James Reilly (Dublin North, Fine Gael) | Oireachtas source

I am very glad to have this opportunity to address the House about the 2014 Health Estimates. I am pleased to announce that I have secured additional funding of €37 million to provide free GP care for all children up to and including five years of age as a key element of the Government's programme of health reform. This will bring an end to Ireland's two-tier health service with the introduction of universal health insurance. I am also pleased that we can continue to invest in mental health, with a further €20 million ring-fenced for mental health services in 2014, to be used primarily to fund community mental health teams.

The gross current budget for the health sector for 2014 is €13,263 million. The overall health expenditure ceiling has been reduced by €361 million. This includes additional funding of €37 million secured to provide GP care free at the point of use for all children aged five and under. A total of €666 million in health savings measures have been identified. Clearly, the health sector faces very serious challenges in continuing to provide the optimum level of safe services within budgetary limits. The health services that can be delivered within the available funding will be set out in the HSE's national service plan for 2014. Given the budgetary constraints on the health services in recent years, my priority continues to be on patient safety and improving the way services are organised and delivered.

The savings measures agreed by Government include the following: implementation of generic substitution and reference pricing following commencement of the Health (Pricing and Supply of Medical Goods) Act 2013; ongoing savings as a result of agreements on price reductions negotiated by the Department of Health and the HSE in 2012 with the Irish Pharmaceutical Healthcare Association and the Association of Pharmaceutical Manufacturers in Ireland; an increase in the prescription charge to €2.50 and an increase in the monthly cap to €25; the de-listing of products from GMS and community drugs schemes; the full-year effect of FEMPI fee reductions; the achievement of further efficiencies in the general medical services scheme through targeted probity measures focusing on both health service providers and medical card validity; the introduction of a new system of charges for private inpatients using public hospital facilities; the maximising of savings from the Haddington Road agreement; a further reduction in health service numbers; and the introduction of a nurse bank initiative, both to improve the continuity of nurse care provided and to contribute towards savings in expenditure on agency nursing staff in the health service.

The Government has approved the provision of a GP service without charges at the point of use to children up to and including the age of five - that is to say, six years of access to a free GP service. This is a critically important health reform which brings us a step closer to the introduction of universal health insurance, and one to which I and the Minister of State, Deputy Alex White, have been very committed. This means GP services will be extended to a further 5.3% of the population, so that by the end of next year, almost half of our people will be able to access GP services without having to pay consultation fees. This health reform is evidence of the Government's ongoing commitment to a universal GP service for the entire population under universal health insurance. It marks the continued movement away from a hospital-centred approach to health care back to a community-centred approach.

As a result of this health reform, approximately 240,000 children aged five years and under will be able to access a GP service without their parents having to worry about the cost of a GP appointment. A total of 43% of the population in this age group are already covered by the medical card or GP visit card and this reform will extend coverage to the remaining 57% in this age group. This is critically important as we drive to have more care provided in the community, rather than in the more costly hospital environment. This measure is estimated to cost €37 million. Primary legislation, however, must be drafted and enacted to provide for this new entitlement. Therefore, while the scheme's organisation and administration will be fully set up and implemented during the course of 2014, a precise date cannot be given at this early stage.

In 2014 the Government has again committed to continuing development and enhancement of the mental health service. Although options for additional spending generally are very constrained, the Government is determined to provide the services needed by very vulnerable people in these extremely challenging times. I welcome our continued commitment to this task, as does the Minister of State, Deputy Kathleen Lynch. In both 2012 and 2013 the Government provided €35 million in additional funding for mental health services. A further €20 million is now being provided to build mental health services in 2014. This will fund adult community mental health teams, child and adolescent mental health teams and specialist community teams. It will also allow us to recruit additional resource officers for suicide prevention and related initiatives.

The prescription charge will increase to €2.50 per prescribed item, with a monthly cap of €25 per household. It is envisaged that the new rate will take effect on 1 December 2013 and it is expected to raise €43 million in a full year. As Minister for Health, this is a measure I was reluctant to introduce, but very difficult choices have had to be made.

The gross income limit for a medical card for people aged 70 years and over will be set at €500 a week for an individual and €900 a week for a couple. This means that a single person aged 70 years or over with an income of up to €700 a week and a couple with an income of up to €1,400 a week will continue to have access to free GP care. Approximately 35,000 people, or one eighth of the wealthiest of the over-70s population, will now qualify for a GP visit card, instead of a medical card, with an expected saving of €25 million in 2014. After this measure is implemented, over 97% of people over 70 years of age will continue to have access to GP services without any charge. The aim is to have legislation in place before the end of the year or early 2014, depending on Oireachtas time. Savings are expected to start to accrue during the first half of 2014.

Savings in the region of €113 million in 2014 have been targeted through continued probity measures in the GMS scheme. The examination will cover areas such as claims from GPs and pharmacists, as well as the validity of medical cards. There is no question that this is challenging. For this reason I have requested a validation exercise to be overseen by the Secretaries General of my Department, the Department of Public Expenditure and Reform and the Department of the Taoiseach. This will involve a full assessment and validation of these savings, with an assessment of their impact on health services.

In 2012 a targeted eligibility review was carried out of 40,000 medical card holders who had not accessed medical services for at least one year. About four in ten medical card holders did not respond to confirm that they were still living in the country. It is important to note that even where a medical card holder is not accessing medical services, the State continues to incur costs. In addition, as medical cards are valid for three to four years, it is likely that changes in the circumstances of some medical card holders during that time would mean they no longer qualify for this entitlement. In our current economic circumstances it is more important than ever that our resources are directed to those who need them most. However, I stress that nobody who is eligible for a medical card will be affected by this measure. It is also important to remember that probity measures in the GMS scheme are not restricted to medical card holders - claims from doctors, dentists and pharmacists will also be examined to ensure compliance with the terms of the scheme.

As I stated, the health sector is facing challenging times and my Department will work closely with the HSE to ensure we deliver a safe health service and minimise any negative impact on services. We will continue to reduce costs in the health system. Collaboration with the HSE, the unions and staff will be vital to find ways of changing how we do our business, identifying how we can maximise the resources we have and minimise the adverse effects.

Health reform will continue in 2014, with the decision to provide free GP care for those aged five years and under and the reorganisation of hospital services into hospital groups. Furthermore, we will continue with progressing the national paediatric hospital, the National Maternity Hospital, Holles Street, and the Central Mental Hospital. Many of the improvements we have seen in the health service are due to the really hard work of the men and women who work in the service.

My Department will continue to work closely with the health service to maximise resources and maintain services to the greatest degree possible. The HSE now has the difficult task of developing a service plan for 2014 that will deliver the maximum level of safe, quality, services possible within the funding available, prioritising services to meet the most urgent needs of citizens. I have no doubt, however, that this is the most challenging year yet the health sector has experienced.

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