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

That is the direction of travel as we seek to achieve universal health insurance with free access to GP care for everybody in the community so that people go to their doctors early and have their chronic illnesses monitored and more prevention can take place and fewer people will end up in hospitals, which is the most expensive end of the health service. This is a case of investing now for the future so that in five, ten, 15, 20 or 30 years' time, we do not have the same patterns of morbidity and mortality that we have today.

The most recent HSE performance report shows that 1,991,148 people have access to free GP care in July 2013, comprising some 1,868,565 people with a full medical card and another 124,925 people with a GP visit cards. Of these 75,348 people had discretionary medical or GP visit cards. Some 54,984 were discretionary medical cards and 20,364 were discretionary GP visit cards. Discretionary medical cards are awarded to people who are unable without undue hardship to arrange GP services for themselves and their families even though their means exceed the HSE's income thresholds. In these cases social and medical issues are taken into account when considering whether undue hardship exists for the applicant.

When this Government came into power, there was no established uniform procedure for medical personnel to assess applications for medical cards on discretionary grounds. When I became Minister for Health, I instructed the HSE to establish a clinical panel to assist in the processing of applications for discretionary medical cards. This allows medical professionals to have an input into granting a medical card to people who exceed the income guidelines but who face difficult financial circumstances, such as the extra costs arising from an illness. This procedure ensures that the specific situation of a person with a particular diagnosis can be considered on a case by case basis.

Chairman and members, we must have clarity on the 1970 Act. There never has there been an automatic entitlement to a medical card on the basis of a specific illness or a specific condition. If we wish to change the law, then regulations will have to be brought before both Houses of the Oireachtas.

An assessment for a medical card must be determined primarily by the overall financial situation of an applicant and dependants in accordance with the health legislation. There is no legal basis for the HSE to award a medical card based on a person being diagnosed with cancer or another condition. The HSE is continuing to assess and issue discretionary medical cards to people to avoid undue hardship. The HSE has a system in place for the provision of emergency medical cards for patients who are seriously ill and in urgent need of medical care they cannot afford and for patients who are terminally ill. Emergency medical cards are issued by the HSE within 24 hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result emergency medical cards are issued to a named individual with a limited eligibility of six months. The arrangement is slightly different for persons with a terminal illness and in palliative care. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate measures to ensure the person gets the card as quickly as possible. There is no means test and the nature of the illness is not a factor.

I will speak very briefly on the other aspects of the budget.

A review was carried out earlier this year under the Financial Emergency Measures in the Public Interest Act 2009 of the operation, effectiveness and impact of the amounts and rates payable to general practitioners under the relevant regulations. Having carefully considered the submissions that were made during the consultation process, I decided to reduce certain fees and allowances payable to general practitioners. I am satisfied that the proposed reductions are fair and reasonable. Overall, the reduction in GP fees will save approximately €38 million in a full year.

Payments to general practitioners have been reduced by 7.5%. Rather than introducing a cut of 7.5% across the board, a more strategic approach has been taken. The weighting for patients over the age of 70 has been reduced. In 2001, when the then Government decided to give medical cards to everyone over the age of 70, it was agreed that each patient over that age would be given a certain weighting when allowances were calculated. It is estimated that the reduction in the weighting for these patients from 3:1 to 2:1 will save €5 million in a full year. I will explain what that means because many members might not be familiar with it. When doctors sought their nursing support grant or practice support grant in respect of a patient over the age of 70, they were given the equivalent of three times the grant that was payable in respect of an ordinary medical patient under the age of 70. That was the weighting. They now receive the equivalent of two times the grant.

The elimination of special payments related to the number of discretionary medical cards will result in savings of €10 million in a full year. These special fees, which were negotiated in 2001, were spread across the general medical services as opposed to being focussed on the actual discretionary medical card itself. The fee payable to GPs in respect of the seasonal flu vaccination is €28.50, whereas the fee payable to pharmacists is €15. There is no justification for continuing to pay GPs a higher fee for the same work. Reducing the GP fee to €15 will yield €5 million in a full year. A range of other reductions, which have been made in capitation and other fees and allowances, will bring the overall reduction to 7.5%. During the consultation process, the Irish Medical Organisation and others expressed the opinion that any fee cuts could result in patients no longer being able to avail of a same-day GP service and could cause GPs to reduce staff hours. These issues were considered along with the other points raised during the consultation process.

Two regulations were prepared to give effect to my decisions and came into effect on 24 July last. Details of the regulations are available in the document that has been furnished to members. Pharmacists, consultant psychiatrists and consultant ophthalmologists have also been subjected to fee reductions under the financial emergency measures in the public interest legislation. Public sector workers have taken significant further pay reductions under the Haddington Road agreement. It is appropriate that GPs should share the burden on the country’s road to economic recovery. I am satisfied that the fee reductions are fair and reasonable and will not have an adverse effect on patient care. I am aware that an OECD study which was conducted a number of years ago found that Irish GPs are the best paid in the OECD area, where records exist. A further review is ongoing. The early findings do not indicate that things have changed. Under the financial emergency measures in the public interest legislation, the Minister for Health is required to carry out a review of the operation, effectiveness and impact of the amounts and rates fixed under the regulations each year. This will involve a full consultation with stakeholders in 2014. A decision will be taken at that time regarding maintaining, restoring or further reducing fees.

I will attend the EU Employment, Social Policy, Health and Consumer Affairs Council meeting on 10 December next. The agenda is set by Lithuania, which currently holds the EU Presidency and is hosting the meeting. Ministers will discuss progress on a number of legislative files which are important from a public health and an economic point of view. The tobacco products directive remains a priority for the Government. In recent weeks, I have assisted the Lithuanian Presidency by arranging for 16 EU health ministers to issue a statement supporting the directive and by sending a joint letter with the Taoiseach to MEPs urging them to support larger warnings on cigarette packs. I hope agreement on the directive can achieved by the end of the year because this product kills 700,000 Europeans every year. I asked my party's MEPs - Seán Kelly, Jim Higgins and Gay Mitchell - to write a letter to MEPs seeking a counter-motion to the original motion that was tabled within the EPP group. They did so successfully and I thank them for that.

Other key pieces of legislation under negotiation, in addition to the tobacco products directive, include the new clinical trials regulation and two medical devices regulations. These regulations will enhance patient safety. We must ensure the regulatory framework for the pharmaceutical and medical device sectors continues to support innovation and maintains Europe’s competitive advantage. While it is possible that agreement on clinical trials can be reached by the end of this year, it will probably be the latter part of 2014 before negotiations on medical devices are concluded. Both of these areas are extremely important for Ireland and the Irish economy. They were the subject of much discussion at the recent Global Economic Forum.

I will update the committee on some significant developments in the health sector since I last addressed it in July. The Protection of Life During Pregnancy Act 2013 was signed into law by the President on 30 July last and will be commenced as soon as is practicable. Some operational issues need to be addressed before it can be commenced. The Department is liaising with the HSE in this regard. These issues include the establishment of a panel of medical practitioners for the purpose of the formal medical review provisions and the putting in place of administrative facilities to enable the review committee drawn from the review panel to perform its functions. A committee has also been established to develop implementation guidelines for the Act. I would like to take this opportunity to thank the Chairman and the joint committee again for the great help they gave during the course of the formulation of that legislation. I believe the committee's input was reflected in the final Bill. I thank all members of the committee from all sides of the House for that.

The HSE directorate was established in July following the enactment of the Health Service Executive (Governance) Act 2013. The new directorate is accountable to me, as Minister for Health, for the performance of the HSE. The establishment of the directorate is a step in the much wider process of reform which envisages the eventual dissolution of the HSE, as set out in the programme for Government. The HSE governance legislation builds on existing accountability arrangements under the Health Act 2004, such as annual service plans and reports, codes of governance and the provision of information to the Minister for Health. The legislation allows the Minister for Health to issue directions to the HSE on the implementation of ministerial and governmental policies and objectives and to determine priorities to which the HSE must have regard in preparing its service plan. I wish to formally congratulate Tony O’Brien again on his appointment as director general.

I announced last month that Ms Eilish Hardiman has been selected as the chief executive officer of the children’s hospital group following an open recruitment process led by the Public Appointments Service. The children’s hospital group includes representatives of Our Lady’s Children’s Hospital in Crumlin, the Children’s University Hospital in Temple Street and the paediatric service at Tallaght Hospital. Ms Hardiman’s appointment as chief executive of the group followed the appointment in April of Dr. Jim Browne as the chair of the children’s hospital group and the appointment in August of a further nine board members. The board will oversee the operational integration of the three hospitals in advance of the move to the new children’s hospital. As the client for the building project, the board will play a key role in ensuring the new hospital is optimally designed and completed as swiftly as possible while providing value for money. The construction of this new hospital is hugely important. It is just as important to ensure we have a cohesive and united board, chair and management from the day the hospital opens. We failed to do that in the past when a number of hospitals amalgamated. We are all aware of the consequences of that.

Under the Health (Pricing and Supply of Medical Goods) Act 2013, which was enacted recently, the Irish Medicines Board is responsible for setting reference prices. This is the price the HSE will reimburse to pharmacies for all medicines in a particular group, regardless of an individual medicine’s price. The initial list of interchangeable medicines, containing groups of atorvastatin products, was published by the board on its website on 7 August 2013. It is expected that the first reference price will be implemented by the end of the year.

I wish to speak about research that was launched recently regarding the benefits of using plain cigarette packaging. This research, which was jointly commissioned by the Irish Cancer Society and the Irish Heart Foundation, both of which we support fully, shows how effective cigarette branding is and how it is used by the tobacco industry to entice children to start smoking. I have said for a long time that they are targeting our children. This research provides more evidence in support of the truth of that assertion. A coalition of children and health organisations is supporting legislation that will make it illegal for tobacco companies to use colour, text and packet size to market cigarettes. We cannot continue to allow deceptive marketing gimmicks to be used to lure our children into a deadly addiction that will ultimately kill half of those who become addicted. Standardised packaging is the next logical step in combatting this public health epidemic. I ask the members of the Joint Committee on Health and Children to give their full support and endorsement to this campaign and I hope they will do so.

I hope to bring the heads of the Bill to them soon for their consideration.

I would like to touch on the research for a moment. The research depicts children looking at the nice shiny cigarette boxes and saying they are lovely and look like a car. Then they see the new boxes we intend to introduce and they say they are yucky and disgusting and ask why anybody would want to smoke. Therefore, they work.

The Government is currently engaged in what is possibly the biggest health reform of a western health care system since the formation of the United Kingdom's NHS. The future health reform programme is designed to replace the current failed model of health care and to hand power and control back to patients and professionals. Part of this process involves the establishment of hospital groups and the reorganisation of all of Ireland's adult public hospitals into six groups which will, over time, become self-governing trusts. The objective is to create a network of hospitals which are big enough to offer patients a full range of safe high quality services, yet small enough to be flexible and adaptive to the local and regional needs of the people they serve. They will also have an academic partner, which will give them a scale and a size that will be very attractive to buddying up with international partners, not just in pharma or medical devices, but also in the area of IT, innovation, management and reorganisation. Therefore, health can be a driver of jobs also.

Legitimate concerns have been raised, both inside and outside the health services as to whether the system has the capability to implement the scale of the changes proposed. The reform agenda for the next three years is particularly complex and requires the health system to implement a series of reforms which have taken other countries much longer to introduce. The recent establishment of the new directorate structure, a systems reform office in the HSE and the creation of a programme management office in the Department of Health are specifically designed to assist and support the implementation process.

We are determined to succeed, to learn from others and to learn from our mistakes, some of which had tragic consequences. We are committed to continuing this programme of reform. I and my ministerial colleagues will be happy to answer committee members questions on the future health reform programme and on any other issues.