Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I welcome the Minister and Mr. O'Brien from the HSE. I also welcome the Minister of State, Deputy Kathleen Lynch, who is back at work following her recent bout of illness.

The HSE service plan for 2014 is in the process of preparation. Was any study carried out by the Department of Health or the HSE of the likely impact of a significant reduction in the budget provision for the Department and the HSE for 2014? When the Minister and his Ministers of State were preparing to engage with Cabinet colleagues, in particular the Mniister for Public Expenditure and Reform, were the necessary details available to them in advance of that engagement? It has been signalled that €666 million will be reduced from the budget for 2014. I have no doubt that the significant impact of that reduction is being worked out in the preparation of the service plan. Did the Minister and his colleagues have a sense of the effect of that reduction? Was it part of their armoury of efforts to protect the overall health budget in their engagements with Cabinet colleagues?

The budget announced the planned extension of medical cards - they are not medical cards but GP access cards only - for all children aged five years and under. I ask the Minister of State, Deputy Alex White, to record that I welcomed the inclusion of this measure in the measures announced. I have argued for this as a first step. I emphasise that it is the first step because if it is not, it will contribute to ever increasing levels of disquiet. There are those who are saying, "I have a child who is seriously ill, who is over six years of age, yet my little child who is well will have a GP access card, while my older child will not." If people do not understand there is a timeframe for the introduction of universal free access to GP care, it will totally undermine the notion of universality and feed into an ever growing level of disquiet. Is there a timeframe for the extension of this measure beyond the age of five years and up to 12 to cover the primary school cohort? Can we anticipate such an extension in 2014, or even more bolder steps? Is it anticipated that within a reasonably short timeframe there will be universal access to free GP care? This is essential.

From where did the figure of €113 million relating to probity come? It is a strange one. Is it based on a specific arithmetic assessment, or just a figure that sat neatly into the proposed targets for achievement in 2014? I ask the Minister to elaborate on where the figure of €113 million comes from.

On the notion of probity, the Minister has quoted statistics that were not included in what we previously received.

Those data are not included in the transcript of the Minister's address, nor in the report on medical cards as prepared for today's meeting. The Minister indicated in his opening remarks that 17,059 people previously in possession of a medical card no longer have it. I did not manage to note all of the figures - the detail was quite vast and I do not have shorthand skills - but I understood he indicated that more than 30% of those called to review did not respond. A family member of mine, more than 80 years of age and with Alzheimer's disease, received two such requests for review but did not respond because it is beyond the individual's capacity to do so at this point in time. As a result, this person's medical card was withdrawn. Is it not likely that a significant number out of the 30% plus who failed to respond did so through no fault of their own, simply because it was beyond their capacity to understand or respond? It is a very hard mallet indeed to apply a cessation of entitlement in such circumstances. These are issues that come to us out of our own life experiences. As a political representative, moreover, I know the instance I have cited is not unique to my family. I am sure this is an experience to which all Members can attest.

It would be remiss of me not to refer to page 9 of the medical card report that was prepared for this meeting. It states: "It is incorrect to assert, as has been widely reported in the media in recent weeks, that medical cards are harder to get". We are not suggesting that is the case. However, the evidence is absolutely clear that discretionary medical cards are indeed more difficult to obtain. That is a fact of life. It is evident from the cases referred to by Deputy Kelleher and others and from discussions we have had recently in Private Members' time and in many other fora. There can be no denying that it is becoming ever more difficult for people to obtain and retain a medical card on a discretionary basis. It is clear from the correspondence that is before the committee today. One of the items of correspondence is from the chairperson of Children's Liver Disease Ireland outlining that organisation's concern at the growing evidence that medical cards for children with serious liver disease are not being renewed. We also have a letter from a father describing the impact of the withdrawal of a discretionary medical card on his 14 year old son who has multiple disabilities and medical issues. The evidence is in the correspondence that has been circulated to all members; it is not anecdotal. Such is the enormity of what these people are contending with, I am confident that nobody in this room would conclude that the individuals in question are not entitled to a medical card.

One of the questions we raised concerned the crisis relating to junior hospital doctors. I thank Mr. Tony O'Brien for the update on this issue in his report. The negotiations are ostensibly concluded and members will be balloted thereon. I wish for a good outcome to that process. However, the issue of the absence of sanctions for hospitals which fail to comply with measures to implement the European Working Time Directive has loomed large in recent weeks. If it is the case that this remains an issue, and knowing the situation historically whereby hospitals have been penalised by reductions in budget, it is an absolute travesty that the people who will ultimately suffer are the patients presenting in those hospitals. It is entirely unacceptable. Will Mr. O'Brien elaborate on what sanctions he expects to see applying in regard to non-compliance with the European Working Time Directive?

The last question I tabled relates to nursing home care. There is undeniably a shortage of places, with hundreds of older people languishing in acute hospital beds as they wait for nursing home places. Yet nowhere do I see a commitment to allocate additional funding for the provision of public nursing home bed opportunities. I know of cases in various Dublin hospitals where elderly people who no longer need medical care but do require residential nursing home care are being left for months in critical facilities. I can share the detail with the Minister and Mr. O'Brien after the meeting. It is beyond belief and the dreadful term "bed blockers" that is applied to these people is a horrendous insult. The fact is that the system is not providing sufficient nursing home places either in the private sector or - most important in terms of our responsibilities - in the public sector.

The Chairman has indicated that I am over time. I hope he will allow me to make one final point regarding an issue that was the subject of a unanimous appeal from members at our last meeting. It concerns the earlier signalled intent to include a programme for bilateral cochlear implantation in the budget for 2014. We wrote to the Minister regarding this matter on 11 October but I have yet to see any indication, either in budget speeches or in any of the contributions here today, that the undertaking will be implemented. I take this opportunity to urge once again that this provision be included in the HSE's service plan for 2014. Can the Minister and Mr. O'Brien provide confirmation in this regard?