Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am only ten weeks in the job, Deputy, and I am about to do it.

It is fair to say that all assessment systems have some limitations. It is probably practically impossible for a single assessment system to take account of all individual circumstances. If one tried with the best will in the world, it would probably become incredibly complex. While it is important that we acknowledge the limitations of the existing eligibility framework, it is also necessary to recognise the potential for improvements that we can make.

I believe that the recently established Committee on the Future of Healthcare will play a key role in this regard. It was set up to achieve cross-party consensus on a single, long-term vision for health care and the direction of health policy in Ireland, and to make recommendations to this House within six months. I firmly believe that the health service will benefit greatly from a single unifying vision that we can all get behind. A long-term vision, built on a cross-party or even a social consensus, can help to drive reform and development of the system over the next ten years.

I am genuinely excited that this new Dáil has come together with the aim of achieving long-term consensus on the fundamental principles of health policy. In striving for the optimal single-tier health service for Ireland, there are inevitable policy trade-offs to be confronted. These trade-offs often involve tensions between efficiency and equity or between comprehensiveness and cost control. In all countries, not just Ireland, the trade-offs centre around three basic dimensions of the health service which must be confronted when designing a health service: the proportion of the population to be covered; the range of services to be covered; and the proportion of the total costs to be met.

On the specific issue before us, Deputies may be aware that the domiciliary care allowance is administered by my colleague, the Minister for Social Protection. It is a monthly payment for a child with a severe disability, aged under 16 years, who requires ongoing care and attention substantially over and above the care and attention usually required by a child of the same age.

I accept, as others, including Deputy Ó Laoghaire, have said, that the DCA measure is not the perfect solution to our health eligibility framework. The latest available data indicate that about 33,000 children qualify for the DCA. By comparison, about 390,000 children under the age of 16 years currently qualify for the medical card. The DCA is not based on a type of disability or the medical need of a child. Under the legislation, it is based on how much extra care and attention a child needs because of it. The DCA also has a range of qualifying criteria. These include the disability being likely to last for at least one year, that the parent is providing the care to the child, that the child resides at home, and that the child meets the medical criteria of the scheme.

Recently, I visited the Health Service Executive's national medical card unit, which administers the general medical services scheme. Its functions include the processing of medical card applications. It was established in 2011 as part of the HSE’s primary care reimbursement service. I acknowledge the hard work of the staff I met. I know that they are committed to ensuring that anyone who is eligible for a medical card under the existing legislation receives their card, and that the system operates in a streamlined way. The medical card unit provides a single uniform system for medical card applications and renewals, replacing the different systems previously operated in local health offices. This ensures that people are treated in a similar manner irrespective of where they live.

The scale of the operations of the national medical card unit is enormous. In 2015 alone, the medical card unit processed almost 400,000 cases.

These included 107,000 applications and 92,000 full reviews of medical card and GP visit card eligibility as well as over 195,000 self-assessment reviews of eligibility.

Currently there are over 1.7 million people registered with a medical card and a further 450,000 people registered with a GP visit card. Under the existing health legislation the standard assessment for a medical card is based on the combined income of the applicant and spouse, or partner, if any, after tax, PRSI and USC have been deducted. In addition a further allowance is made for the costs of rent or mortgage, for the costs of travelling to and from work and the costs of child care that a family might face. In the assessment process the HSE can take into account medical costs incurred by an individual or a family. Where deemed appropriate in particular circumstances the HSE may exercise discretion and grant a medical card even though the applicant's means exceed the relevant threshold.

Deputies may be aware of a major report in 2014 by an expert panel on medical need for medical card eligibility which was chaired by Professor Frank Keane. The Keane report recommended that a person's means should remain the main qualifier for a medical card. Nonetheless, it is absolutely clear that there are people, including children, with medical needs and it is important that they should be able to access necessary assistance in a much more straightforward manner. On foot of the Keane report, the HSE established the clinical advisory group on medical card eligibility. This group is to develop a framework for assessment and measurement of the burden of disease and appropriate operational guidelines for the medical card scheme. The membership of the clinical advisory group includes clinical experts from specialist services and professions and, importantly, patient representatives. The group reports to the national director of primary care on a quarterly basis. It is expected that the group will make a report when it has completed its work in the near future.

As a result of the range of improvements implemented by the HSE on foot of the Keane report, the HSE is exercising greater discretion. There are now over 106,000 discretionary medical cards. This is the highest number of discretionary medical cards on record in the history of the State.

I shall conclude by saying that more needs to be done. I welcome this opportunity to address the House on the Government’s commitment to provide medical cards to all children in receipt of the domiciliary care allowance. This is a key commitment in the programme for Government and is a priority for me in budget 2017. I am privileged to have become Minister for Health at a time when we are in a period of reinvestment in the health services, which gives me the opportunity to address some immediate issues such as this. I will act and we will act, as I hope will all Members, with a sense of urgency. The money will be put in place in the budget in October and we will move forward with the legislation. There are parents currently sitting in the public gallery. These, and the parents of 11,000 other children, will receive an automatic entitlement to a medical card early in 2017. That is acting immediately and urgently. We must all move together.

See this speech in context