Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I thank the Minister for Health and wish Mr. O'Brien the best of luck in his new role.

In respect of the HIQA report on the death of Savita Halappanavar, guidelines were issued in 2007 after the death of Tania McCabe in the context of national guidelines on dealing with sepsis. The investigation into Savita's death highlighted the fact that only five maternity units had implemented the national guidelines issued after Tania's tragic death. In view of that record, who will oversee full implementation of HIQA's recommendations in respect of maternity services? Will HIQA be invited regularly to observe the ongoing implementation of these recommendations, or will this be done by an internal HSE group?

Against the backdrop of the budget and cuts to the value of €666 million in the health service next year, as well as the withdrawal of discretionary medical cards, I have a major difficulty with the statistics the Minister and Mr. O'Brien gave us. I receive a huge number of e-mails from people who contact me regularly. As I do not think I am a special Deputy, I assume they contact other Deputies, too. There are obviously many who fall through the cracks, as the Minister said. At this stage, the cracks have almost become a canyon. There is an avalanche of people who are genuinely very distressed that their discretionary medical card has been withdrawn or who have been refused a discretionary medical card because they do not qualify under the guidelines for a means assessment.

Mr. O'Brien has pointed out that 53,000 discretionary medical cards were issued up to 8 October. How many discretionary medical cards have been issued this year, as opposed to previous years? I would like to see a profile of the discretionary medical cards issued. I suggest the number issued is reducing rapidly. The empirical evidence is the statistics. We must also acknowledge that the population is fluid. People are born; they might have disabilities or other challenges; they get sick and may not qualify under the income guidelines. I find it hard to believe there has been such a rapid reduction in the number of discretionary medical cards issued. I just cannot reconcile this with the evidence that we receive from various organisations such as the Jack & Jill Children's Foundation and the Irish Cancer Society and people with liver disease. They constantly highlight very tragic cases, yet the people concerned lose their medical cards. We have itemised them. This issue was also highlighted in the Irish Examiner last week, with detailed examples of people who were unable to access a discretionary medical card.

If there have been no changes to the guidelines, how is it that a discretionary medical card was withdrawn from a child with intellectual and physical disabilities, who is incontinent and cannot use his limbs and whose circumstances have not changed and will get progressively worse?

How is it that this child's discretionary medical card was withdrawn? After a long, arduous battle the child was eventually awarded a discretionary medical card for a six month period. The reason I highlight this case is that it is one of a myriad cases and every Deputy and Senator is aware of many similar cases. There has to be some change somewhere along the line because that child's circumstances did not change. It is one of hundreds of cases on which information has been provided for us. We have tabled parliamentary questions and contacted the Department and the HSE without making much progress. People's circumstances have not changed, yet their discretionary medical cards are being withdrawn and they are not receiving medical cards through a means assessment. That is a key issue with which we must deal. I, therefore, ask for a profiling of discretionary medical cards issued in the past few years. That might show that there are fewer discretionary medical cards being issued this year than last year. I do not believe the health of the population has changed that dramatically. People are getting sick and developing very serious illnesses, while babies are being born with disabilities. They may be above the income guidelines and are not now securing discretionary medical cards. Whatever one says, there is a different attitude to the use of discretion. In fact, that discretion has been taken from the HSE in the granting of medical cards.

Fianna Fáil has been raising the broader issue of tax relief on medical insurance premiums for some time. This decision will have a significant impact on the number of people who will be able to afford private health insurance. The stated policy of the Government is that a policy of universal health insurance is to be implemented within a certain timeframe. I would have assumed that there would be active encouragement of as many people as possible to take out medical insurance, yet the change in tax relief on medical insurance premiums announced in the budget will do the exact opposite. The Government and the HSE are planning to charge private health insurance companies the full cost of private patients in public beds. This will have a knock-on inflationary impact on health insurance premiums. The gold-plating to which the Minister for Finance referred is not the whole picture; the cost of health insurance for ordinary people will increase if their insurance premiums go above the tax threshold and tax relief will be lost. The figure is €127 million. This decision will impact on a great number of families. What the Minister for Finance said in the Dáil and other Ministers have said subsequently means that this measure could impact on up to 50% of those who hold private health insurance. This will have profound implications for their ability to retain their private health insurance and mean that they will depend on the public health system which is already under stress.

Prescription charges have been increased up to €2.50 per item. When first introduced, the Minister said the charges would have a negative impact on people's health, that people would be unable to access health care because of them. Is there evidence to suggest this is not the case? Prescription charges are now up to €2.50 per item, with a maximum charge of €25 a month. This is a fundamental change.

On the issue of mental health, it is well known that society is under stress, with families and individuals under pressure. Mental health services do not seem to be in place. The ring-fencing of €35 million a year to implement the strategy under A Vision for Change has been scrapped. The Minister of State with responsibility for mental health issues was handed €20 million. I know the Minister of State well and I am her constituency colleague. I know she made a ferocious argument to secure the sum of €35 million but to no avail. The lack of funding will have a profound impact on the ability of the new HSE directorates to implement the strategy under A Vision for Change and there is no point pretending the strategy is being implemented. For example, the number to be employed as mental health professionals has fallen far short. Why have mental health services received only €20 million when a commitment was made that funding of €35 million would be ring-fenced?

I refer to the new troika in the Department of Health, the three Secretaries General who will oversee implementation of the cuts of €666 million next year. I note that a Bill has been published which will move the HSE into the Department in the near future. The Vote for the HSE will be held in the Department, into which the HSE will be subsumed. What are the roles and responsibilities of the other two Secretaries General in overseeing implementation of the budgetary framework as outlined last Tuesday?