James Reilly (Dublin North, Fine Gael) | Oireachtas source

I am joined by the Secretary General of my Department, officials from the HSE and my fellow Ministers, Ministers of State, Deputies Alex White and Kathleen Lynch. The committee will be aware there is a time conflict here with the Private Members' business motion in the Dáil. The Minister of State, Deputy Kathleen Lynch, will have to leave at 12.15 p.m. to take that motion. Perhaps when we finish our opening statements, if members have questions on her area of responsibility, the elderly and mental health, they might be taken first.

I thank the Chairman and members of the committee for their invitation to discuss the health service issues. As I said, I am accompanied by my fellow Ministers, Ministers of State, Deputies Kathleen Lynch and Alex White, senior Department officials and officials from the HSE. We will do our utmost to provide the committee with as much information and clarification as possible. I apologise that my opening statement is significantly longer than the norm. However, as requested by the committee, I have addressed a number of substantive issues.

To the forefront of all our thoughts is patient safety and the care of our citizens but we are also very conscious of the budget announced earlier this week, in particular its implications for the health services. I am pleased the Government has provided funding for free GP care to children up to five years of age and under the age of six as the first step towards providing universal GP care in line with the development of universal health insurance as set out in the programme for Government. I am also pleased a further €20 million has been provided to continue the investment in mental health services, primarily in the area of community mental health teams.

The budget provision for the health sector is €360 million less than was provided in 2013, which represents a 3% reduction in funding over past year. As a result, 2014 will be another extremely challenging year for the health services. The Government has had to make some very difficult decisions in regard to the health Estimates as part of the budgetary arithmetic. The prescription charge will increase from 1 December to €2.50 per item with a €25 monthly cap on expenditure per household. In addition, the income thresholds for medical cards for persons over the age of 70 will be reduced to €500 per week for an individual and €900 for a couple. Legislation to give effect to this change will be enacted before the end of the year. It is important to note, however, that all those who will come off the full medical card will migrate to a free GP card and will have the further backstop of the drugs payment scheme which limits their exposure to medical costs, in terms of pharmaceuticals, to €144 per month.

Very ambitious savings targets have been set in regard to medical card probity and for pay savings to be achieved under the Haddington Road agreement. However, these challenging savings targets will be the subject of a verification exercise as to their achievability, a process which will conclude before the finalisation of the Revised Estimates Volume. The verification exercise will be overseen by the Secretary General of my Department, along with the Secretary General of the Department of Public Expenditure and Reform and the Secretary General to the Government.

The implications of the budget for the provision of health services will be set out in the HSE's national service plan which will be formally submitted to me within the next three weeks, in line with the provisions of the Health Act 2004. The 2013 service plan required the HSE to continue to focus its delivery of services on the dual challenge of protecting patient outcomes while, at the same time, reducing costs. Next year will be no different in this regard and measures impacting on the health system as a result of budget 2014 will again be assessed against these key criteria, with the outcomes of this consideration set out in the service plan.

There is no doubt that the level of funding available for the health services in 2014 creates a significant challenge to the HSE. In setting out the operating framework for the delivery of HSE services throughout 2014, the service plan will look to deliver the maximum level of safe quality services possible within the funding available, with prioritisation, where necessary, of certain services to meet the most urgent needs. The plan will also set out targets in respect of each programme area to ensure that performance can be evaluated throughout the year in order to identify any emerging areas of concern and, should any concerns arise, allow for the implementation of necessary remedial measures without delay.

The joint committee asked that particular attention be given to the employment conditions of non-consultant hospital doctors at today's meeting and I am more than happy to do so. I said before that I want to create a health system that protects, nurtures and develops the people who work within it. That is why I am determined to change the role of NCHDs within our health system. It is essential that doctors enjoy reasonable working conditions. I want to reassure hospital doctors that the Government is committed to achieving compliance with the European Working Time Directive in respect of NCHDs by the end of 2014.

This is a complex task and a key challenge is to ensure that we achieve compliance while maintaining essential hospital services. I want also to emphasise that this is not primarily a matter of resource availability. Among the range of measures to be addressed are changes to NCHD rosters and work patterns, greater use of consultant teams, introduction of electronic time and attendance systems, reallocation of tasks between health professionals and reorganisation of services.

At my request, in 2013 the HSE has brought a renewed and urgent focus to compliance with the European Working Time Directive. In particular, a senior national group has been working closely with individual hospitals, with an emphasis on eliminating shifts of more than 24 hours and instances of doctors working more than 68 hours per week.

Achievement of compliance with the European Working Time Directive cannot be a top-down process. In my view, the best approach is that there be a strong joint process involving the HSE and the NCHDs themselves in working through the practical steps necessary. Ireland must have sustainable arrangements to train and develop the medical workforce we need in order to provide safe and effective services to our population. I am, therefore, committed to retaining doctors who are educated and trained in Ireland within our health service.

In July of this year, I set up a working group chaired by Professor Brian MacCraith, president of DCU, to carry out a strategic review of medical training and career structures, with a view to improving retention of graduates in the public health system. This group is currently working to produce an interim report by the end of November 2013 and a final report by the end of June 2014.

I would like to refer to the issue of medical cards awarded on a discretionary basis. This issue has received a significant level of publicity since our last meeting and, as recently as last week, was the subject matter of Private Members' business in the Dáil. I was glad that, with my colleagues in the Department, I had the opportunity to again set the record straight and to reject out of hand the contention that there is a deliberate targeting of holders of discretionary medical cards. There has been no change to the policy on discretionary medical cards in the past year and the scheme continues to operate in such a way that those who suffer financial hardship as a result of a medical condition receive the benefit of a medical card.

The processing of medical cards at a national level rather than at a local level before mid-2011 ensures that all people are assessed in a similar and fair way when applying for a medical card. At my request, the HSE put in place a process where a medical doctor would consider the assessment for discretionary medical cards.

In previous years, there was a decentralised process which meant there could be inequities throughout the system. Now the process is standardised and there is fair and equitable treatment for all. The variation throughout the country meant people in identical circumstances were getting a discretionary medical card in one part of the country but not in another. Sometimes people who were worse off were not getting medical cards on a discretionary basis because of the variation.

Let me clarify the matter further as it is a topic of major interest to people. Since 1970, medical cards have been awarded to people who were unable without undue hardship to arrange GP services for themselves and their family. The cards are awarded typically when their means are below the HSE's incomes thresholds. That remains the case today. However, I am concerned about the content and volume of recent media stories about vulnerable people whose medical cards have been removed.

On Monday, I met the CEO of the HSE, the HSE director of primary care and the assistant national director of primary care reimbursement service to express my concerns directly to them. I requested a detailed examination of every person who held a discretionary medical card in March 2011. Of these 97,121 people on 1 October 2013, 39% still held a discretionary medical card - that is 38,283; 43% had migrated to an ordinary medical card based on an assessment of means - that is 41,779 people; and 18% of people no longer held a medical card - that is 17,059 people. Of those 17,059 people, 14% are deceased, that is 2,361; 38% did not respond to correspondence from the HSE and their medical cards are now suspended - that is 6,265; 12% initially engaged with the review process but did not conclude the assessment, that is documentation to allow the assessment to be completed was not provided - that is 2,109 people; and 37% of people completed the review process and were found to be ineligible for a medical card or a GP visit card, that is 6,324 people. That figure represents 6.5% of all people who held discretionary medical cards in March 2011.

I also asked the HSE to provide a study of cases in which individuals lost their medical card but had originally been awarded one on a discretionary basis. It found that after allowances were made for loans, mortgages, rent, travelling to work expenses and all medical expenses, 49% of these cases were still over 200% above the guideline amounts for eligibility; 92% of cases were still 50% above the guidelines for eligibility. Member are free to question officials on this after my contribution.

Since my appointment as Minister for Health, the Primary Care Reimbursement Service, PCRS, officials have exercised discretion in a positive way on 36,000 occasions. Since January 2013, some 23,000 new medical cards have been issued on a discretionary basis. Let me assure members there has been no change in policy but there has been probity. The members know full well that the Committee of Public Accounts will inquire as to the reason people have medical cards who should not have them. There is a balance to be struck.

An additional 250,000 medical cards are in circulation since the beginning of 2011 - that means 43% of the population have access to free GP care, the highest proportion since records began. It is not just the highest proportion in terms of the percentage of the population but the highest number in real terms. We have seen a 8% growth in population since 2006.

The Department of Health estimates that the measures in yesterday's budget will further increase the proportion of the population with free GP care to 49%, in effect nearly half the population will be covered for GP care, which is the direction of travel that we wish to go.