Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I ask the Minister of State, Deputy Kathleen Lynch, to respond to the question on the fair deal scheme, and the HSE will deal with the question about recruitment in Beaumont.

I listened to Mr. Breslin's answer to the question about universal health insurance on my trusty iPhone. That is the position. We are pressing ahead with the first concrete step, which is to provide free GP care for those aged under six years and over 70 years, and we continue to widen discretion for medical cards. I do not like the term "private health insurance" because it is just health insurance. We do not have public health insurance in Ireland. I want to make health insurance more affordable, and this initiative is already showing good results, with an increase in the number of people with health insurance in the last two quarters. I expect to see a significant increase this quarter and next year with the introduction of lifetime community rating. When we receive the findings of the work from the ESRI and the Health Insurance Authority in the next couple of months, I will bring a roadmap to the Cabinet on further implementation of UHI. It will then be a matter for the Government to decide whether to proceed on the basis of that roadmap, but I think it is the way to go. However, the issue is much more complicated than anyone appreciated at the outset, not least because we do not even have a basic patient identifier for every patient in the country or a single financial system across the hospitals. A considerable number of building blocks need to be put in place before we proceed further. If we have learned anything from Irish Water, it is that we should not set up new entities in a hurry.

There are various ways of measuring the health budget, including outturns, Estimates and income from different sources, such as insurers, car parks and payments received from patients. This is the first time in seven years that we have increased the budget, which is a considerable achievement. The increase is approximately €150 million, or 1.5%, which allows us to end the cycle of cuts and make targeted improvements in a number of areas, including mental health, primary care, hepatitis C drugs and the extension of BreastCheck. Money is still tight, however, and the 1.5% increase in our budget is reflected in the 1.5% increase in the budget for the fair deal scheme. If there is a backlog or an increase in demand, the money is not available to deal with that. The Minister of State, Deputy Kathleen Lynch, the witnesses from the HSE and I are in a similar position to everyone else working in the health service, whether they are managers or working on the front line. We are trying to deal with a wide range of problems and a huge level of demand on the basis of constrained resources. We are spending €1.5 billion less than we did seven years ago and we have 15,000 fewer staff. Not many other countries are in that boat. I assure the committee that we are doing our best within these limitations, and we will continue to do so.

On the issue of discretionary medical cards, members will appreciate that I cannot comment on individual cases. I do not have access to patients' information or financial details and I do not make decisions based on individual cases. I have some responsibility for the rules, however, and we have made a number of reforms. Terminal illness cases have medical cards for as long as they are needed. Random reviews of discretionary medical cards are no longer carried out. Discretionary card appeals go to medical officers for adjudication. This is important because it means it is not just a financial decision made by a computer or an official. Local health officers can make a visit if an issue arises, and can offer other supports including aids and appliances or a doctor visit card. Supports are now available which were not available in the past. For example, the cost of wigs for children undergoing cancer treatment is reimbursed regardless of income. A number of changes have been made in that regard. The number of discretionary medical cards is now 75,000. Approximately half of these are restored medical cards and the other half are new cases. Including doctor visit cards, the number of medical cards is 108,000. I expect the number will continue to increase, because it is my view that we need to widen discretion further. This will be done with the assistance of the clinical advisory group that was recently appointed. The Minister of State, Deputy Kathleen Lynch, and I will be meeting the group in the next couple of weeks to see how we can widen discretion to take in more of the hard cases we hear about from time to time. However, as I said last November when we announced the ten-point plan to reform the medical card system, as long as there is a threshold, whether that is a means test or a sickness test, there will always be people who are just above the threshold. All of us know cases of elderly people who are €5 or €10 above the threshold. If we raised the threshold by €10, there would still be people who were just above it; they would just be different people. The same issue would arise for any kind of sickness test or medical needs test. The only solution to this is universality, which would mean individuals and families were not required to submit reams of information about their finances and health. This is why it makes sense to provide medical cards to those aged under or over 70. It is the first step towards no longer making a distinction between people based on means or sickness tests. I hope I can make the argument more strongly in the next several months that the solution to unfairness and anomalies in the system is to get rid of means tests and sickness tests and replace them with a universal system, beginning with the youngest and oldest in society.