Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I warmly welcome the Second Stage debate on the Health (Amendment) Bill 2017, which provides for two key advances in health care delivery, each of them potentially leading to greater or even more important developments in the provision of health care in this country. First, the Bill provides for the automatic granting of a full medical card to every child in receipt of domiciliary care allowance. This will have a welcome impact on the lives of 9,800 children and their parents when it comes into effect on 1 June 2017. The second measure will have a small but welcome impact on the monthly budgeting of households of citizens over the age of 70, and their dependants where applicable. Both of these measures were promised in the programme for Government. I welcome the presentation of this Bill and its implementation that will follow its successful passage through these Houses. The granting of a full medical card to all children in receipt of the domiciliary care allowance is an important step. I hope it will lead to a universal health care system in this country that is free at the point of delivery and is paid for through direct and fair taxation.

Domiciliary care allowance is a monthly payment that is made in respect of children up to 16 years of age who have severe disabilities that require continuous care and attention over and above what a child of comparable age would normally require. Some 33,000 parents are currently receiving domiciliary care allowance each month. More than 20,000 of their children already have medical cards. This Bill will extend that entitlement to almost 10,000 children whose parents are in receipt of domiciliary care allowance but who have not qualified for medical cards to date. All children whose parents are in receipt of domiciliary care allowance will now qualify for a full medical card, irrespective of family means.

I have been advocating the extension of medical card entitlement to all such children for a long time. This has been a core proposition in a series of Sinn Féin election manifestos and in our alternative budget proposals. In December 2015, when I was still my party's health spokesperson, I introduced our new health policy document in which we urged that this critical advance be made and undertook to introduce it if we were in government. When I did so, I was mindful of the needs of severely challenged children and their parents. I was particularly mindful of the case made by the Our Children's Health campaign group, which was launched in May 2014 by families affected by illness and disability with first-hand experience of the struggle to secure and retain medical cards for their children. Its primary aim is "to ensure children with serious medical need are no longer subjected to the crude, unfair, lengthy and frustrating means test in order to be considered for a medical card".

The campaign has condemned the onerous application process, the exclusive focus on financial hardship and the failure to take account of medical need and the impact of a serious medical condition on a child and its family. Our Children's Health has argued:

We cannot continue to have a situation whereby children with the most serious medical need coming from ordinary families with modest incomes and huge outgoings remain ineligible. This is simply wrong and unjustifiable.

Sinn Féin has long argued that the Department of Social Protection's domiciliary care allowance, operated until 2009 by the Health Service Executive, provides an example of an assessment model on which a new medical card eligibility test could be based in that it is independent of both financial means and diagnosis titles. Eligibility would be based on reaching a threshold of care needs.

The horror stories of seriously ill children being refused medical cards and the lengths to which distressed parents have been forced to go to apply for medical cards have continued to this very day. Today is but a start and stepping stone towards a universal health care system, as I stated. The Government must introduce and implement a schedule for the extension of full medical cards to people with serious illness and disabilities without a means test, and not only focused on the primary measure in this legislation. The Government is extending a full medical card to every child qualifying for the domiciliary care allowance and, despite the long years lost, I say "well done". I mean that sincerely. I also say with great sincerity that the Government should now take the next steps.

We should legislate for a distinct new medical need ground for eligibility for the medical card with an associated application route, using the domiciliary care assessment framework as a model. That is an assessment involving the establishment of a threshold of medical need and not tested against a household's financial means or diagnosis titles. We should then invite applications to this distinct application process for a card that would be reviewed at intervals informed by the recommendation of the medical assessor. This new route would be open to applicants of all ages but any child who has been granted the domiciliary care allowance would gain the card automatically, as we are providing for now. Medical cards awarded on this new ground would not be impacted by changes to employment status or income. This is essential as otherwise the medical card system will continue to trap people with disabilities in unemployment and poverty. This would initially result in a further 14,500 cards meeting the health care needs of a further cohort of deserving people challenged by disability and serious medical needs on top of the 9,800 additional cards provided for in terms of the domiciliary care allowance. Ultimately, all of this should lead to universal health care.

In the last couple of minutes remaining in my slot I will address the second matter the Bill provides for, the reduction in prescription charges for medical card holders over 70 years old. I remember very well as a health spokesperson before my very able and esteemed colleague arrived. She has been performing this role with great verve and capacity over the past 12 months. I remember very well being on these benches when the Minister's predecessor, the deputy leader of Fine Gael, was an Opposition spokesperson on health, as I was myself. Prescription charges were introduced at 50 cent and that was the position when the Minister's party went into Government in 2011. Senator Reilly, then a Deputy, was an able spokesperson on health in opposition and I will not go further than that. Like any of us here in those days, he articulated fierce opposition to prescription charges and not just for those aged over 70. However, as the record shows, Fine Gael and Labour introduced a fivefold increase in this charge from 50 cent to €2.50. All these years later, the Government has decided to reduce the charge by 50 cent but only for those aged over 70. What of everyone below 70 years of age, who must continue to pay €2.50 per item up to a €25 maximum per month? Why not extend this reduction to all medical card holders and why not remove the charge entirely? We should be done with it, as the former Minister and deputy party leader, Senator Reilly, so strenuously argued for here in this Chamber not all that many years ago. I encourage the Minister to do it.

We will support the passage of this Bill in the hope that it will be followed by the further steps that can and should be taken, bringing us ultimately to the introduction of a national health care service across our land. I use those words with purpose. That is a worthy goal and a real and proud legacy for all of us to leave for future generations. If the Minister says he will do it and he means it, we will work with him every step of the way.

See this speech in context