Seanad Éireann díospóireacht -
Wednesday, 7 May 2014

Adjournment Matters

Medical Card Eligibility

Senator John Kelly

I thank the Minister of State for taking this Adjournment debate. Like many other Deputies and Senators, I have grave concern about what is happening with medical cards of late. I had grave concerns when responsibility for issuing medical cards was first centralised in the PCRS. I spent 28 years dealing with medical cards as a community welfare officer. I have never previously experienced such anger over the withdrawal of medical cards and it never happened before the PCRS took over.

I know a young lad in my area who cannot walk or talk and cannot eat other than through a tube. He requires care 24 hours a day and seven days a week. He had a medical card for years and it was withdrawn. We spent five months fighting to get the card back for him.

There are many other cases of people with, or recovering from, cancer, people with all kinds of disabilities, 90 year olds who have medical cards until 2015, which all of a sudden are being reviewed. One of the problems at issue is in the primary care reimbursement service, PCRS, where staff have been stressed out for a long time and cannot cope.

For 21 of the past 28 years the guidelines for medical cards increased, not by much, on 31 December. For the past six or seven years there has been no increase. That is a problem. Everybody from the young to the old, the disabled to the deserving, feels intimidated by the review process. Cards validated into the future are being withdrawn or reviewed. People feel that the Health Service Executive, HSE, is trying to find the €37 million for the under-six medical cards by taking it from those who need it most.

What is worse are the procedures applied. In every case the PCRS asks for further information. In most cases the information is already submitted but it loses it or cannot find it. When I send in medical card applications I scan everything first and send it off but the PCRS tells me that some information I have e-mailed has not arrived, although it has. This buys time for the PCRS. When I send in the information again the PCRS will not read the application for a further 15 working days. During that time people have no medical cards and the process goes on much longer.

I have it on very good authority that the situation in the PCRS is like Bedlam. The powers that be thought it would be a panacea for medical card delivery but it is not. When this was dealt with at local level compassion was shown, there was knowledge of the cases and delivery was expedient. That has all gone in order to take cards away from deserving people. They are deserving not only because of illness but also because many have financial difficulties, which are not taken into account. People have loans that are not assessed for medical card purposes.

I do not know if the Minister of State is aware that the HSE has brought in a German company to review the medical cards. One could almost say that Chancellor Angela Merkel is reviewing medical cards in this country because that is how it appears. Due to the moratorium on recruitment this company, Arvato, which has no experience of reviewing medical cards, is here. It shows no compassion whatsoever. If one is over the limit by €1 one is no longer entitled to a medical card.

There is no need to consider a third tier medical card. If the work was sent back and dealt with locally, as it was for years, we would not have this problem. The process in the PCRS is a complete and utter failure.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I have every sympathy with the Senator's matter on the Adjournment which I am taking on behalf of the Minister of State, Deputy Alex White. I thank the Senator for raising the issue. He may be aware that approximately 40% of the population, or almost 2 million people, qualify for a medical card or GP visit card. The scale of the administration of the general medical services, GMS, scheme is very significant. The people in the PCRS are doing a very good job although the scale of the job is significant. Over 700,000 individuals were assessed by the HSE in 2013 and well in excess of 95% of completed applications were processed within the target of 15 working days. The HSE is now completing medical card reviews for approximately 86,000 individuals per month.

The HSE operates under the legislative framework of the Health Act 1970, as subsequently amended. In the interest of probity, the HSE is obliged to ensure that a person's eligibility is correctly recorded in line with the eligibility legislation and the national guidelines. The HSE aims to ensure every person who is entitled to a medical card or a GP visit card is given the opportunity to avail of his or her entitlement. The current structured processes in operation in the PCRS concerning medical and GP visit card applications, reviews and appeals must be supported with a range of documentation, as outlined on the application forms. The processing time for incomplete applications is dependent on the furnishing of the required supporting documentation by the applicant. I understand the Senator's point on that issue. Where such supporting documentation is not supplied or is incomplete to enable the assessment of an application in accordance with the national assessment guidelines, the HSE will issue correspondence to the applicant, specifying the additional information required to progress the assessment of their application.

It is important to be aware of the protection in place for persons undergoing a review even where delays occur. First, any medical card holder undergoing a review to renew a medical card, who genuinely engages with the HSE, will not have his or her entitlement withdrawn before the review is complete, regardless of the expiry date shown on the medical card. Second, in cases where a decision is made not to grant a medical card, the applicant is informed of the decision and is notified of his or her right to appeal this decision. Contact details for the appeals office are provided to the person. Where a person submits an appeal to a decision not to renew a medical card within 21 days of that decision, he or she also retains the medical card or GP visit card until the appeal is decided.

Efforts are also being made to improve the quality of medical card processing through increased co-operation between State agencies. Increased data sharing between the Revenue Commissioners, the Department of Social Protection and the HSE has the potential to reduce the level of documents and information required from families as their eligibility status is reviewed. The processing of medical card applications and reviews is continuously monitored by the HSE. The Senator may be aware that, each week, the HSE publishes the turnaround time for medical card processing and this data is available on the PCRS website. In view of the assessment processes involved, I am satisfied that every effort is made to assist, support and facilitate persons undergoing review and, particularly, in a timely fashion. I do understand the Senator's point and will convey his thoughts to the relevant Minister.

Senator John Kelly

I appreciate that the Minister of State is taking this matter on behalf of another Minister of State and that this is a written response from the HSE for that Minister of State to read. I have already pointed out the failings in some of its answers. It receives material which is then lost. It would be better to lift the moratorium and recruit staff than to bring in a foreign company to do something about which it knows nothing.

In response to the first sentence in the Minister of State's reply, 40% of the population has had medical cards since the 1980s. This did not happen overnight or since the PCRS took over. It was always 40% and on occasion more.

I thank the Minister of State for her response and appreciate her taking this matter.

Deputy Kathleen Lynch

I thank the Senator. The population of Ireland has increased significantly as has the cost of medicine. The Government is seriously concerned about this and no later than this morning we met to discuss the issue. I thank the Senator for tabling the matter. It is very topical and people are concerned about it. I hope we will be able to resolve it.

Telecommunications Services Provision

An Cathaoirleach

I welcome the Minister for Communications, Energy and Natural Resources, Deputy Pat Rabbitte.

Senator Colm Burke

I thank the Minister for taking the time to deal with this matter which relates to an area at Courtbrack, which is less than 15 miles from Cork city and approximately four miles from Blarney. There are over 250 houses there but it has inadequate telephone lines and broadband, as well as insufficient access to mobile phone reception. There is a letter from eircom, dated 15 April, which indicates the company will not do anything about this issue.

There are three old telephone exchanges servicing Courtbrack, with one at Dunoughmore to the west, one at Grenagh to the north and one at Blarney to the east. This area is at the end of the line for each of these exchanges. The problem is that over the past ten years there has been a number of new houses built, and there are over 250 families in the area. One housing estate includes more than 50 houses built in the past four to five years. Nobody has access to any service. The road runs along the River Shournagh and there were a number of serious accidents on a morning when roads were icy but nobody could access emergency services. It took quite a while before somebody could get access to communications, as mobile phones did not work in the area either. I ask that the issue be reviewed. Matehy is not far away and it has been included in the outline broadband roll-out launched in the past few weeks by the Minister but Courtbrack has been excluded.

Minister for Communications, Energy and Natural Resources (Deputy Pat Rabbitte)

Having listened to the Senator I wonder if there is something particular about Courtbrack which I should consider. To be honest, the matter has not been brought to my attention before today but as a result of the Senator's remarks, I will examine it. The Senator is already aware that Ireland's telecommunication's market has been liberalised since 1999 and has developed into a well regulated market, supporting a multiplicity of commercial operators providing services over a diverse range of technology platforms. The State is not a service provider in the market and can only intervene in cases of demonstrable market failure.

Thanks largely to significant commercial investment, we have witnessed considerable progress in recent years in terms of both coverage levels and improved speeds. However, much of this has been confined to the main urban centres. The Government's national broadband plan, which I published last year, aims to radically change the broadband landscape in Ireland by ensuring high-speed broadband is available to all citizens and businesses, and this will be achieved by providing a policy and regulatory framework that assists in accelerating and incentivising commercial investment and a State-led intervention for areas where it is not commercial for the market to invest.

Since publication of the plan, fixed-line and wireless telecommunications providers in Ireland have accelerated the roll-out of high-speed services and are now investing €2 billion in services and broadband coverage across Ireland. The extent of coverage and quality of service significantly exceeds the targets to which industry committed at the time the plan was published. On 25 April I signalled the Government's commitment to a major telecoms network build-out to rural Ireland with fibre as the foundation for future-proof broadband services as part of the State intervention under the national plan. This commitment is a clear expression of the Government's determination to address the connectivity challenge in rural Ireland in a meaningful and sustainable way. The fibre build-out will be part of an end-to-end strategy that will address all parts of Ireland which cannot access commercial high-speed broadband services. Central to the strategy will be a fibre build-out to locations in every county in the State identified as having no existing or planned enabling fibre network.

As the Senator knows, I published a preliminary county-by-county list of towns which takes in more than 1,000 locations. I should point out that this list is only indicative and is based on information currently available. It is subject to revision upon completion of the comprehensive mapping process currently under way. Further locations, such as Courtbrack, may be identified as the process continues. Similarly, it may be determined that some of the locations will be addressed by the commercial sector and will therefore not require State intervention. From the Senator's comments, that does not seem likely in this case.

A comprehensive implementation strategy containing details of all the proposed elements of the State intervention, along with the outcome of the mapping process, will be published for public consultation later this year. It is my intention to ensure that by delivering an end-to-end market intervention with fibre as a core component, all parts of rural Ireland, including Courtbrack, will enjoy opportunities similar to those in urban areas. In committing to a fibre build-out at the heart of this strategy, the Government is acknowledging that broadband is the key infrastructure of the 21st century.

Senator Colm Burke

I thank the Minister. I wrote to the Department some time ago and awaited a response on the roll-out of broadband. I fully accept that the Department and Minister have done much work in the area, which is welcome.

This area has seen a number of new estates being built and normally we think about water or sewerage services, although we insert no stipulation regarding the provision of telecommunications services. This is an unusual case, as there is an inadequate phone line and the area cannot access mobile phone coverage. It is a major issue for approximately 250 families, many of which have young people in college. One person working for the ambulance service bought a new house and sometimes he cannot be contacted when he is on-call.

He is at a huge disadvantage and he is very concerned about it. I have left a copy of the eircom letter with the Minister. I ask him to ensure that it would be looked at and if at all possible that something would be done to try to bring it in under the remit of the broadband roll-out but also to get Eircom involved. I know it is not physically possible to force eircom to do it but representations will be made. I thank the Minister for his contribution.

Deputy Pat Rabbitte

I entirely agree with the Senator that in the 21st century high-quality connectivity is as important a part of the infrastructure as are energy, roads or water. It is puzzling that a new community should be left bereft of the services Senator Burke has outlined. All I can say is that we have two very radical initiatives under way which I think will be revolutionary in their impact in the provision of high-quality connectivity to rural Ireland. The first is the legislation that I took through this House some six weeks ago in the matter of enabling the ESB, in conjunction with the leading telecommunications company, to roll out fibre to parts of rural Ireland using its own supply infrastructure. That is a very important initiative and we will make an announcement in a couple of weeks on it.

The second initiative is the announcement of last week where the Government has committed €500 million to the direct State intervention to provide such quality connectivity. Unfortunately, we have to go through state aid rules. We have to do a detailed mapping exercise in order to satisfy the Commission that we can make a State intervention of this order. I have the letter from the Senator in respect of Courtbrack and I will be glad to examine it and see what I can do.

Senator Colm Burke

I thank the Minister very much.

Northern Ireland Issues

Senator Paul Bradford

I welcome the Minister of State, Deputy Ciarán Cannon, and ask him to pass on my comments and views on the Adjournment matter I raise to the Taoiseach at his convenience. I have raised the need to reconvene the Forum for Peace and Reconciliation arising from my concern not simply at the events of recent days in Northern Ireland but at the drift which has occurred in recent weeks and months which should cause all of us to reflect on the fact that the relative peace which we have had in the northern part of the island since 1994 is not a permanent given and must be worked upon and further developed and bedded down.

You were in this House 20 years ago, a Chathaoirligh, in May 1994 when a ceasefire had not been declared. You will recall that in both this House and in the other House statements were required on a monthly and sometimes a weekly basis in response to various atrocities, murder and mayhem on the streets of Northern Ireland. Then in the autumn of 1994 the IRA ceasefire was declared following years of hard work by various politicians from virtually every political party. That helped lead to a process whereby we have enjoyed a relative peace on this island since.

One of the developments which played a significant role in building a political process and getting people from different backgrounds into one room was the Forum for Peace and Reconciliation. It was at the instigation of the then Taoiseach, Albert Reynolds, that the Forum for Peace and Reconciliation met for the first time in October or November 1994. Over the course of the next two years or so it met on approximately 40 separate occasions. The representatives of virtually every political party in the Republic of Ireland and a significant number of political parties in Northern Ireland came together to discuss problems and solutions and tried to plan for a shared future based on mutual respect, trust and peace. It was a unique forum. As a participant I found the divergence of views interesting. Of note was the respect in which submissions were held and the robust nature of the debate and engagement on some occasions. It all added to a mix which worked in getting people to think about future co-operation on this island. The forum served a significant purpose.

Sometimes the phrase “a political talking shop” has negative connotations. One could suggest perhaps that the Forum for Peace and Reconciliation was a political talking shop, but I have always thought it was a case of the more talk the better in the context of Northern Ireland politics. At least when people are around the same table no matter what their background or where they are coming from politically or going to, having people speak face to face means progress is at least possible. A huge amount has been achieved but, uniquely, the Forum for Peace and Reconciliation did not conclude, it simply adjourned. The then Taoiseach, Bertie Ahern, was in charge at the time. The official position was that should a future set of circumstances require it, the forum could meet again. I previously suggested it would be an ideal vehicle to tease out and consider the prospect of a truth and reconciliation commission. What we have seen recently in Northern Ireland must be a warning shot that we cannot be sure of permanent peace on the island and that work is required. We must recognise the victims and the atrocities and that much healing is still required.

I do not expect a significant statement from the Minister of State, but I would urge him to encourage the Taoiseach to contemplate bringing together again all the political parties who wish to be involved in the process. They all have something to add. One difficulty I have perceived during the past decade is that dialogue is very much Government to Government, in addition to one or two of the political parties in Northern Ireland – depending on whoever is in charge at the time – making the political running. All of those who are interested in the topic have something to say. The forum brought all voices - some politically strong, others weak - to the table and made significant progress. I respectfully suggest that 20 years after the IRA ceasefire and what we all hoped would be the beginning of a new island and a new Ireland – to some extent that has been achieved – we should look back at what worked well. The Forum for Peace and Reconciliation did work very well. It could work equally well in the course of the next few months and years to discuss other matters, not just in terms of the current political situation but in terms of the need for a truth and reconciliation commission, the need to engage with victims, and to ensure a stable political environment on the island. I ask the Minister of State to please pass on my comments to the Taoiseach at his convenience.

Minister of State at the Department of Education and Skills (Deputy Ciarán Cannon)

I thank the Senator for raising this issue. He has spoken with a great degree of knowledge and passion on the subject of achieving a lasting peace on the island. The Forum for Peace and Reconciliation was established in 1994 following the first IRA ceasefire, and consisted of membership from across the Houses of the Oireachtas, as well as from political parties in Northern Ireland.

It met for the first time in Dublin Castle, chaired by Mrs. Justice Catherine McGuinness. Its terms of reference were, "To consult on and examine ways in which lasting peace, stability and reconciliation can be established by agreement among all the people of Ireland, and on the steps required to remove barriers of distrust, on the basis of promoting respect for the equal rights and validity of both traditions and identities". A draft report entitled, Paths to a Political Settlement, was published in 1996. However, as some Members will recall, the forum was suspended following the Canary Wharf bombing in February 1996. While it reconvened briefly in 1997, the then ongoing multiparty talks, referendum, elections and establishment of the institutions meant that no further meetings of the forum took place until it was reconvened again in November 2002. The context on that occasion was the suspension of the institutions in October that year. The forum met on a handful of further occasions but has not met since February 2003. Several serving Members of the Houses of the Oireachtas were delegates to the forum in 2003, including Senators Paul Bradford and David Norris, as well as Deputies Eamon Ó Cuív and Jan O'Sullivan, and contributed to the important work which it was doing at that time.

The political and institutional context has changed significantly since. Since 2007, the Northern Ireland Executive and the Northern Ireland Assembly have been operating and delivering power-sharing government for the people of Northern Ireland. Without doubt, there have been significant political challenges over the period since, including in recent weeks and months. As we committed to at the time of the signing of the Good Friday Agreement, the responsibility and priority of the Government now, working with the British Government, is to support the power-sharing institutions in Belfast as they face the challenges of everyday government and the additional challenges of dealing with the legacy of the Troubles. Taken together with the other institutions established under the Agreement, including the North-South Ministerial Council and the British-Irish Council, these are the appropriate fora in which to further lasting peace, stability and reconciliation, as the Forum for Peace and Reconciliation had done previously over a number of years.

The Good Friday Agreement set out the guiding principles for peace, stability and reconciliation in Northern Ireland, namely, devolution, power-sharing, agreement on sovereignty, human rights, parity of esteem, support for the rule of law and the continued shared responsibility of the two Governments to guarantee these principles. However, we must acknowledge that the full potential of the Agreement has yet to be reached. As is the case in any comprehensive political agreement, full implementation is essential to the integrity and balance of the whole.

The Government is also working to consolidate and to continue to implement the outstanding elements of the Good Friday Agreement and its related agreements, including an Irish language Act for Northern Ireland, a Bill of Rights for Northern Ireland and a North-South consultative forum. In terms of the North-South consultative forum in particular, many Members will share the view that the establishment of such a forum would stimulate more informed public debate on key societal challenges, North and South. For that reason, the Government will continue to press for its establishment as an essential part of the framework to deliver peace and reconciliation.

Most recently at the plenary meeting on 8 November 2013 of the North-South Ministerial Council, the Government expressed support for the re-establishment of the North-South Consultative Forum as a valuable and, as yet, unimplemented provision of the Good Friday Agreement. In terms of the work of the North-South Ministerial Council across government more broadly, we have been working hard and to great effect with the Northern Ireland Executive to advance areas of practical co-operation. We have intensified work since November 2013 focusing on potential new areas of North-South co-operation. Northern Ireland’s First Minister, Peter Robinson, commented recently that North-South relations are better than they have ever been. The Government shares this view.

Members of this House and of Dáil Éireann are playing a valuable role in facilitating discussions on the current political situation in Northern Ireland. The Joint Committee on the Implementation of the Good Friday Agreement regularly hears from a wide range of groups in Northern Ireland and undertakes visits there. The establishment of the North-South Interparliamentary Association in July 2012 was a welcome recent development arising from the ongoing implementation of the Good Friday Agreement. Under the leadership of the Ceann Comhairle and the Speaker of the Northern Ireland Assembly, the association has provided new opportunities for discussions between Members of the Houses of the Oireachtas and members of the Northern Ireland Assembly. The association has had exchanges of views with a wide range of experts on EU issues, health matters and economic co-operation.

The British-Irish Parliamentary Assembly is of much longer standing, having been established in 1990, in the aftermath of the Anglo-Irish Agreement. It is going from strength to strength. At its meeting last month, it considered a report on the implementation of the Good Friday Agreement on its 15th anniversary and heard presentations on the workplace of the future.

I welcome the opportunity to debate Northern Ireland in Seanad Éireann. While I greatly appreciate the sentiment and concern behind Senator Paul Bradford's suggestion, the Government believes the Good Friday Agreement institutions must be let get on with their work. Members of this House, and of the Dáil, have several different avenues where they can contribute to the promotion of peace and reconciliation on this island and across these islands. The peace and reconciliation thus far achieved on this island has been hard won and will continue to be consolidated by this Government as it continues the work towards the full implementation of the Good Friday Agreement as the best underpinning and framework for lasting peace, stability and reconciliation.

The Seanad adjourned at 6.45 p.m. until 10.30 a.m. on Thursday, 8 May 2014.