Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Thursday, 26 Nov 2015

Vol. 243 No. 12

Commencement Matters

Medical Card Eligibility

I welcome the Minister of State, Deputy Ó Ríordáin.

I thank the Minister of State, Deputy Ó Ríordáin, for coming to the Chamber to take this matter on behalf of the Minister for Health. I will keep this short and sweet. I have been working in politics for more than 25 years and have dealt extensively with people applying for medical cards while helping them with their applications. I have never come across a case in which a full-time student did not receive a medical card in the same way as his or her parents. In this case, which I encountered recently, the mother is an invalid and the father is a carer. The student in question works during the summer and at weekends to help finance her way through college because her parents cannot afford to help her. However, due to her income from this work, she has been disallowed from getting a full medical card as held by her parents and she has only been given a GP visit card. I have no problem with eligibility being based on a student's income, provided this is applied across the board and all students are assessed on their income and means. This means in the case of parents who do not have medical cards because of their income, a student who has part-time earnings should be so assessed and it should be across the board. What if the girl in question happens to get sick and ends up in hospital? This is not beyond the bounds of possibility and could happen because while in college, my own daughter contracted glandular fever and ended up in hospital on a drip for nearly eight days. In such a scenario, this girl would not be able to afford €750 for hospital expenses because her parents certainly cannot afford it. I reiterate it is fair enough if this applies across the board but one cannot pick and choose whereby some students are assessed on their means while others are assessed on those of their parents.

I wish to know when the criteria were changed because I did not hear about it and I am sure many other Members have not heard about it. One cannot get a straight answer from the primary care reimbursement service, PCRS. Its answer is, "That is the way it is". The reason I tabled this Commencement matter is in the hope that the Minister of State will tell me what is going on in the PCRS.

I thank the Senator for raising this issue. She will be aware that, in accordance with the Health Act 1970, as amended, full eligibility and a medical card is awarded where a person cannot arrange GP services for himself or herself and his or her family without undue hardship, having regard to his or her financial circumstances.

In the situation outlined by the Senator, it is possible for a student who has income of €164 or more to be assessed in his or her own right for a medical card and the medical card status of the parents is not a relevant factor. The Minister of State, Deputy Kathleen Lynch, has not been made aware of any instances where problems referenced by the Senator have arisen and she has not provided details of any individual case. Should the Senator wish to provide information concerning a specific applicant, the national medical card unit would be happy to undertake a review and revert directly.

Eligibility under the medical card scheme for persons aged 16 to 25 years is assessed by reference to the HSE's medical card and GP visit card national assessment guidelines which state that persons aged 16 to 25, who are dependent on medical cardholders, are eligible for a medical card. A 16 to 25 year old is classed as a dependant if he or she is living with parents or a guardian or living away from home attending school or college and has no income or a weekly income less than €164. Where an applicant in this age bracket is earning more than €164 per week, then he or she is assessed as being financially independent. The figure of €164 is the current medical card income guideline for a single person living with family.

Where deemed appropriate, the HSE may exercise discretion and grant a medical card where an applicant exceeds the income guidelines but where he or she faces difficult financial circumstances, for example, costs arising from an illness. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses. Greater discretion is being exercised by the HSE as is evidenced by the number of discretionary medical cards in circulation, which has increased from approximately 52,000 in mid-2014 to nearly 96,000 on 1 November this year.

On foot of the Keane report, published last year, the HSE established a clinical advisory group to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system. The group is continuing its work on the development of guidance on assessing medical card applications involving significant medical conditions. I hope this clarifies the matter for the Senator and reassures her that the HSE endeavours to operate in a fair manner within its legislative framework.

The reason I did not supply the details is because I am talking about a policy rather than an individual but I will supply the details to the Minister of State to show that what I outlined has happened. According to the reply, the Minister of State said any student with an income of €164 in his or her own right will be assessed on his or her own means. Is that correct? Does that mean any student whose parents do not have medical cards but where he or she is working part-time and earning €164 will be assessed on his or her own merits? I wish to clarify that point.

That is grand. Basically, what we are saying to students is that they are far better off to earn their own income and to get more than €164 a week and they will get a medical card even if their parents are not entitled to one. I wish to clarify that the change was made across the board and that the PCRS was not picking and choosing who to assess and who not to assess. I will supply the Minister of State, Deputy Kathleen Lynch, with the details to show that it is happening as she does not appear to be aware that is the case.

Autism Awareness

I welcome the Minister of State, Deputy Jimmy Deenihan, to the House.

I welcome my fellow county man, the Minister of State, Deputy Jimmy Deenihan, to the Seanad. I raise the need for the Minister of State at the Department of Health with special responsibility for primary care, social care, disabilities and older people, and mental health to introduce Ireland's first ever national autism awareness week from 1 April to 8 April 2016 and to have Ireland's first ever national autism awareness day on 2 April 2016 as a commencement debate. This is a very important matter and one which I will champion. The reason I have suggested 1 April to 8 April is that it coincides with World Autism Week, and 2 April coincides with World Autism Day.

For too long, people with autism have suffered in silence, many not even knowing that they have the condition. More must be done in order to highlight autism and its effects. I have been in contact with Irish Autism Action which agrees with me that we need to educate society about autism. It is its belief and mine that the people of Ireland are unaware how many suffer with autism. Irish Autism Action refers to a study which shows that one in 100 people in Ireland suffer with this condition at some level on the spectrum. However, that might be a conservative estimate, as in the UK it is believed that one in 88 people are on the autism spectrum.

The purpose of this Commencement debate is to raise awareness about autism. For every one that has the condition, five to six other people in the family are also affected. It is important that this message is delivered throughout society, and to one and all, to let people who are dealing with autism on a daily basis know that they are not on their own. The Government has implemented a number of measures to help improve the lives of people with autism. An additional €4 million was allocated in 2014 to assist in the implementation of the progressing disability services programme, equating to approximately 80 additional therapy posts. Further investment of €4 million has been provided this year to support the programme's ongoing implementation.

Improving access to therapy services for children in primary care and in disability services is a particular priority for the Government. Additional funding of €12 million was allocated by the Health Service Executive to meet the needs of approximately 1,400 young people who required continuing health-funded supports on leaving school or rehabilitative training this year. However, we can and must do more. We can also look to the Step Ahead programme and, in turn, roll out the programme throughout the country. Step Ahead is a unique 14 week interdisciplinary programme, providing both direct intervention and parent training and education to children under the age of five diagnosed with an autism spectrum disorder. The child receives four hours of direct support weekly, two hours each Monday and Thursday, by skilled interventionists under the guidance and direct supervision of the team's speech and language therapist, occupational therapist and board certified behaviour analyst. The aim of the programme is to provide meaningful assessment across all early learning domains to establish strengths and needs, identify the most effective individualised intervention strategies and support parents to learn the intervention techniques to promote continued growth beyond the duration of the programme. Ultimately, the goal is to encourage at as young an age as possible those skills necessary to benefit from the most naturalistic and inclusive settings. We need to help extend this model to more families.

I thank Senator Sheahan for raising this issue today and I compliment him on his presentation and its content. I am pleased to outline the position on the situation on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch.

I am aware that every year, autism organisations around the world celebrate World Autism Awareness Day in early April with unique fundraising and awareness-raising events. This is a very good way of maintaining focus on citizens with autism and their families. However, what has struck the Minister of State, Deputy Kathleen Lynch, again and again, is that the one thing that people with a disability want more than any other, regardless of their condition, is to live as normal a life as possible in the community and to have the same opportunities as all other citizens to participate in their community. Government policy in relation to disability is not condition specific and encompasses all citizens who have a disability. At this stage, the Minister of State does not believe there is a need to introduce a specific national autism awareness week.

The Government is already committed, under the national disability strategy, NDS, to ensuring that people with autism are empowered by policy and programmes to participate meaningfully as citizens in society. The NDS is driven by this basic but fundamentally important objective and is the most effective combination of legislation, policies, institutional arrangements and services to support and reinforce equal participation for all people with disabilities.

A comprehensive consultation process is under way with a view to putting in place a new national disability inclusion strategy. This process is being led by my colleague, the Minister of State, Deputy Aodhán Ó Ríordáin. This will allow interested parties to make recommendations in key areas such as service provision, accommodation, health, employment, and education.

The Cabinet committee on social policy has been examining issues around autism across Departments in association with the National Disability Authority, NDA. This work by the NDA, which has included consultation with families, has been of significant assistance in informing how best to address the needs of people with ASD as part of the national disability strategy, which covers a wide range of policy areas across Departments and agencies, so that we can be sure that they are appropriately reflected and included in policies and actions. The proposed approach was also discussed with the national disability strategy steering group. A programme of specific measures has now been agreed for delivery by the relevant Departments and agencies, including specific actions to be delivered by the NDA.

I thank Deputy Deenihan for his reply on behalf of the Minister of State at the Department of Health, Deputy Kathleen Lynch. I am quite disappointed that she does not feel there is a need to introduce a specific national autism awareness week. Why is that the case? We want to highlight autism and it would be of no cost to the State or Department. I believe strongly that we should have a national autism day and week in order to raise awareness of autism spectrum disorder. I will speak directly to the Minister of State, Deputy Kathleen Lynch. The only direct question I have for her is why can we not have a national autism day and week to highlight autism, the people who suffer from it and the families that live with it every day?

I will convey Senator Sheahan's comments to the Minister of State. His commitment to having an awareness week is very much reflected in his contribution here this morning. It should be examined further and I will request that the Minister of State facilitates this.

Charities Regulation

I thank the Minister of State for coming to the House. I wish to discuss the position in respect of the charities regulator. Even though the relevant legislation was enacted in 2009, the regulator was not put into place until 18 months ago. The Minister of State is very involved in the area of philanthropy, fundraising and charity. I am here to speak on behalf of the Exchequer, the public and the charity sector. One has to look into every section of the Government. We gave between €4.5 billion and €5 billion to the charity sector. I have read the answer given by the Minister for Justice and Equality in reply to a question in the Dáil recently. The regulator is in place but when will the Minister seek to give it teeth? There are problems and Christmas is coming. I am involved in a very good charity, the Jack & Jill Foundation, of which the Minister of State will be aware. Trust is a word that is terribly precious in our society. The Irish are incredible givers but trust is in short supply with charities because of events that occurred in recent years. In addition, information relating to other events is out there and will come to the surface.

I visited the Office of the Scottish Charity Regulator, OSCR, which does a very good job of administering 23,500 charities. It has 55 employees and a budget of £3.5 million. I am glad the Minister of State has increased the budget of the Irish regulator to €2.66 million for 2016. Perhaps this will help us to reach the necessary level. I hope the Minister of State will not give me the comforting answer that the regulator has compiled the statutory register of charities and is waiting for the remaining charities not established under the Companies Registration Office, CRO, to put in their paperwork and register. Before this regulator was put in place, the Irish Nonprofits Knowledge Exchange, INKEx, had a register ready to go and most charities are registered with the CRO, so most of that work has been done. The public needs to know that charities are using their resources correctly and who exactly is responsible for running a particular charity. It also wants to know that the Government has an up to date database of charities, that charities are compliant, what is spent on marketing and payroll and where exactly their money is going.

On behalf of the Minister for Justice and Equality, Deputy Fitzgerald, I thank Senator Mary Ann O'Brien for raising this important issue. The Minister regrets that she cannot be present here this morning because of pressing issues.

The Charities Regulatory Authority was established as an independent agency on 16 October 2014 under the provisions of the Charities Act 2009. The aim of the authority is to provide better regulation of charitable organisations through a framework of registration, regulation and support. This framework is intended to enhance public confidence in the vast majority of charities which do immense work to improve outcomes and circumstances for those they are established to help. As was indicated by the Minister for Justice and Equality on the establishment of the authority, it has a wide range of functions under the Charities Act 2009, which are being introduced on a phased basis, beginning with the compilation of the statutory register of charities. The initial priority of the authority was the development of the register. Some 8,500 CHY charities with tax exemption status were registered automatically on the register of charities on the establishment of the authority. In addition, any charity established before 16 October 2014 and not automatically registered must apply directly to the authority for inclusion on the register by 16 April 2016.

The authority has undertaken a variety of work since its establishment, including the establishment of the register of charities and a fully online system for registration and annual reporting by charities; communication with the 8,500 CHY charities with tax exemption status regarding the additional information and legal documentation required to support their registered status; development of an online system for organisations to apply for inclusion on the register of charities; provision of information to the charities sector on its obligations and duties under the new regulatory regime; and the continuation of services hitherto provided by the commissioners of charitable donations and bequests for Ireland.

The range of services to be provided by the authority is being developed on an ongoing basis. These services include the development of an annual reporting framework for registered charities, the development of a monitoring and compliance programme and the development of the investigative role of the authority under Part 4 of the Act, which has not yet been commenced. The register, when more advanced, will underpin the investigative and other regulatory work of the authority. In the meantime, the authority has put in place an interim process for the handling of complaints it receives about suspected abuse of charitable status or fraud in charities.

Under this process, all complaints received in writing will be subject to an initial review and assessment by the authority to determine whether any further action is appropriate. The Minister for Justice and Equality is committed to ensuring the authority has the necessary resources available to enable it to fulfil its statutory mandate. Significant additional resources and a budget allocation for 2016 of €2.665 million, which represents an 88% increase on the allocation for 2015, are being made available to the authority. This includes additional funding of €1.25 million which will enable an expansion of staffing levels and other resources available to the authority in 2016. The approval of additional staff for the authority during 2015 and the provision of significant additional resources in the 2016 Estimate to facilitate the recruitment of further staff amount to clear evidence that the Minister is determined to ensure the authority is appropriately resourced.

I thank the Minister of State for his reply from which I do take comfort. I ask him to imagine an analogy. If he and I had started a business and were spending €4.5 billion in approximately 12,000 charities, we would want to know which of them were efficient, how the funds were being used and the value being delivered to the taxpayer. I welcome the extra budget provision, for which the Minister has fought, for the regulator. I hope the Minister of State, following our interaction, will inform the Minister that I cannot stress enough the importance of this matter. The public wants to go on giving, but we need to give the regulator teeth. If there are complaints or inefficiencies in the sector, we need to give enough money to the regulator to staff the authority.

I referred to the Office of the Scottish Charity Regulator, OSCR. Scotland has a similar charity landscape to ours. We can achieve a satisfactory result. The sum of €4.5 billion is a lot for the Exchequer. One could sleepwalk into the area because a lot is going on. We have to keep trust in the sector and the sector on the straight and narrow. It is wonderful. If we were to talk long and hard about it, we would find every single sector of Irish society was dependent on the charity sector. For instance, there are many good charities doing work in the medical, hospital, education and disability fields.

I thank the Senator for raising this important issue. Like her, I, too, am involved in a number of fundraising initiatives and have been so involved for possibly the past 40 years. I agree that where there is considerable Exchequer and private funding involved, it is important to ensure the confidence and trust of the donor are paramount. Otherwise people will stop giving. I empathise with what the Senator is saying and assure her that the Minister for Justice and Equality is fully cognisant of the need to ensure the highest standards of transparency and good governance in the charity sector. Accordingly, she is committed to ensuring the Charities Regulatory Authority will be an effective regulator of the sector.

Among the principal functions of the authority set out in section 14 of the Charities Act 2009 is the requirement for the authority to increase public trust and confidence in the management and administration of charitable trusts and organisations. The staffing of the authority has been increased since its establishment on 16 October 2014. It must be noted that the authority is just more than one year old and still very much in a capacity building phase. The significant increase in resources being made available by the Government to the authority in 2016 is a clear signal of the Government's determination to ensure the authority will continue to expand its range of activities and become a strong regulator of the sector.

Middle East Issues

On 22 October and 10 December 2014 Seanad Éireann and Dáil Éireann, respectively, adopted motions calling on the Government to recognise the state of Palestine. A wave of EU parliaments, including those in the United Kingdom, France and Spain, have passed similar motions. In most cases, recognition is part of an overall approach to the Middle East peace process. In May 2015 the Vatican concluded its first treaty formally recognising the state of Palestine, with an agreement on church activities in areas controlled by the Palestinian Authority.

After this House and the Dáil passed the motions referred to last year, the Minister for Foreign Affairs and Trade, Deputy Charles Flanagan, stated in the Dáil that he was open to early recognition, if that would be helpful. The Minister said he would reflect on the question, including by engaging in a reflection at EU level on the European Union's overall approach to the Middle East process. This reflection was initiated by High Representative Mogherini. The Minister has also stated a move towards recognition would help to jump-start a peace process that has stalled.

One year on I am very disappointed that the Government has not acted on the recommendation of the Seanad and the Dáil. The latest direct negotiations between Israel and the Palestinians broke down in March 2014 and there is no expectation of a resumption of the negotiations in the foreseeable future. There is no political or peace process in being. The latest Israeli Government, formed by Prime Minister Netanyahu in May, is a coalition of nationalist and religious parties, most members of which are openly hostile to the establishment of a Palestinian state and support ongoing expansion of the legal settlements. On the Palestinian side, the Palestinian factions are fragmented. The West Bank and Gaza are disconnected and there are serious leadership and legitimacy issues.

The Minister appears to be waiting for a broader EU consensus to grow on the issue of recognition of Palestine. One third of the member states of the European Union already recognise Palestine, with Sweden being the most recent, having done so last year. Given the division among EU member states on the issue, consensus is unlikely to be reached in the short term. Granting recognition is a member state competency; it is not one which is reserved to the European Union. This would be a progressive measure for Ireland to take and one which does not require consensus at EU level. A full year on since the motions were passed by the Oireachtas, it is clear that it is time for Ireland to follow the example of Sweden and recognise Palestine without further delay.

I have tabled this matter to draw the Minister's attention to it and, in particular, to the fact that more than one year has passed since the motions were passed by the Seanad and the Dáil. Will Ireland now move to recognise Palestine without further delay?

I thank the Senator for raising this issue. The Minister regrets that he cannot be in attendance and wishes for me to convey his apologies to the Senator in that regard.

The achievement of a sovereign Palestinian state, recognised not just by Ireland but by everyone, including Israel, has been a major foreign policy objective of the Government since it took office. It is something we seek to achieve in reality, not just in words, and all of the Government's actions in relation to the Middle East conflict are directed towards that end. Only a two-state solution, with a Palestinian state existing alongside and in peace with Israel, can satisfy the need of both peoples for security and prosperity.

Last year the Seanad, on 22 October, and the Dail, on 10 December, passed motions calling on the Government to recognise Palestine and to help to achieve a two-state solution. The Government did not oppose or seek to amend the motions which were calling for something on which we were already working. There were similar motions in other European parliaments, prompted by the decision of Sweden in October to recognise Palestine. In Ireland, as in most countries, recognition of sovereign states is a matter for decision by the Government. The views of the Oireachtas are, of course, a very important factor in that consideration, but it remains for the Government and, in the first instance, the Minister for Foreign Affairs and Trade to consider if this would be an appropriate step and, if so, when it might be best to take it.

With other Ministers, the Minister spoke in the Dail debate on 9 and 10 December. They set out in detail the Government's view on the issue. The Minister made it clear that, while successive Governments had always seen recognition as part of an overall peace agreement, he had no difficulty with early recognition by Ireland if he felt it could be helpful to the situation, that is, the efforts to reach such a peace agreement.

The statements in that debate also set out, in more detail than I can state today, the many and various factors which the Minister would weigh up when making that decision. We all know that recognition by Ireland will not of itself bring a Palestinian state into being. We need to consider not just the positive symbolic significance that recognition might have for Palestinians but also what effect it might have on the Israeli side whom we seek to influence and persuade. We must consider how it might affect Ireland's influence and voice on the issue both in the region and in international discussions, particularly at EU level, and any impact it might have on Ireland's ability to continue its work on the ground. There are potential downsides to be considered as well as gains.

In terms of timing, clearly some events in the past year would have weighed on the consideration as regards when might be the right moment for a decision to be made on recognition. These include the lengthy election and coalition building process in Israel in the first half of the year, the continuing debate in the EU on Middle East policy and latterly the upsurge of violence in Jerusalem and elsewhere. During that period, the Minister has visited Israel and the Palestinian territory. He has also discussed the recognition question with some EU colleagues and the Palestinian Foreign Minister. It is also worth noting that no further EU partner has followed Sweden's example and recognised Palestine. The Minister for Foreign Affairs and Trade is continuing to consider the question of early recognition by Ireland of the state of Palestine.

I thank the Minister of State for his reply and appreciate that he will bring this issue to the attention of the Minister. I wish to stress that recognition by itself will not end occupation and only Israel can do so. Ireland's recognition of the state of Palestine would have enormous symbolic significance.

Last year, after this House passed a motion that I had initiated, I was invited to speak at a UN conference on Palestine that was held in New York. At the conference other countries warmly welcomed the fact that Ireland had taken such a step and there was a sense that it would be positive and helpful if more countries did so. The Minister of State pointed out that Sweden had been the only EU state to have recognised Palestine. Twelve to 18 months have elapsed and one third of the EU already recognise Palestine so there is a significant group.

Throughout its history Ireland has had a proud tradition of standing out and not just following the herd, and waiting for common consensus. On issues of human rights and international justice, we have proudly stood out and led the way and this is another area where we need to do so. As Trócaire has pointed out, the recognition of the state of Palestine would be anti-occupation and not anti-Israel. Ireland has recognised the State of Israel and recognising the state of Palestine would help to create a parity of status which could only be helpful in getting the peace process off the ground and jump starting it which the Minister said was necessary a year ago. I ask the Minister of State to bring my remarks to the attention of the Minister and to ask him to correspond with me directly when he has had a chance to consider the issue again.

I thank the Senator and congratulate her on being invited to speak on this issue at the UN. Both the Minister for Foreign Affairs and Trade and the Government are quite willing to move on early recognition of Palestine if it is concluded that it can be helpful, and if now is the right time. Such a commitment is significant and sends out a very clear message of support for a Palestinian state. The Minister made this viewpoint very clear during the debate in the Dáil last year, as well as the factors which would guide that consideration. I know that he is continuing to carefully consider this question. I will be happy to advise him of the arguments advanced by the Senator here today and I advise her to write to him directly. I know from speaking to the Minister that he has a special interest in this area. He has travelled to Palestine and Israel so he has a very good understanding of what is happening on the ground there and he has seen it at first hand. I am convinced that he will make the vital decision on recognition when it is appropriate.

Sitting suspended at 11.15 a.m. and resumed at 11.30 a.m.