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Seanad Éireann díospóireacht -
Wednesday, 22 Jun 2011

Vol. 208 No. 11

Adjournment Matters

Medical Cards

I thank the Minister of State for attending the Chamber to respond to this issue. On 1 July, the HSE will take control of medical cards and centralise them in Finglas, Dublin . By doing so, the HSE is taking away the discretion shown by community welfare officers in regard to certain family situations that arise. The community welfare officer knows the clients and knows where there are gambling difficulties, alcohol addiction or illness in a house. They show discretion in 10% of cases and this means that people are less stressed. I am particularly concerned about cancer patients and those who suffer from MS, along with many other medical problems. The HSE and community welfare officers always showed a level of sympathy and because of this, discretionary medical cards were granted to these people. Once the service is centralised, discretion will go out the door. People will be dealing with faceless bureaucrats who do not know them and who live 200 miles away in some cases. In those cases, many people will be refused medical cards. Over the years, GPs have advised cancer sufferers to get a medical card from the community welfare officer because they were entitled to it. Consultants gave out that information but this may have been because they were fed incorrect information. Cancer patients are treated the same as everyone else for medical card purposes. They must undergo a means test and if they qualify, they receive it. That is why we introduced discretion in these cases. It is cost neutral because of that.

I call on the Minister for Health to grant medical cards to cancer patients who are undergoing treatment until their illness is cured. This will take away the stress for them. As a community welfare officer, the last thing I wanted to do was means test someone who visited me. People did not realise whether they were terminally ill. We have already learned from the takeover of the over-70 medical card by the Primary Care Reimbursement Service, PCRS, in Finglas that many elderly people had problems in processing their applications. They cannot get through to the centre on the telephone and the same thing will happen in this case. When people are telephoning Departments they use their mobile phones. They might start off with €20 credit and when credit is gone and no one has come on the other end of the telephone, that is the end of the issue. This issue must be addressed. The takeover should be deferred until we can get a commitment on discretionary cards. It will be a major issue and will affect every politician. Saying that everything will work out when this begins on 1 July is the same as saying that community welfare officers are being taken over by the Department of Social Protection, that they will be told all about the job when they start and that everything will be fine. We need to address this matter before it gets to that stage.

I thank the Senator for raising this important issue, one with which I am familiar. I can provide information on the background to the initiative taken by the HSE to standardise the processing of medical cards throughout the country. Medical cards are provided to persons who, in the opinion of the HSE, are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants. While income guidelines are the principal benchmark used for deciding medical card eligibility, the HSE looks beyond the applicant's financial situation and has regard to other matters it considers appropriate in assessing a person for a medical card.

If a person's income and outgoings fall outside the HSE guidelines and there are personal and financial burdens arising from medical or social circumstances, the HSE may issue a discretionary medical card. The essential principle applied to such cases is that, if by bearing the cost of services covered by a medical card, an individual's or family's ability to meet essential costs is compromised, then a medical card will be issued. Taking into account the circumstances of each case, it is a matter for the experience and judgment of the decision-maker to determine if there is hardship within the context of the legislation and guidelines.

The HSE decision to centralise the processing of all medical card and GP visit card applications and renewals to the PCRS is part of the HSE value for money programme. There is a requirement on the HSE to make efficiencies in business practices in order to realise savings in a very challenging economic environment and provide a modern service to the public within sustainable levels of expenditure. The centralisation project is well under way and almost 40% of medical card applications are now processed centrally by the PCRS. Phased implementation of the centralisation project allows the situation to be continuously monitored and, if required, modified to address any issues arising. Local offices will also provide appropriate local services to the central office to ensure that when local input and information is needed it will be available and there is a resource to gather and provide it.

Under the centralisation plan, the HSE's local offices will continue to provide the public with assistance and information locally on medical card criteria and making an application, and the current status of the application or review. From a customer perspective, this means that at all times a person will be able to seek advice from his or her local health office. Local health offices can also deal with queries of a general nature about the medical card scheme and will continue to provide necessary supports to any person making an application. Local offices can also handle all inquiries from clients in respect of the medical card scheme, including assisting them in the completion of their application and advising them of their entitlements.

At the new national processing centre, medical card processing is characterised by standardised decision making aligned with the medical card guidelines. The process is transparent from application receipt through to completion, with customer service provided through multiple channels including phone, correspondence, online facilities and SMS messages. Applicants for medical cards, discretionary or otherwise, will benefit, under the centralised application process, from a quicker, more streamlined and more consistent approach to the appraisal of their applications than was available under the old decentralised system. That is the theory. The challenge is to ensure that happens in practice. We must learn from the experience of the early days in terms of the pilot project in the past 18 months. There are lessons to be learned. I wish to ensure that the HSE has taken those lessons on board and has adjusted and improved the service accordingly, and I undertake to ensure that happens.

I am glad the Minister said that it was the theory because in my 29 years' experience as a community welfare officer the theory is never put in place in practice. When this is taken away from local involvement it will be a disaster. How does the gambler, for example, ring somebody in Dublin to tell them their wages have been spent on gambling? How does the alcohol abuser do the same? Who listens to them?

The Minister said local offices will provide assistance. They will not. They know nothing about this, except that they will no longer be dealing with medical cards. To which local offices is the Minister referring? Is she referring to the staff in the sections that dealt with medical cards after the community welfare officer? My understanding is that they will be redeployed to other posts within the HSE so they will not be there. As regards dealing with these matters online, it does not work. The telephone also simply does not work. The correspondence that will take place will be purely by letter. People will send in their application, receive a refusal and appeal it. It will be paperwork back and forth unless it is addressed.

Senator, as there is no provision for even a question, I have given you a great deal of latitude.

Thank you, a Chathaoirligh. We must address the issue of the cancer patients and give them medical cards. That will solve many of the problems.

I have a great deal of experience with this because my constituency was the first to move into the centralised system. It was quite problematic in the beginning and there were many teething problems. It is fine if an application is straightforward and the person is under the income limits. The system is very efficient and there is a 15 day turnaround. The difficulty arises where discretion is required.

First, there is the question of it being an efficient service. There were teething difficulties and I hope they are ironed out. I wrote to the HSE today asking it to assure me that there are adequate numbers of staff in place to ensure that it is an efficient service. Second, there is the matter of discretion. We need an assurance, which I have requested, that the decision makers are adequately trained and understand the hardship caused to people who are trying to get by on relatively low incomes which are a little above the income limits and to cope with all the additional expense a serious illness causes.

I have written to the HSE to seek those assurances. I wish to be satisfied that it has learned the lessons from the early days and the pilot project and that we will have a service that works for the benefit of the people applying for medical cards and who need them desperately. I will be happy to report back to the Senator when I hear from the HSE.

Public Service Agreements

I thank the Cathaoirleach for allowing me to raise this matter on the Adjournment and I am grateful to the Minister, Deputy Phil Hogan, for his attendance. It is good that many senior Ministers come to the House to reply to Adjournment matters. I am anxious to put that on the record.

I raised this issue following the publication of the first progress report on the Croke Park agreement, the perceived savings accruing from that agreement and in light of an article on the front page of last weekend's Sunday Business Post. The article stated that while there are savings of almost €300 million, the net benefit to the State might be far less. The proposed Department of public expenditure and reform has not yet been legally established and the Minister does not have any legal powers, which is, perhaps, why he is not in the House tonight. That Department confirmed to the media that the figure of €289 million does not include the cost of retirements and increases in the Civil Service and public service pensions bill.

Will the Minister confirm what is the net benefit to the State's finances of the Croke Park agreement in the past year and what is the cost of retirement lump sums and increases in the pensions bill as a consequence of the number of staff leaving the Civil Service and public service? Is there any chance that the amount of money saved by the Croke Park agreement over the past 12 months will be less than the amount of money set aside to pay retirement lump sums, which can rise to 150% of a person's final salary, and future pension entitlements? I do not seek to be critical of the agreement; I supported it and still do. My party, which I supported in Government, helped to implement the agreement. I am anxious that it should succeed as it is important and it provides opportunities for transformation, greater efficiency and greater value for money for the taxpayer.

We face a mammoth task in reducing the deficit; it must be our first priority. It is a challenge that should consume every Member of the Oireachtas and the only surprise is that it has not engaged the public in the same way political debates about the deficit do in the United States. If we do not reduce our deficit, our ability to grow and create jobs will be impaired. Throughout much of today in the Seanad we have discussed the need to be innovative if we are to create jobs. However, a cloud of deficit hanging over the country, the people and businesses will surely destroy any hope of creating the jobs our citizens need. I hope that in the future the net value of savings from the Croke Park agreement will be published, rather than the gross figures. We must be realistic and very clear about the challenges we face.

I thank the Senator for raising this matter. I apologise that the Minister with responsibility for public expenditure is unable to be present. It is not for any legal reason.

The first progress report of the implementation body under the public service agreement or Croke Park agreement was published on 15 June. The conclusion of the body was that the parties have made solid and measurable progress to date and that with the positive engagement of public servants: staff numbers are falling substantially; services to citizens and business are, by and large, being maintained and, in some cases, improved; productivity has increased; thousands of staff are being redeployed within and across organisations and sectors, and services are being restructured and reconfigured; and industrial peace has been maintained.

Clearly, a key objective of the agreement is to deliver significant and sustainable pay savings. I welcome the finding by the body that sustainable pay bill savings in the order of €289 million have been achieved during the review period. This saving has been driven primarily by not filling vacancies arising from a reduction in staff numbers of 5,349 during the period but also other factors such as reductions in overtime costs, down by 5.2%, and reformed work practices and rationalisation. The report clearly shows that public service bodies are generating significant non-pay cost savings through better use of resources, reorganising work and achieving greater internal efficiencies. Costs are also being avoided as a direct consequence of the flexibility and co-operation provided by the agreement and specific examples are highlighted in the report.

While the progress reported by the implementation body is welcome, the reality is that we must go much further. Given the severe fiscal constraints, further significant cuts in expenditure, together with further reductions in the numbers employed in the public service, are unavoidable. At the same time, we must also ensure that services to the public are protected to the greatest extent possible. That will be the challenge for the agreement in the period ahead.

In regard to the specific issue raised by the Senator, the public service agreement is a pay agreement between the Government as employer and its employees, represented by the public service unions. Its focus is on the measures needed to deliver sustainable savings in public service pay costs over a four year period in terms of reducing staff numbers, significant redeployment and extensive reform and reconfiguration of services. The focus of this progress report is on the sustainable long-term pay savings accruing as a direct consequence of the co-operation and flexibility which the agreement is providing. It would, therefore, be wrong to include in such a report the pension costs of those who have retired from the public service and who are no longer part of the Croke Park reform process.

It is true that public service pension costs have increased in recent years. However, this is not a direct function of the Croke Park agreement but represents costs which would arise in any event, not least due to the increased longevity of public servants. The body's report, correctly, foot-noted the pension increase over the period but, equally correctly, did not seek to relate it to the Croke Park reform process. This is because the numbers and payroll reduction are not directly related to pension costs. The reductions in numbers reflect not just retirements but also career breaks, special leave, resignations, people moving to shorter working patterns, unpaid leave and so on and can be offset by recruitment or people increasing their working year.

Furthermore, as regards the early retirement programmes, the body's report makes clear that only a relatively small element of the overall increase in pension costs can be attributed to the schemes which operated during the review period and, in fact, such costs decline over time as the early retirees reach the age at which they would have retired in any event.

The report also footnotes the costs associated with the voluntary early retirement and redundancy schemes which were offered in the health sector last year, with one-off costs of €99 million for lump sums and statutory redundancy paid in 2010. There has to be acceptance that schemes to incentivise people to take early retirement or redundancy are going to carry initial up-front costs. This is necessary to assist us in generating the long-term sustainable savings in the Exchequer pay bill that the Croke Park agreement is facilitating and which the implementation body is monitoring.

It is important to emphasise that steps have been and are being taken to reduce pensions costs. Retired public servants and officeholders have had their pensions cut by an average of 4%. Retiring public servants also will, after the expiry of the grace period at the end of February 2012, have their pensions calculated on the basis of their actual reduced pay, amounting to an average cut of 7%, with more significant reductions at higher pay levels owing to the tapered nature of the pay cut. This cut was effected by the Financial Emergency Measures in the Public Interest Act 2010, which is delivering a reduction of €100 million in the cost of public service pensions paid to pensioners in 2011 and a commensurate reduction applying in future years. It would, however, be wrong to include the savings from the public service pension reduction in the report.

I welcome the progress outlined in the implementation body's report. In regard to the matter raised, public service pensioners have left the public service and it would, therefore, be wrong to include their pensions costs in a progress report on the Croke Park pay agreement.

This issue will have to be further investigated because the correct figures are not being provided. It is not credible for a Minister to claim to the House that pensions savings are not related to pay or other issues in the Croke Park agreement. Pensioners are part of the Civil Service's costs because they are getting paid by the State.

I understand the Senator's concerns but pension costs have been reduced by €100 million and that is commensurate with savings in future years. The achievement of that objective is clear from the figures presented.

Fire Stations

I wish to raise the issue of three fire stations in my constituency of Donegal South-West which are in urgent need of upgrading or replacement. The stations, which are located in Gleann Cholm Cille, Ballyshannon and Bundoran, are vital to the local populations they serve as well as to the increased populations in these areas during the summer months.

The smallest of the three stations, Gleann Cholm Cille, requires a new building. I understand the Department of the Environment, Community and Local Government and Donegal County Council have confirmed that it is not possible to modernise the station and, therefore, the only option available is to build a new facility on the existing site. From the Department's point of view the next stage is to permit the council to seek planning permission for the construction of a new station. I hope this project can progress given that the parish is at present serviced by the fire station in Killybegs, which is a considerable distance away. Killybegs is one of the country's largest fishing harbours and if a fire or accident occurred there, the tender would not be available for Gleann Cholm Cille, Carrick and Kilcar. The station in Glean Cholm Cille will probably comprise two bays.

The other two stations are located in large towns which are serviced by town councils. The previous Government decided, following consultations between the Department and the county council, to build new stations in Ballyshannon and Bundoran. A site was identified in Bundoran and the next phase involves seeking planning permission and issuing a tender. Bundoran fire station is in a poor condition. The population of the town increases from 4,500 to more than 20,000 during the summer months and at weekends throughout the year. Major apartment buildings and holiday accommodation have been built around the town and it also contains several four storey hotels. The station urgently requires to be upgraded given that it also services the northern parts of counties Sligo and Leitrim. A site adjacent to the by-pass at Ballyshannon has been identified by Donegal County Council for a new station.

The Department is carrying out a review of the decision of the previous Government to proceed with the construction of new stations in Ballyshannon and Bundoran. I am concerned that the review may result in a decision to build one station on a site located between the two towns. This would not meet local demand, however, because studies have revealed that call-outs to areas north of Ballyshannon cannot not be dealt with by fire tenders based in Finner Camp or Bundoran. We must proceed with the two stations to which the previous Minister committed. Any reversal of that commitment would be unacceptable.

I respect the Minister, Deputy Hogan, and I appreciate that he is in the House to take this matter. I hope he can provide clarity on the issue for the people of these areas.

I thank the Senator for raising this matter. I acknowledge the courage and commitment of all personnel engaged in the fire and emergency services in County Donegal and throughout the country. The professionalism and dedication of the retained service in Donegal received particular attention in early May during the spate of gorse and wildfires which caused substantial damage in Ard an Ratha, Glenties and An Clochán Liath. The communities were very appreciative of the great efforts made by local crews and I commend the fire fighters, local management and the Defence Forces for the efforts they expended.

The provision of a fire service in Donegal, including the establishment and maintenance of a fire brigade, the assessment of fire cover needs, the provision of premises and the making of such other provisions as it considers necessary or desirable is a statutory function of Donegal County Council under the provisions of the Fire Services Acts 1981 and 2003. My Department supports fire authorities through the setting of general policy and guidance and the provision of capital funding, including the recoupment within the overall funding available of costs incurred by fire authorities on the approved purchase of fire appliances and emergency equipment, as well as construction and upgrading of fire stations. The Department's fire services capital programme has channelled significant investment to fire authorities over the past decade and as a consequence, Ireland's fire service infrastructure is now acknowledged to be first rate.

There are 15 fire stations in County Donegal and the fire service responds to approximately 1,300 call-outs annually. Donegal County Council, in partnership with my Department, has made substantial progress in modernising fire stations in the county and has replaced 12 fire stations following investment of €11 million by my Department over the last decade. I acknowledge the involvement of the former Minister of State, Pat the Cope Gallagher, MEP, in fast-tracking a number of these projects.

Donegal County Council is to be commended for undertaking this ambitious programme of fire station replacement in recent years. The following towns in County Donegal are now served by modern fire stations with full facilities: Milford in 1998; Buncrana in 2000; Letterkenny where the headquarters is located and An Fal Carrach, both in 2003; Carndonagh and Donegal town, both in 2004; Killybegs in 2005; An Clochan Liath, Glenties and Moville, all three were built in 2007; and most recently Gaoth Dobhair and Stranorlar in 2009. In total, more than €12.8 million has been invested by my Department since 2002 to fund the station replacement programme and to acquire fire appliances and specialised emergency equipment.

I agree with the Senator that it is important to build on the significant progress to ensure the development of consistent and effective fire services to keep communities safe from fire and other emergencies. Value for money is a key theme in the current climate and future developments, including investment in station infrastructure, will have to be brought to fruition within tighter resource constraints.

In recent years, international trends in managing emergency service provision have moved towards the use of integrated risk management or a risk-based approach, RBA, and the Department's national directorate is currently funding the development of such a system. It is envisaged that the output from this work will inform decision making on the optimum allocation of resources to support fire service operations in all parts of the country, including those relating to Bundoran, Ballyshannon and Gleann Cholm Cille fire stations. Outputs will also inform decisions on how best to determine an appropriate balance between fire prevention, protection and response measures. It is not true to say that the Department approved two stations at Bundoran and Ballyshannon at any time in the past. If it had approved them then the Senator would not have raised the matter.

I am sure Senators will concur it is important that value for money is delivered from all expenditure under the fire services capital programme. Following completion of a review of the programme, continued investment in the fire appliance fleet has been identified as a key national priority measure. In that context, I have recently approved a new programme of joint procurement of 17 fire appliances which will involve fire authorities working together to aggregate demand and drive value for money. I expect this collaborative approach will deliver budgetary and administrative savings.

Given the tight constraints on public finances any further support from my Department's fire services capital programme to Donegal County Council for the replacement of fire stations in Ballyshannon, Bundoran and Gleann Cholm Cille in the period ahead will have regard to the council's priorities, the extent of previous investment, the value for money offered by proposals, the spread of existing facilities and the totality of demands from fire authorities countrywide. Accordingly, I am not in a position to state categorically when construction of any of the three fire stations referred to by Senator Ó Domhnaill can proceed to construction.

Does Senator Ó Domhnaill have a question?

I have a question and a point of order also. I did not say that two fire stations were approved but what I did say, categorically, is that the previous Minister whom I lobbied extensively, as did the previous Tánaiste, asked the county council to forward two site proposals for two new fire stations, one in Bundoran and the other in Ballyshannon. They were forwarded by the council. Agreement was given that there would be two individual stations. I am very much concerned by the result of the review that——

Does the Senator have a question for the Minister?

Finality must be brought to the issue. It is not fair on Donegal County Council nor the local community and the town councils in Bundoran and Ballyshannon. The Minister has acknowledged all of the stations that were built under the previous Administration but the Department now seems to be rowing back on the commitment which was given to Donegal County Council to build two new fire stations, given that the council in conjunction with the Department agreed that there would be a site in Bundoran and a site in Ballyshannon with two base stations——

Does the Senator have a question?

——to be newly built on each site that was identified at the time. That information has been sent by the council to the Department.

I do not wish the Senator to misinterpret what I have said. I have been very clear.

It is not clear at all.

The Senator might choose for it not to be clear, but to be absolutely clear, there are proposals in the Department from Donegal County Council to build new fire stations in the three locations mentioned by Senator Ó Domhnaill, namely, Ballyshannon, Bundoran and Gleann Cholm Cille. I have no money to build any of them at the moment, thanks to the fact that we have ceded our economic sovereignty to the EU and IMF. I am waiting to see what the capital programme for 2012 is like before I make a decision about any fire station in the country. I do not have money for capital investment in any fire station in any part of the country in 2011 thanks to the work of our predecessors.

Is there such a thing as a point of information?

Not at this stage.

I just wondered. The Minister's reply was the longest "No" in the history of the Seanad.

The Seanad adjourned at 7.15 p.m. until 10.30 a.m. on Thursday, 23 June 2011.
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