Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I welcome this opportunity to address the House today on the Government's commitment to extend medical cards to all children in receipt of the domiciliary care allowance, as outlined in our agreed programme for a partnership Government. I welcome most of the comments made tonight during this debate, some of which I will deal with later in my contribution.

This is a very important issue that affects many thousands of families throughout our country. Deputies may be aware that the domiciliary care allowance, DCA, 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. It is administered by the Department of Social Protection in accordance with the social welfare legislation. As a parent of a daughter with an intellectual disability, I spent many years campaigning for disability rights and the domiciliary care allowance. Now, it is in the programme. That is action. I also spent many years campaigning for the restoration of the respite care grant. That was restored four weeks ago. That is action. It is important that people, when making comments, know what is going on and the difference between action and inaction. This commitment is stitched into the programme for Government.

It is important to note that the DCA is not based on disability or the medical need of a child. Under the social welfare legislation it is based on the how much additional care and attention a child needs because of a disability. There are a range of qualifying criteria in respect of eligibility for the domiciliary care allowance. 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 on the child meeting the medical criteria of the scheme. It is estimated that approximately 33,000 children currently qualify for the domiciliary care allowance. By comparison, approximately 390,000 children under the age of 16 years currently qualify for the medical card. I agree that when moving towards a universal health service we need to set priorities. Children that are sick and children with disabilities, and not children that are healthy, are my priority. By contrast, the medical card scheme, which is administered by the HSE in accordance with the Health Act 1970, as amended, is primarily a means based scheme. Under health legislation, medical cards are provided to persons who, in the opinion of the HSE, are unable without undue hardship to arrange GP services for themselves and their dependants. The legislation also requires the HSE to have regard to the overall financial situation of the family.

I listened to many of the comments from my colleagues in regard to the urgent need to deal with the reform of medical card system. In the assessment process, the HSE can take into account medical costs incurred by an individual a family. Where deemed appropriate, in particular circumstances, it can exercise discretion and grant a medical card even though an applicant's means exceed the relevant threshold. As a result of a range of improvements implemented by the HSE since mid-2014, the HSE is exercising greater discretion. Since then, the number of discretionary medical cards has doubled. There are now over 107,000 discretionary cards, which is the highest number of discretionary cards on record.

I share the hope of the Minister for Health that we will be able to get cross-party support for this measure. I also recognise that there are enormous demands and cost pressures on our health service. Health care continues to rise to meet the needs of our growing and ageing population, as well as the increasing incidence of chronic conditions and medical technologies and treatments.

We have secured a substantial increase in funding for the health services for 2016 but I do not underestimate the challenges involved in the delivery of a safe and efficient health service for our citizens. I welcome the attendance in the Visitors' Gallery tonight of our children's health group, which I have always supported and will continue to support. I am pleased that the House has discussed this important issue this evening. I am determined to prioritise this commitment as part of the upcoming discussions and to see it implemented as soon as possible after we have secured the required resources. The discussions on the Estimates will continue over the summer months.

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