I thank the Cathaoirleach. I thank the Minister of State for taking this Commencement matter this morning. It is disappointing that a line Minister is not here. If there are outstanding items, I would appreciate if I could get a response in writing. This issue will not be a new one for the Minister of State. I am sure his office deals with queries about medical cards in the same way my offices in Waterford city and Dungarvan do on a regular basis. He will also know the stress and strain periodic reviews of medical cards for those aged over 70 can cause. Generally, that generation is not as tech-savvy as the Minister of State or myself. There are some who are, of course, very tech savvy, but in general they need assistance from family members. Often, they do not have family members there to assist them with downloading and printing off statements and so on. The stress and strain it causes are significant. The fear of losing a medical card is very real, even though numbers indicate that the number of over-70s in receipt of medical cards has increased every year from 2020. The data, which I reviewed in the HSE publications, showed that in February 2020, 359,722 persons aged 70 and over were in receipt of a medical card. This accounted for 23% of all medical cards issued. Data from this month showed that 390,676 persons aged 70 and over are in receipt of a medical card. This accounts for 24% of all medical cards currently held. That data shows that despite periodic reviews of this cohort, generally every three to four years, the number of over-70s with medical cards has not dropped. The reason is simple; this age cohort, generally, is on a fixed income, in retirement and, barring taking up employment or winning the lotto, its income and means are not going to change. Despite this, the HSE is paying significant amounts for reviews of this cohort. It is a pointless exercise. How much money is being spent by the HSE on reviews of medical card eligibility? Whatever that figure is, if it is multiplied by 24%, that is the saving that could be made by ceasing this practice. If someone over 70 goes through the assessment process and is deemed to have an entitlement to a medical card, he or she should not have to go through a periodic review process every few years, save where they take up employment. That could be stipulated in the regulations. I can only think of a handful of cases in my 15 years as a politician in which, on review, a medical was removed. To park the hardship, stress and strain it causes for older persons, on a cost-benefit basis alone, there are significant savings to be made by ceasing the practice of reviews of medical cards for over-70s. I stress that it is over-70s. I am not saying that reviews should be ceased for all cohorts but this cohort is generally on a fixed income.
Nithe i dtosach suíonna - Commencement Matters
Departmental Reviews
I thank the Senator for raising this important matter of what annual savings are made from periodic reviews of medical cards for over-70s versus the cost of carrying out those reviews in light of the increased income and means test thresholds. I have experienced the same situation in my office. Often, even those who have them removed get them back on review or appeal. I welcome the opportunity to update the House on this matter. Eligibility for a medical card is primarily based on a financial assessment conducted by the HSE in accordance with the Health Act 1970, as amended.
The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn in a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means-tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the universal social charge. Certain expenses are also taken into account.
Persons aged 70 or older are assessed under the over 70s medical card income threshold, which is based on gross income. In November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1,050 for a couple. Since 2015, every individual aged 70 and over has automatic eligibility for a GP-visit card.
The HSE is required to ensure that all applications for new medical cards and all renewals of existing medical cards are issued in accordance with the Health Act 1970, as amended. For the majority of individuals this involves ensuring that the relevant financial thresholds are satisfied. It is important to note that the implementation of a review of medical cards upon reaching their expiry dates is not undertaken to deliver savings, rather it is carried out with a view to ensuring that the HSE is complying with Government policy and legislation on medical card provision. The granting of eligibility through means-testing is considered an objective, fair and equitable approach to providing eligibility to persons with lower incomes. The qualifying threshold calculation takes into consideration the applicant’s particular expenses as well as their income as information regarding these is necessary to validate the applicant’s eligibility for medical card or GP-visit card.
The HSE has given the Department of Health the following information regarding medical cards for people over 70. Any medical card approved for an individual over 70 is usually provided for four years. A total of 194,770 of such cards for individuals over 70 were due to expire in 2023. Of those expiring cards, 89% were extended for people based on information available to the HSE without the need to contact those people directly and only 11% of expiring cards required direct client engagement. Of the 19,347 full applications assessed fewer than 1,000 did not retain medical cards. Any individual not retaining a medical card would retain a right to an over 70s GP-visit card.
Insofar as it can, the HSE seeks to limit the number of people over 70 who are asked to formally engage with the application process. It does this based on a data-driven approach, while also ensuring that it complies appropriately with its statutory responsibilities regarding financial assessments.
To ensure the medical card system is responsive and sensitive to people's needs, the Department of Health keeps medical card issues, including the current medical card income thresholds under review. Any changes are considered in the context of Government policy, the annual budgetary Estimates process and other issues which may be relevant.
I thank the Minister of State. I note that only 20,000 of the 194,000 medical cards for those age 70 and over that expired in 2023 were reviewed. However, as he can see from the data, fewer than 1,000 were ruled ineligible, which is 1,000 out of 194,770 persons over 70. I specifically asked for the cost of carrying out those 20,000 reviews and the Minister of State did not provide that information in his reply. I know it is not done on a cost-saving basis. I am sure that the Minister of State will agree with me that common sense should prevail. Where fewer than 1,000 are deemed ineligible following a review out of 194,000, we need to consider the cost savings that could be made let alone the stress and strain caused to individuals and families. The Government needs to review this. The policy needs to reflect common sense. I feel that common sense is not being applied in this area.
I again thank Senator Cummins for raising this important issue. He is correct in saying that the actual cost was not provided by the HSE. As I have said, eligibility for the medical card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970, as amended. In this regard, the HSE is required to ensure applications for a new medical cards and renewals of existing medical cards are issued in accordance with the Act. However, insofar as it can, the HSE seeks to limit the number of clients over 70 who are asked to engage with the application process.
Any medical card approved for an individual over 70 is usually provided for four years. According to the HSE, based on the 2023 figures, 89% were extended for people based on information available to the HSE without contacting the client. Of the remaining 11%, the 19,347 with full applications assessed, fewer than 1,000 did not retain the medical card. To ensure the medical card system is responsive and sensitive to people's needs, the Department of Health keeps medical card issues, including the current medical card income thresholds, under review. I will certainly bring to the Minister's attention that in the response, the HSE has not provided the specific answer to the question the Senator raised.
I would appreciate getting that in writing.
I welcome our guests the Public Gallery.
Health Services
I welcome the Minister of State, Deputy Rabbitte.
I am particularly pleased to see the Minister of State, Deputy Rabbitte, arriving in the Seanad Chamber. She is directly responsible for the disability sector. It is always great when the line Minister with responsibility, with knowledge, with expertise and with her finger on the pulse in terms of the policy comes to the House. I am not so sure that she has her finger on the purse but she certainly has in terms of the policy. I thank her for coming to the Senate on this important issue.
My Commencement matter today deals with the crisis in the St. John of God services. Families of the service users there are deeply concerned about the proposed change over from St. John of God Community Services to the HSE. To set some context, St. John of God Community Services provides residential and community care for over 8,000 people. That was a surprise to me. I am very familiar with the service. I am very familiar with the exceptional work the staff, the brothers of the Hospitaller Order of St. John of God and their board do, and more importantly what the volunteers, parents and family members do in providing such a comprehensive holistic service. It is important that we do not lose sight of that and acknowledge that.
It is providing care for over 8,000 people with intellectual disabilities, and mental health, special educational and training needs. It employs over 3,000 people. It is a huge community. It is a workers collaborative and includes the families, volunteers and of course the order itself whose very ethos is care, humanity, dignity and respect for all the order comes in contact with. It is important that we do not lose sight of that. That vision and ethos are rich in its work.
The St. John of God service has made the case for years that the level of State funding provided is not sufficient to cover the costs of providing the appropriate care and services needed. The Minister of State will be aware that St. John of God Community Services has been in negotiation with the HSE for several years. It claims there is a shortfall in funding to meet the needs of its services and to address the deficit. The failure to find agreement on sufficient levels of funding despite three years of talks is devastating and a setback for all involved. It is causing unnecessary anxiety. I have had calls from people in Dublin, Kerry, Kildare, Wicklow, Meath and Louth who are availing of these services and are really concerned.
At the very core of this issue is the accumulated deficit in the financial operation and the sustainability of St. John of God Community Services. In the limited time available, I would like to hear a quick overview of where we are going from now. When will the Minister of State be sitting down with the chief executive and the board of St. John of God services? Hopefully she has already done so. Is there a plan or a schedule to meet them in the coming days to iron out the difficulties?
In December the Minister of State launched the Government's disability service action plan for 2024 to 2026.
I have printed the press releases and the various media statements on this. The plan speaks about key priorities for the period, measures to increase the capacity of children's disability services, expanding respite services, and having extra residential places, extra home supports and personal assistants and services. There is a real need to get this going. There is a need for major financial support of, and investment in, St. John of God Community Services and others.
A total of 8,000 people are in the care of one organisation. We need to look at this again. When there is a crisis in an organisation that has this amount of responsibility, it leaves the State and everybody very exposed. I am here to listen to the Minister of State. We may need a further debate on this as time goes by. I am conscious these are sensitive times. This is a time for negotiation. The Minister of State knows the finer detail of it. I would like to take away from here today when the Minister of State will look these people in the eye and facilitate a meeting between herself, the HSE, and the board of St. John of God Community Services.
I thank Senator Boyhan for raising this important matter for discussion in the Chamber today. As he quite rightly said, St. John of God Community Services provides services for 8,000 of our most vulnerable citizens across their entire life spectrum. It has 3,000 staff working for it. There is a collaborative approach, with the person at the centre, between the staff, the parents and the volunteers. A lot of parents whose young person has gone through service also give back their time.
The HSE has worked intensively with the organisation throughout the sustainability impact assessment process to address financial and operational sustainability challenges. The Government's clear preference is for St. John of God Community Services to continue to provide these services if this is possible. Most recently the HSE, with the backing of the Department, reaffirmed a strong commitment to support its service provision. As recently as last Thursday, the HSE's chief executive officer, Bernard Gloster, set out an extensive package on offer to St. John of God Community Services in addition to the €200 million. Notably, the HSE's financial projections indicate the service provider will achieve a break-even position in 2024 as it has done since 2019. Since 2019 we have worked with St. John of God Community Services and provided additional funding to ensure the continuation of the exceptional service it delivers to meet the needs of the most vulnerable and, at the same time, balance this with ensuring the service breaks even.
The HSE and the relevant Department was, therefore, surprised and disappointed last week when the board of St. John of God Community Services indicated its decision to commence a transfer of services to the HSE. This prompted further high-level engagement over the weekend. I am conscious of my language here this morning. I need to keep it very measured because intensive negotiations are taking place. As I stand before Members, the board of St. John of God Community Services is meeting. The Department is meeting the people from the HSE involved in the SLA. I felt it was incumbent on me to respond to the Senator this morning, which is why I am here. A lot of intensive and sensitive negotiations are going on.
The CEO of the HSE met directly with representatives of the board of St. John of God Community Services at 3 p.m. on Sunday. He followed this with an extensive letter yesterday morning. Engagement between the parties is ongoing and it is important that we provide every opportunity for an outcome that would avoid the transfer of services. All parties acknowledge this would be in the best interests of service users, their families, service staff and public confidence.
Significant work on the sustainability impact assessment process has provided a pathway to sustainable high-quality services that meet service users' needs and address corporate governance considerations. It is important to me, in the same context as Senator Boylan mentioned the disability capacity action plan, to acknowledge that St. John of God Community Services is not the only service provider that finds itself in this situation. This is why it is important that we find a sustainable pathway out of crisis and deficit.
The HSE, backed by the Department, remains committed to following through on the outcome of the process and has communicated to St. John of God Community Services that additional funding is available to enhance the services and support related reforms. As the Minister of State with responsibility for disability, a key ongoing objective of mine is to ensure appropriate funding is available to deliver quality services for people with disabilities. We committed to finding innovative solutions to these systemic challenges by continuing to work with HSE, service providers, staff and service users. The organisation has received close to €1 billion in funding since 2019. I will continue to work closely with the HSE to ensure appropriate funding is available to service providers. I assure the staff, service users and families that the HSE, backed by the relevant Department, is committed to funding St. John of God Community Services. Senator Boyhan asked me when will I look people in the eye. I sent an email last Friday.
Sending an email is very different to looking someone in the eye.
I have requested it. I am awaiting a response.
The Minister of State said she was measured in her words and so am I. I have correspondence in front of me that I could have read into the record but it would not be appropriate because it is sensitive.
I appreciate that.
We know that EY has completed a report into St. John of God Community Services on the financial deficit and has confirmed that €27.9 million - let us be precise - is the accumulated deficit as a result of the SLA for St. John of God Community Services. I wish the Minister of State well and I wish everyone well. This is a time of working together. At the end of the day the focus here, as the Minister of State rightly said, is beyond St. John of God Community Services. There are other challenges for other people. The focus has to be the responsibility for residential support for the families who are left with people with disabilities. Many of them now rely on older parents, foster parents or family members. I thank the Minister of State and I want to work with her. I hope we can progress these matters.
I finished by saying I issued an email. It was issued in the context of wanting the process to work. The process has to work and not only for St. John of God Community Services. I have to believe that in the Department and in the HSE under the leadership of Bernard Gloster, the process works. It is one thing to ensure we have sustainability to deliver services. The other part of the process is to address the outstanding deficit. I wish both parties, St. John of God and the HSE, well. I believe both want a positive solution and both look at having the person at the centre, as does Senator Boyhan and as do I. We cannot be sellotaping on a year-by-year basis. We need a long-term solution and I am committed to this.
Road Projects
I thank the Minister of State for coming to the Chamber for this debate on the A5, the N2 and the TEN-T in the North. It was fantastic that there was an announcement yesterday of €600 million for the A5. It is brilliant news. I would like to know where everything moves from here. The A5 has been the blockage for so long. I remember being told on air by some of the Acting Chair's colleagues in Donegal not to worry about the A5 because Conor Murphy, the Minister in Northern Ireland, was dealing with it and it would be sorted. This did not happen.
We hope the funding is back on the table. Stormont is back up and running and we hope the A5 will now start to move with progression. Projects were held up on the Southern end and Northern end. I am particularly dealing with the Northern end and the TEN-T project. It is important that they all move forward. I know the Department has a case study on the TEN-T. This must come to Cabinet and it needs approval. Perhaps the Minister of State will brief us on the projects, including the TEN-T in the North, the A5 in between and N2 Clontibret piece at the bottom. Will the Minister of State give us an update on this?
I remember meeting the then Taoiseach more than 20 years ago to lobby for the N2 and A5. That was back at the time the national development plan was announced. Many other projects were also announced, such as the M1, the N4, the N6 from Galway to Dublin, the Limerick to Cork route and the famous Waterford route.
Back at that time the N2-A5 at the midway point had the exact same traffic volumes in 2000 as the Galway to Dublin route had. It had greater traffic volumes than the Limerick route or the Waterford route. Now, almost 25 years on, we are still awaiting our project. Because of that, we have fallen back as a community. We are not getting the same opportunities. Without those business opportunities, it is not possible to create the same jobs, leading to a brain drain that is a strain on our economy. It is really important that we drive these projects on as speedily as we can.
I thank the Senator for raising this important matter on the status of Irish Government funding for the N2 and A5 Dublin to Derry route and also the important issue of TEN-T. As he will be aware, the Government’s commitment to the A5 upgrade was discussed at Cabinet yesterday and an allocation of €600 million was confirmed for this project. This financial commitment towards the costs of the A5 road upgrade project will sit in parallel with the progression of planning and design work on the related N2 Clontibret and Donegal TEN-T schemes. The scale of this financial commitment is indicative of the significance of the A5, and of the related Donegal TEN-T and N2 Clontibret upgrades, for the north-west region and cross-Border connectivity on the island.
The Government welcomes the restoration of the power-sharing institutions in Northern Ireland and we are optimistic that yesterday’s announcements will send a positive signal of the Government’s ongoing commitment to working together. In particular, we look forward to the early resumption of meetings of the North-South Ministerial Council. The North-South Ministerial Council is the formal institution of the Good Friday Agreement with the mandate to advance practical co-operation on a North-South basis. The Government will work closely with the new executive, including on the many areas where North-South co-operation makes a positive difference to communities on both sides of the Border, such as the matter in question.
The funding announced yesterday illustrates the Government’s long-standing commitment to the upgrade of the A5 and its desire to see swift progress on its construction. This upgrade is long-overdue and is of paramount importance for the improvement of safety and mobility on the island of Ireland. We strongly believe that the allocation of €600 million of Irish Government funds towards the upgrade of the A5 will provide a critical impetus to this important project - a project which when completed will provide a tangible positive impact for people across the island.
Not only will this infrastructure project improve lives and opportunities in the north west, it is also a demonstration of the Government’s belief in the benefits of collaborative investment in large-scale all-island infrastructure. This is the driving rationale behind the shared island initiative, building a more confident, inclusive and prosperous island that delivers for everyone, North and South.
The commitment to the A5 and better connecting Dublin, Derry and the north west exemplifies the tangible benefits of cross-border investment co-operation and is indicative of the myriad of possibilities available through partnership with both the new executive and the British Government. We hope that the Government contribution will facilitate the project in proceeding as quickly as possible, in conjunction with confirmation of funding from other sources. The Government is optimistic that the upgrade of the A5 and N2 is but one example of where we can enable the creation of a more connected, safe and prosperous island.
I agree with everything in the Minister of State's statement. Yesterday's news that the Irish Government's money is back on the table was absolutely fantastic. I implore both the UK Government and the Stormont Administration to step up now and make this project a reality. I ask the Minister of State to take a message back to the Minister, Deputy Ryan, and the Department of Transport. The case study for the TEN-T project is with the Department and is due to come to Cabinet. I would like the Minister to put urgency on that project. It needs to happen. There is a complete logjam in the town of Letterkenny at the moment.
There is a four-pronged approach in that project: the Ballybofey-Stranorlar bypass; the route down Lurgybrack on to the N14; the new bypass in Letterkenny, the bridge across the River Swilly; and the road that will join up to the A5. It is a four-pronged project, taken as one project. It is a very significant piece of infrastructure. Now that progress is happening on the A5, this project can now also progress. I would like the Minister for Transport to give this the urgency it needs.
Again, I thank the Senator for raising the very important matter of the delivery of funding for the A2 and N5 Dublin to Derry route. He welcomed the Cabinet decision to allocate €600 million for this very important project. This funding is now confirmed. He has been fighting this cause for some time and has been lobbying intensively to get this funding across the line. The funding that has been announced is very important.
The improved connections between Dublin, Derry and the wider north-west region through this infrastructure project will provide multiple benefits, including for trade, tourism, investment and road safety. It has been the consistent expectation of business and community stakeholders that the road be built and this must be delivered.
We hope that the resumption of activity of the North-South Ministerial Council will enable the Government to engage constructively with the executive in Northern Ireland to further this project without undue delay.
The Government is aware of the value and importance of North-South connectivity. This funding will not only benefit Donegal and Derry, but will benefit the much wider area in terms of support for the communities right across the north west and connectivity down to Dublin.
Arts Policy
I thank the Minister of State for being here. I received apologies from the Minister, Deputy Catherine Martin, which I appreciate.
I want to get a sense of what the Government is doing on workspaces for artists. The availability of workspaces for artists throughout the country in both urban and rural areas has been an issue for as long as I can remember. A recent Dublin City Council audit found that there are only 529 workspaces in Dublin. That needs to be considered in the context of a city that has a 17% office vacancy rate, which shows how unjust it seems to be.
There is a market failure in the arts, which need Government support. I welcome the chance to get an overview from Government. The Department needs to do more in this regard. There is a consensus based on work Dublin City Council has done on this. The creative and cultural sector can be characterised by very out-of-date research. I commend the work that councillors in Dublin city have done in pushing for an audit and changing the development plan in respect of artists' workspaces, and engaging with artists and communities in the Liberties around Bridgefoot Street and Merchant's Quay artists' workspaces. I am sure the Minister of State will mention that Government money is going into that. It is clear that we now need a once-in-a-generation investment in artists' workspaces.
The national cultural institutions are central to the Project Ireland plan. We need specific investment over a five-year term in artists' workspaces to ensure that this problem no longer exists. We need to have plenty of artists' workspaces to encourage them to stay here in Ireland to combat the creative of our artists going to Glasgow, London, Berlin and elsewhere to find work and to find space. I put this all in the context of the office vacancy rate that exists, but also in the context of the investment the Department of culture and Government will make in the national cultural institutions and in ensuring that we can maximise the artists' workspaces in those institutions.
I thank the Senator for raising this very important issue regarding the need for the Minister for culture to outline what actions are being taken to address the acute urgent need for artists' workspaces across the State. I am taking this matter on behalf of the Minister, Deputy Catherine Martin, who sends her apologies.
She is aware of the pressures that artists and creatives face in finding suitable workspaces, especially in Dublin, and the difficulties with the provision of artistic venues there. Last June, she announced, along with the Lord Mayor of Dublin, details of a €9 million capital works programme called Space to Create. In this case, the Minister announced that €3 million in funding was being provided by her Department to this initiative. The Space to Create project will see 60 artists provided with turnkey workspaces as well as opportunities to use performance and gallery space and flexible office spaces. This funding speaks to the Government's commitment under the programme for Government to increase the provision of affordable workspaces for artists and creative practitioners and ensure the timely delivery of arts and culture investment commitments as outlined in Project Ireland 2040.
Budget 2023 provided a separate allocation of €7 million for the provision of artists' workspaces. It is now proposed that a new capital scheme will soon be opened by the Department to progress this proposal. Under this scheme, local authorities will be invited to apply for funding towards projects that provide artists' workspaces in their towns or cities nationwide on a sustainable basis.
In recent years, other arts and culture capital schemes have been rolled out by the Minister, Deputy Catherine Martin, and her Department. While the primary focus of these schemes is towards the refurbishment and enhancement of existing arts and culture facilities, funding is also being provided towards the provision of additional working spaces for artists in these buildings. A new pilot capital support scheme for arts, culture and the night-time economy will support the development of vibrant late night arts and culture scenes in Irish cities, particularly in Dublin city, towns and villages. This will also provide additional capital to assist artists through the provision of building and equipment needs.
The Arts Council currently provides programming and revenue supports to a range of initiatives such as arts centres and residencies, required to sustain artists nationwide. Record funding of €134 million annual funding for the Arts Council is in place for 2024. The Arts Council is also currently developing, with the Dublin Port Company, the possibility of creating artists' workspaces in buildings in the port area.
I certainly welcome the €9 million. What is probably needed is a longer term strategy that indicates over a government's term how much would be invested in this space, and also to get a sense of how much space is needed. The only audit that has taken place is by Dublin City Council. I wonder if the Arts Council or the Department has done that work. There is empty space everywhere - in private office blocks, public buildings, departmental buildings, and I am sure there is a huge amount of spare space in RTÉ and above shops.
I welcome the memorandum of understanding between the Arts Council and the Dublin Port Company on their intention to repurpose buildings at the Odlums flour mills site at Dublin Port and to turn it into an artists' workspace and campus. That was announced in 2022. At the time the Arts Council said it hoped it would be open by the start of 2025 and that 50 artists' studios would be available there. Is that on track and what is the timescale for it?
I will write to the Minister and thank her for her statement. I thank the Minister of State for delivering it here on her behalf. I will also write to her about the need for an overall national strategy.
I hope that I have provided an overview for the Senator of the work being carried out the Department of Tourism, Culture, Arts, Gaeltacht, Sport and Media. I do not have specific answers to the more detailed questions but I will certainly raise them with the Minister. There has been sustained investment in arts and culture in recent years and in budget 2024 a total of €367.406 million was provided for arts and culture elements of the Department's budget, an increase of €10.424 million from €356.982 million in 2023.
I thank Senator Warfield. I am sure the Minister, Deputy Martin, would join with me in thanking him in particular, as well as other Seanad colleagues for their engagement on this matter.