordinating committees and bearing in mind other competing demands for funding for disability services.

The Seanad adjourned at 7.35 p.m. until10.30 a.m. on Thursday, 16 February 2006.