Seán Power (Kildare South, Fianna Fail)

I thank Deputy Crawford for raising this matter on the Adjournment and I wish to reply on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

The aim of the home help service is to enable people, who might otherwise need to be cared for in residential care, to remain at home where appropriate. It is recognised that the home help service is an essential support to family and informal carers. In line with the Government's continued commitment to community support for our older people, an additional €33 million was allocated in the budget to the home help service —€30 million for 2006 and €3 million for 2007. The additional investment will provide 1.75 million home help hours this year and is being implemented in a flexible way by the HSE.

By its nature, the home help service is a flexible service which responds to clients' needs. As a result, therefore, the level of service required in individual cases will fluctuate from time to time. To ensure effective prioritisation of the service, assessments are undertaken at local sector level and carried out in all cases by the Health Service Executive's public health nursing services. The service is targeted at high and medium dependency clients in accordance with their assessed needs. The Health Service Executive is responsible for the implementation of the home help service on a national basis. The HSE has advised the Department that it is currently implementing the national rollout of the additional €30 million allocated to the service for this year.

In addition, €55 million was also allocated in budget 2006 for home care packages. It is planned to have an extra 2,000 packages in place by the end of 2006, almost trebling of the current service. Home care packages will deliver a wide range of services and in many cases these will also include an element of home help.

In the case of the particular example cited by the Deputy, the HSE has indicated to my Department that it would be happy to review this case if requested.

Under the Health Act 2004, the determination of eligibility for medical cards is the responsibility of the Health Service Executive. Persons aged 70 and over are automatically eligible for a medical card without reference to their means. Assessment guidelines, having account of both income and allowable outgoings, are used by the HSE to assist in the determination of a person's eligibility. These guidelines are not statutorily binding and in cases where a person's income exceeds the guidelines, a medical card may still be awarded if the HSE considers that his other medical needs or other circumstances would justify this.

Information supplied to my Department by the HSE's primary care reimbursement service for March 2006 indicates that there are 1,168,273 persons covered for services under the general medical services scheme. This is 23,190 more than the comparative figure for January 2005. A further 10,034 people hold GP visit cards.

Funding of €60 million was provided in 2005 to the HSE to provide an additional 30,000 traditional medical cards and a further 200,000 persons with GP visit cards. Since the beginning of 2005, significant improvements have been made to the way in which eligibility for medical cards and GP visit cards is assessed. In January 2005, the income guidelines were increased by 7.5%. In June 2005, the means test for both medical cards and GP visit cards was simplified. It is now based on an applicant's and spouse's income after tax and PRSI, and takes account of reasonable expenses incurred in respect of rent or mortgage payments, child care and travel to work costs. This is much fairer to applicants.

In October 2005, the income guidelines for both medical cards and GP visit cards were increased by an additional 20%. This means the income guidelines are now approximately 29% higher than they were at the end of 2004. It will be noted that the income assessment guidelines used for GP visit cards are 25% higher than those used for medical cards. The HSE has publicised these changes to encourage people to apply and has made the application process as simple as possible. The HSE has also provided a national information helpline. My Department and the HSE will continue to monitor the number of cards issued and will examine any further changes to ensure the targets of an additional 30,000 medical cards and the provision of 200,000 GP visit cards are met.

Records show that between June 1997 and March 2006 the number of medical card holders recorded by the HSE has reduced by approximately 76,000 — that is, from 1,244,459 to 1,168,273. However, these changes may largely be attributed to the increased number of people in employment and the improved economic situation nationally with people on higher wages. The ongoing management and review of medical card databases has also been a factor which has improved data quality in the HSE's databases.

Regarding counties Cavan and Monaghan, current information for March 2006, provided by the HSE, shows that there are 35,540 people with medical cards compared to 34,752 in March 2005. Thus, over the last year, the number of people with medical cards has increased by 788. Furthermore, including GP visit card holders, there are 1,191 more people in counties Cavan and Monaghan who now have free access to GP services under the general medical services scheme than this time last year.

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