Michael Harty (Clare, Independent) | Oireachtas source

Sections 6 to 8 of this Bill refer to the payments made to women who suffered unnecessary symphysiotomies, those who received payments through the Our Lady of Lourdes Hospital redress scheme and those who suffered as a result of Thalidomide. Another group of people who are unfairly assessed in respect of the nursing home support scheme, the fair deal scheme, is farmers. If they need to go into nursing home care the farm is taken into account in an assessment of their income and assets. Normally, 80% of a person’s income is taken into account and the person’s home. For farmers, however, the entire farm is taken into account in the assessment of assets.

It is viewed as money in the bank. A farm might be worth €500,000 or €600,000. Its income generating capacity could be €20,000 or €25,000, but the full value of the farm is taken into account in assessing their assets. In that regard, farmers are often liable for the entire cost of their nursing home care. That is unfair. I will be seeking, certainly in this budget if it is possible, to have the value of a farm assessed not at 100% of its value but perhaps at 10% of its value. That would still involve a farmer's offspring making a contribution towards his or her nursing care but would not cripple the farm.

Also, if a farm is transferred to a relative five years or more at the time of a patient requiring to go into a nursing home, there is no liability on the land. However, if the parent goes into a nursing home within five years of transferring the property to a son, daughter, preferred nephew or whoever it might be, the entire asset value of the farm is taken into account. The Minister might consider reducing that five year rule to a three year rule.

There is a difficulty with regard to drugs and appliances. The morning after pill was referred to earlier. However, there are other drugs which should be available on the General Medical Services, GMS, scheme but which are not. One is a drug called Macushield. It is prescribed by ophthalmologists for the treatment of macular retinal degeneration, which is a life-threatening eye condition. It is a vitamin preparation which has been removed from the GMS reimbursement scheme. It costs about €30, yet it is being prescribed to GMS patients who have to fund the full cost of that. It was refundable through the hardship scheme, but it has been removed from the list of drugs that are refunded through that scheme. It is a drug the Minister of State might consider adding to the list of reimbursable drugs.

The morning after pill is available across the counter to anybody. Unfortunately, if someone wishes to get it through the GMS scheme they have to submit a GMS prescription. It is open to the patient to buy the drug in an emergency, and the morning after pill requirement is for emergencies. It is available, but it is not free unless one has a GMS prescription.

In terms of the morning after pill provision, there is an added benefit in someone going to see their general practitioner. They may need counselling on the use of the morning after pill. They may need to be on the contraceptive pill, which would mean they would not have to take the morning after pill. There is an opportunity to counsel people if they attend their GP, which is a positive aspect.

With regard to drugs and appliances, there are many dressings which are required for the treatment of people with leg ulcers or bed sores or people who are incontinent. Many of those dressings are not available through the GMS. They were available through the hardship scheme but that has also been discontinued. It is necessary now for those patients to see a consultant to approve the requirement for those dressings, and we all know how long it can take to see a consultant to get a letter stating one should be getting the dressings, which previously were available to one prior to their removal from the scheme. That is a huge problem for public health nurses who visit these patients but who do not have the dressings or the appliances to treat them properly. The Minister of State might consider that question also.

On the packaging of cigarettes, anything that can be done to diminish the consumption of cigarettes is welcome. If changing the packaging will make a difference, which is questionable, it should be introduced. However, what is more important is the prevention of smoking. As the Minister with responsibility for health promotion, she will understand that education is far more important than drug packaging. Getting children in primary and secondary school to consider the health, social and cost aspects of smoking is far more important and will have a lifelong effect on them. Getting that message to children in primary and secondary education is very important. Also, if children hear about the bad aspects of cigarettes, they apply pressure on their parents to give them up. That, too, is an important intervention in regard to smoking.

Deputy James Lawless referred earlier to medical manpower and the No Doctor No Village campaign, of which I was a part. As the Minister may have heard this week, there are huge problems in terms of medical manpower, not only in hospitals but particularly in general practitioner services. Thirty-three per cent of GPs are over the age of 55 and 20% are over the age of 60; I qualify on both counts. There is a manpower crisis coming down the line because young GPs are not coming in to general practice. The contract is so unpalatable they will not take it up. A new contract with GPs must be negotiated urgently and put in place, which hopefully would redress the emigration of young GPs or the failure of young GPs to take up GMS contracts.

Our campaign, No Doctor No Village, is attempting to highlight that issue. Witnesses who come before the Committee on the Future of Healthcare outline how chronic multi-morbidity care in the community is the only way forward for our health service. If elderly people and those with chronic multiple illnesses end up in hospital unnecessarily, which is an extremely expensive way to care for people, our health service cannot sustain that cost. We need to keep people at home. We need to have chronic disease management in primary care and in general practice, but to do that we need to double the number of GPs. We have approximately 2,400 GPs. If free care is to be given to the entire population, and if there is a transfer of care from secondary to primary care, we will need twice that number of GPs. The likelihood is that in the next ten years we will lose one third of GPs. I do not know how that will be squared, but we need a huge investment in GP manpower. We need a new contract, and we need to attract back the many graduates who have emigrated.

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