Mary Harney (Dublin Mid West, Progressive Democrats)

I cannot accept the amendment. This would be an entirely new role for the Health Information and Quality Authority. The remit of that authority is to set standards, monitor compliance with those standards and to enforce the standards. It is not to be an assessor of anything relating to the provision of services. That is not an appropriate role for the Health Information and Quality Authority.

Even if I were to accept the amendment because I believed it was a good amendment — Deputy Reilly suggests the function could just transfer over and this could be achieved with the passing of legislation — it would be a major challenge. There is currently dialogue between the two organisations and the Department on the transfer of staff in the nursing home area because we wish to introduce the regulations on nursing home standards early in the new year. We want HIQA to begin carrying out inspections during 2009 and to have the resources to do that. We are currently putting that in place but none of these developments can happen quickly.

Inspections, setting standards and reporting on adverse events, such as the report on the Rebecca O'Malley incident or the report on Ennis that is currently under way, constitute the appropriate role for the Health Information and Quality Authority. I do not believe assessing people for medical cards or for other services would be an appropriate role. That is for the organisation that has the budget for these services and has an obligation to live within that budget. The Accounting Officer, Professor Drumm, is responsible to the Committee of Public Accounts for the budget that is voted to the Health Service Executive each year by the Oireachtas.

There is nothing in this legislation to change the discretionary cards, either now or into the future. Discretionary cards are given on the basis of discretion but, as in other areas, there are budget limitations. There is a limit on the HSE budget next year; there have been budgetary limits for the health services for every year I have been a Member of this House, regardless of whether they were being run by the health boards or the HSE and regardless of which parties were in Government. There is a finite budget within which the health services must live each year, although it has increased substantially in recent years. There has been a fourfold increase in the provision by the taxpayer for public health services. That is why the transformation of how we provide the service, particularly moving to more primary and community-based care, is so important. It is more effective and we know that 95% of people's needs can be met at that level.

That brings me to the issue of eligibility for health services. We are involved in drafting major legislation, which will be controversial, surrounding eligibility for services and defining the different services to which different categories of people are entitled. It is particularly important in the context of primary care. I listened to the comments earlier about universal entitlement. There is universal entitlement to hospital services. That does not mean citizens will not take out additional insurance cover. Even if we were to move to universal entitlement for hospital services, which is a compulsory tax, that does not mean other citizens would not top up the benefits they might get.

I was previously a fan of universal health coverage, and I believe there is merit in examining how we fund our hospitals. I am particularly concerned about the level of private activity in many of our publicly-funded hospitals at the expense of public patients, who often have to be treated by the National Treatment Purchase Fund. Private patients heretofore have received preferential access. That is why the new consultant contract, which has a one-for-all access to diagnostics, changes fundamentally the way consultants work and increases the number of consultants so that people have access to services, particularly on an outpatient basis. These issues are all important in terms of access to services.

Deputy Reilly referred to two cases at the committee meeting last week. If I understood him correctly, they were persons who were terminally ill. If he will bring the personal circumstances to my attention, I will be delighted to have the cases investigated. My understanding is that discretionary cards are granted to people who are terminally ill. If I am under a misunderstanding in that, I will be happy to hear from Deputy Reilly.

In general, discretion is applied. It depends on the person who is assessing the matter but there are rules surrounding discretion. In the past, under the health boards it seemed to vary from one area to another, and the number of discretionary cards in one health board area might be substantially higher than in an adjoining health board area, even though the circumstances of the populations appeared to be similar. It is hard to understand the reason for that. With a single unified organisation there is clarity on the issue of discretionary medical cards. If the Deputy has examples of people who were terminally ill within the last six months, I would be obliged if he would make the circumstances known to me. I can talk to the HSE about the examples.

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