Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I move: "That the Bill be now read a Second Time."

It is my pleasure to introduce the Health (Amendment) Bill 2017. In A Programme for a Partnership Government, the Government set out its aim to increase access to safe and timely care as close to patients' homes as possible. We outlined that progressing this objective will be a priority for the partnership Government. In our programme, we committed to extend the entitlement to a medical card for all children in receipt of the domiciliary care allowance. This initiative was subsequently announced as part of range of health measures included in budget 2017. This Bill delivers on this important commitment in full, on time and without qualification.

We also committed to reducing prescription charges for medical card holders. The Bill, which will see the prescription charge reduced for medical card holders over 70 years of age and their dependants, delivers on this commitment for the group most affected by prescription charges.

The legislation has two primary purposes. First, it will ensure all children currently in receipt of a domiciliary care allowance payment will now receive a medical card. Up to now, over 33,000 parents were in receipt of a domiciliary care allowance payment for their children but over 9,800 of these children did not qualify for a medical card. This Bill will rectify this and now all 33,000 children who receive a domiciliary care payment will be entitled to a medical card. The scheme will be operational from 1 June with the Health Service Executive, HSE, having a paper-based and online pre-registration system in place from 1 May. This pre-registration will assist in allowing all those who wish to do so to use their new medical cards from 1 June.

There will be several ways in the initial roll-out of the scheme for a child to receive the medical card. First, for a child in receipt of domiciliary care allowance but who currently does not have a medical card, the parent or guardian will register for the scheme either online or through the paper-based form. Second, for a child who is currently eligible for a medical card, discretionary or otherwise, and is confirmed to be in receipt of a domiciliary care allowance, the HSE will automatically issue them with a new medical card. Finally, for a child who is currently eligible for a GP visit card, under discretion or otherwise, this card will automatically be upgraded to a full medical card.

The second purpose of the legislation is to reduce the prescription charge for medical card holders aged 70 years, or older, and for their dependants to €2 per prescription item with a monthly cap of €20 for an individual or family. This targeted measure, which will cost €12 million in a full year, will benefit nearly 390,000 people. It is expected to save this group of patients €10 million in 2017. Deputies will note this reduction has been implemented from 1 March. I decided, following consultation with the Attorney General, to introduce the reduced charges on an administrative basis by the HSE, pending this legislation, in order that older citizens need not wait. A circular was issued to pharmacies from the HSE setting out the reduced charges and process. I take the opportunity to thank the HSE and pharmacies across the country for the swift implementation of this important measure. In addition, I stress the importance of delivering this legislation in March to place the measure on a statutory basis. I ask for the support of Deputies and Senators in enabling this benefit for older citizens.

Shortly after I was appointed Minister for Health, I spoke with a campaigner for Our Children's Health outside Government Buildings on my way into the first Cabinet meeting. Many of us, as public representatives, have been struck by the practical challenges that parents face in meeting the needs of a child with a disability. As we discussed the issue that day, I came to understand that, for many of these parents, meeting their child's needs was the first time that they had sought assistance from the State. Children in receipt of a domiciliary care allowance payment are children who the State has considered to have a severe disability under the age of 16 years which requires ongoing care and attention substantially over and above that required by a child of the same age.

Caring for a child with a serious disability is a most difficult, stressful and worrying time. Dealing with a diagnosis can at times require every ounce of strength from parents. These parents face many struggles in dealing with a difficult diagnosis. Accordingly, struggling to access services should not be a further burden that the State adds to them. That is why we are committed to ensuring all children in receipt of a domiciliary care allowance payment will have access to a medical card. It will be an automatic entitlement with no reviews or concerns about what further paperwork must be submitted. This medical card will be an automatic entitlement and will provide security to 33,000 children, along with comfort to their families and carers. Providing a medical card for these children will alleviate the stress and anxiety of parents in terms of dealing with medical costs associated with their child's disability. Undoubtedly, it will also relieve some of the financial burden these families have experienced. It will also ensure they can more easily access health services which their children require.

By virtue of now having a medical card, these children will be eligible for the following services free of charge: inpatient and outpatient hospital, GP care, prescribed drugs and medicines, subject to a co-payment; dental, ophthalmic and aural services; and aids and appliances. In addition, parents will now not be required to undergo the process of providing family financial information, expert or medical reports and additional supporting information when applying for a medical card. This was a real burden on parents. All Deputies know from their constituents the hassle and stress a parent, already busy caring for their child with a disability, encounters when they have to fill out more forms and a note from the HSE seeking a review when they child clearly has a disability and is in need of a medical card. By providing these children with a medical card without the need for the detail required by the standard application process will ensure a quicker and easier process for parents.

The reduction in the per item and monthly maximum prescription charges will also apply to children in receipt of the domiciliary care allowance. To ensure all families are treated equally, where there is more than one child in a family in receipt of the domiciliary care allowance, and the payment is made to the same parent for each child, the legislation allows that family prescription cap of €20 per month will apply. The Government is committed to reducing the cost of medicines for patients. Several actions are currently reducing medicine costs. Pricing arrangements agreed with industry last year are providing ongoing and increasing savings, both for the taxpayer and for patients in pharmacies. The list of medicines approved for substitution, allowing pharmacies to dispense the most cost-effective version of a drug to patients, continues to expand. The introduction of biosimilars, the equivalent of generics for very expensive and complex biologic products, will free up significant resources to allow more people to be treated across the health system.

The commitment to reduce the cost of medicines includes reducing prescription charges for medical card holders. The prescription charge was introduced in the Health (Amendment) (No. 2) Act 2010, to address rising costs in the medical card scheme. The charge is set by regulation. The current charge of €2.50 per item, with a monthly cap of €25 per person or family in, was set in 2013. It reduces the cost of the GMS, General Medical Services, scheme by approximately €120 million a year. Under the existing legislation, specific groups such as asylum seekers and children in care have been exempted from the prescription charge. However, while the Act provides for exemptions, it does not allow the charge to be amended for a particular group. Accordingly, this Bill will identify the over 70s and provide for a lower charge to over 70s and their dependants.

The most effective use of the resources available for reducing the charge, at this stage, is to target a particular group of people who are under greater pressure because of their medical needs. People aged 70 years and over have higher medication requirements than the general population. Over 70s patients are just under 20% of the medical card population, but nearly half of the drugs dispensed under the scheme are for over 70s. I am advised the average number of items dispensed per person over 70 years is seven, compared to two items per person under 70. In addition, this group are generally on fixed incomes. Given this, it is fair and just to direct the resources available to reducing the cost of medication for this group.

Budget 2017 announced a reduction in the prescription charges for this group. The reduction will be from €2.50 to €2 for each prescription item, up to a maximum of €20 per person or family per month, reduced from €25. I would like to further build on these reductions in prescription charges in future but this first step in reducing prescription charges rightly targets our older citizens, and their dependants, for the variety of reasons I outlined.

The main provisions of the Health (Amendment) Bill 2017 are as follows. Section 1 provides a definition for the purpose of reference to the Health Act 1970. Section 2 provides a definition of who is eligible for full general practitioner and other health services, in this case, the children in receipt of domiciliary care allowance.

Section 3 amends section 59 of the Health Act 1970. This section provides a definition of those over 70 years and their dependants and those in receipt of domiciliary care allowance access to drugs, medicines and surgical items. It outlines the charging of fees in respect of prescribed items dispensed by community pharmacy contractors to persons with full eligibility.

Section 4 amends section 59 of the Act by inserting a new section, section 59A, into the Act, to allow for the variation of the prescription charge and monthly expenditure cap for over 70s medical card holders. The current section allows for exemption of specified groups from the charge and for the variation of the charge overall but does not allow for variation of the charge for a specified group. Section 59A(1) identifies medical card holders aged 70 and over, and their dependants, as the class of persons to whom the section applies. Section 59A(2) sets the prescription charge for this class of persons at €2 per item. Section 59A(3) sets the maximum amount of prescription charges payable in a month by this class of persons at €20. Section 59A(4) provides that the Minister may, with the consent of the Minister for Public Expenditure and Reform, make regulations to vary the amounts in this section. It also provides criteria to which the Minister should have regard to when making such regulations. This will make it easier in the future if one wishes to make further changes regarding the level of charge.

Section 5 states the short title of the Act and includes a standard provision relating to commencement of the provisions of the Act.

I am personally very pleased to bring forward this legislation. It is our obligation, as the representatives of the citizens of Ireland, to provide ease of access for all to health care. Providing ease of access to a medical card for this group of people, children with disabilities whose parents are in receipt of domiciliary care allowance, is the right and appropriate thing to do. People have been campaigning for this measure for a long period. I acknowledge, as I did at the outset, the work of Our Children's Health and that of so many advocacy groups. It is because of the work of those groups, their campaign, perseverance and important highlighting of this issue that I am on the floor of Dáil Éireann introducing this important legislation which I hope will be passed on Second Stage. We should not underestimate the importance in terms of peace of mind that this Bill can provide to those families. We do not need a situation where children who are in receipt of domiciliary care allowance are constantly having reviews of their medical card and medical circumstances by the HSE. This will provide certainty of access to a medical card for as long as a child is in receipt of domiciliary care allowance. It is not only the nearly 10,000 children who will receive a medical card who do not currently have one as a result of this Bill, it is the entirety of the 33,000 who will have certainty that they will be review free once they have a medical card under this legislation while they are in receipt of the domiciliary care allowance.

The legislation will give children in receipt of domiciliary care allowance access to the services that they need, without unsustainable financial burdens on their families. At the other end of the spectrum we are talking about medical cards for children with disabilities. The other issue this Bill addresses is prescription charges for those aged over 70 years. For both the young and the old, this legislation endeavours to make life that little bit easier for those two cohorts of people in society who deserve and require these supports.

For me, this is all about people. It is about looking after the most vulnerable in society. I am committed to doing everything we can to help those who most need it. I acknowledge, as I am sure we will hear in this debate, the unanimous and cross-party support for this measure. This is an issue that nearly every party in this House subscribed to during the general election. It is one that we are delivering and that we will get over the line, and I hope we will do that as quickly as possible. I thank everyone who has brought this measure to this point and who campaigned so hard for this. This is not the answer to all the burdens that families encounter on a regular basis, but we hope it is one little step along the road to making life that little bit easier for a family caring for a child with a disability. I hope the Bill will receive the support of all Members of this House because it provides support for that vulnerable group of children and also for older people in a very tangible fashion.

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