Dáil debates

Friday, 1 July 2022

Health (Miscellaneous Provisions) (No. 2) Bill 2022: Second Stage


1:50 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

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

I am pleased to introduce the Health (Miscellaneous Provisions) (No. 2) Bill 2022 to the Dáil. First, I acknowledge that the Title has changed in recent days. This is reflective of the core purpose of the Bill being expanded from solely abolishing inpatient charges for children. Subject to my bringing a Committee Stage amendment next week, it will also encompass provisions relating to the introduction of a free contraception scheme, which will have a very real impact on sexual and reproductive health and rights in Ireland. I acknowledge and thank the Joint Committee on Health for agreeing to waive pre-legislative scrutiny of the Bill.

The programme for Government sets out the pathway for expanded access to healthcare in keeping with the vision of universal healthcare. We promised to expand universal access to healthcare in a manner that is fair and affordable. We have delivered and are continuing to deliver on that commitment. The measures being introduced as part of this legislation are very much intended to support access to care for those who need it. I am very conscious of the current financial pressures on families and it is something I am working to address. In budget 2022, the Government announced the introduction of a range of affordability measures in health that are intended to help ease the financial burden already being experienced by many families. These measures include increased funding for new medicines, a reduction in the amount people pay for their medicines through the drugs payment scheme, sustainable funding of the dental treatment services scheme, DTSS, and abolition of the inpatient hospital charges incurred for children accessing care in our public hospitals. This range of measures is intended to enable more people to access affordable healthcare. I will provide further detail in a moment on progress made in advancing these individual objectives.

I will focus first on the immediate objective of abolishing public hospital inpatient charges for children. Better access, together with affordability and improved quality, are among my top priorities in healthcare. This legislation, when enacted, will ease the financial burden on parents or guardians when bringing their child to hospital for inpatient care, helping to ensure that cost is not a significant consideration for families when children require access to inpatient treatment. Public patients, including children, are currently subject to a statutory acute public inpatient charge of €80 per day up to a maximum of ten days - or €800 - in a year. Medical card holders and other certain specific classes of persons are already exempt from these charges but I think colleagues will agree that parents or guardians bringing their child to hospital are already dealing with a very stressful situation for their child, themselves and their family and the idea that coming out of hospital, they could be landed with a bill of €800 for the child's stay in hospital is something we can consign to the dustbin of history. This is exactly what this Bill will do.

I will now provide a brief explanation of the sections. Section 1 contains standard provisions setting out the Short Title, citation and provides that the Bill shall be subject to a commencement order. Section 2 amends section 53C of the Health Act 1970. Section 53C provides that charges shall be made for acute inpatient services provided by or on behalf of the HSE. Subsection 9(aa) confirms that the €80 public charge is not applicable to persons who have chosen to avail of private acute inpatient services under section 55 of the Health Act, in which circumstances the more significant charges set out in the Fourth Schedule appropriately apply. In other words, there are circumstances in which hospitals will offer private facilities or provide the same healthcare to the child as a private patient. Those charges can range from over €800 to over €1,000. We will abolish the public charge for public patients. If parents opted to avail of private facilities or care, we would not also pay €800 or €1,000 per night for that. I look forward to hearing the contributions of Members but that is a matter on which Members will agree.

Subsection 9(bb) provides for the exemption of children up to the age of 16 years of age from the charge arising for acute inpatient services. The Bill also provides that under section 2(c) and (d), the existing inpatient charging exemption provisions for children will not be impacted. The key effect of these amendments is to remove the acute public inpatient charge of €80 per day for children below 16 years of age in all public hospitals.

I will update the House regarding a Committee Stage amendment that I will propose. Following Government approval earlier this week, I propose to amend the Bill to introduce the legislative framework to support the introduction of free contraception starting with women aged 17 to 25, as laid out in the programme for Government. Obviously, we want to roll this out further. It makes sense from a practical perspective to introduce the contraception provisions in this Bill as both policy objectives relate to reducing the cost burden when accessing healthcare. The proposed Committee Stage amendment I will bring forward will provide that the contraception scheme will be introduced at as early a time as possible to ensure access for women aged 17 to 25. The scheme is due to be launched in late August or early September. It will be open to all women aged between 17 and 25 ordinarily resident in Ireland and will cover the cost of medical appointments to discuss and prescribe suitable contraception; the cost of fitting and removal of long-acting reversible contraception, for example, implants and coils, as well any necessary checks; and the cost of the wide range of prescription contraceptives currently on the reimbursement list and available to medical card holders, including contraceptive injections, implants, intrauterine systems and devices or coils, the contraceptive patch and ring and various forms of the contraceptive pill, including emergency contraception.

A question has quite rightly been asked as to whether this scheme will cover only part of the costs of access to contraception or will cover the costs right the way through, from meeting the GP to the cost of the devices, medications and prescriptions and the cost of return GP visits for check-ups and so forth. It will cover all of the associated costs of contraception. Approximately €9 million was allocated in budget 2022 to support the roll-out of the scheme from August to December 2022, which represents a wonderful opportunity to increase access to contraception and better support sexual and reproductive healthcare and gender equality in Ireland.

There is a strong rationale for introducing the scheme commencing with 17- to 25-year-olds in line with the programme for Government. The scheme will reduce cost barriers to effective contraception and crisis pregnancy rates among this high-risk cohort, many of whom are still in full-time education and are least likely to have independent sources of income. Introducing the scheme for 17- to 25-year-olds will also allow for expanding health service capacity by training more medical professionals to fit and remove long-acting reversible contraception, such as the coil, and monitoring the operation and costs of what is a demand-led scheme.

Free contraception is enthusiastically supported by stakeholders, particularly clinicians and others working in the area of women's sexual and reproductive health. Given that the costs of prescription contraception are typically faced by women, the measure will have a significant positive impact on gender equity reducing costs for women but also benefiting their partners and families.

The scheme will reduce costs to this vulnerable age group who are not eligible for a medical or a GP visit card. We know that analysis in other jurisdictions has concluded that free contraception is a cost-effective measure. It is, as the Irish Family Planning Association, IFPA, pointed out, a landmark development. I hope to roll out this scheme in a way that it is accessible for all women in Ireland.

I was up on Parnell Street a few months back with IFPA and it was a wonderful visit because it was set up, I believe, in the 1970s in direct response to the impact on women's healthcare of the ban on contraception at that time. It was wonderful to be able to go up and have a meeting with them about the fact that not only, obviously, is it not banned but it is all now being made free. I want to acknowledge and thank everyone in that association for all of the work they have done, not just over the years, but over the decades to deal with some of the implications and restrictions we have had in Ireland on contraception, particularly as it relates to women's healthcare.

Women’s health, as we have discussed, is a top priority for me and for this Government. It is strongly supported in this budget with a €31 million additional fund. In fact, the full year cost of that €31 million is nearly €50 million and the main reason for that very significant increase is this free contraception scheme. We have put in approximately €9 million for this year but in fact the full year cost, from memory, is a little under €30 million and considerably upwards on €20 million. It is the completely right thing to do and we have had to allocate a very substantial amount of money to ensuring it is carried through.

We have also recently launched our Women’s Health Action Plan, which sets out an ambitious programme of work to bring about progress in critical areas of women’s health in the country. It takes a targeted approach to addressing health issues that affect women’s everyday lives and, critically, has been informed by what we called a radical listening exercise. In other words, this is a Women's Health Action Plan informed by women and by what they have said they need and want in this country.

Bearing in mind all the very positive impacts that will arise from the introduction of contraception for women aged 17 to 25 under the scheme, I will be seeking the support of the Oireachtas for this very significant improvement in women’s health affordability measure.

The funding allocated to health for this year in budget 2022 is the biggest ever investment package in Ireland’s health and social care services and demonstrates the Government’s commitment to deliver universal healthcare. The abolition of in-patient charges for children and the introduction of free contraception for women are two of several affordability measures that were announced. Taken together, these measures are intended to ease the financial burden being experienced by many families and to help more people access affordable health care.

We are also committed to increasing access to GP care without charge for more children. This is an important healthcare measure that will remove what can be a prohibitive cost barrier to accessing GP care for children and, indeed, for their parents and will help improve children’s health as we move through this.

The budget made resources available to introduce GP care without charge for six- and seven-year-old children. As of 1 June, approximately 2.1 milion people, just over 41% of the population, already have access to a GP care card or medical card without charges. It is estimated that approximately 80,000 children aged six and seven years of age will be, after this expansion of the scheme, eligible also now for a GP visit card. It is not everything, but is a very important step in the right direction.

Consultation with the Irish Medical Organisation, IMO, representing GPs is ongoing and the service will be introduced as soon as possible after the completion of these negotiations.

This Government is committed to reducing the cost of medicines and making essential healthcare more affordable and accessible. The drugs payment scheme, DPS, significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines. This year's budget provided €11.5 million to fund a further reduction in the DPS threshold, for an individual or household, where it has moved from €114 to €100 from 1 January, and from 1 March, we have dropped this further to €80. That means for many families around the country just over an extra €400 less in cash a year will be spent by them on drugs via the DPS. It is at least something where these awful inflationary costs which are causing so much pain for people will not be passed on because, through the DPS, there is only a certain amount a family will have to pay. The State may end up paying more but the citizen is essentially protected from those increases in costs for the medicines via the DPS which is very important.

While we are talking about new medicines, I am committed to funding access to new and innovative therapies, including those for rare diseases. It is clear from my own analysis of the trends over the past few years that the overriding factor in medicines making it through the process to reimbursement is the availability of funding. In other words, over a significant number of past years, when funding is available for new drugs, new drugs are approved. When that funding is not available, we tend not to see them approved in the same way.

I would like to acknowledge that most if not all of the Deputies here have advocated for different drugs for children, for adults, for rare diseases and for common illnesses over the years. Last year, we allocated €50 million to new drugs. This funding enabled the sanctioning of 27 oncology medicines and 19 medicines for the treatment of rare diseases, including conditions like spinal muscular atrophy which we have discussed before here in the House. This is very important and I will be very happy to send a note around to colleagues on the long list. This is something that, as a State, of which we should be very proud. Obviously, there is an infinite amount that one would like to be able to do but there has been a very significant increase in the availability of new drugs. In talking to patients, to patient groups and to parents, some of these drugs are very much life-changing and it is fantastic. We have added an additional €30 million this year for new drugs. In the plast two years we have sanctioned €80 million just for new drugs and it is having a very big impact. So far this year the HSE has already approved 30 new drugs, which includes several drugs which are the so-called "orphan" drugs for rare diseases.

In December of last year the State signed a new four-year agreement with the Irish Pharmaceutical Healthcare Association, IPHA, and Medicines for Ireland, MFI, on the supply and pricing of medicines. This is a very good deal and I commend the officials involved on negotiating it. The agreements should contribute between €600 million and €700 million towards the cost of medicines over the next four years which means there will be more Exchequer funding available for new drugs and for new ways of tackling rare diseases and new therapies. It is very exciting.

Reform of dental services is something we are committed to also, to align it with the National Oral Health Policy. Work on that reform has commenced. The Government and I have been concerned that medical card patients in some, and indeed in increasing parts of the country, have been experiencing problems in accessing dental services and this is something that has to be addressed. In the past few years, a significant number of contracted dentists have chosen to opt out of the dental treatment services scheme. Essentially, that is the scheme where dentists, who are self- or privately employed, provide services to medical card holders. To address this problem, I secured an additional €10 million for this year to provide expanded dental health care for medical card holders, including importantly, the reintroduction of scale and polish. That is something that is now available under PRSI but had been withdrawn from medical card holders. It is important that we have parity there and I am delighted to see that back in.

As well as that €10 million, I am also allocating an additional €16 million of an underspend to this year’s Estimate allocation to increase the fees to the private dentists. If we look at the schedule, the fees have increased quite substantially because of this. The combined effect of these two interventions represents an additional investment of €26 million this year over and above what was spent on the scheme last year. I hope this significant additional investment will attract back more dentists into the scheme.

Regardless of the impact this will have, we have also committed to a root and branch reform or discussion with the representative body on oral health and a dental scheme that is fit for the future.

To conclude, there is a great deal of work underway within my Department to advance the objectives of affordable healthcare.

A range of very good policy measures have either been implemented or are being finalised and this Bill speaks to exactly that. This is the legislative basis for two of the affordability measures to which we have committed.

The provisions of the Bill, in conjunction with the other health affordability measures being developed or deployed, will help and enable more people to access affordable healthcare. The cumulative effect of the measures, which is what matters, will help mitigate the financial pressure people face and ensure that cost is not a significant consideration, and it should not be a consideration when people need to access healthcare. This includes access to hospitals for children in this Bill and access to contraception, which will be reflected in the Bill as a result of Committee Stage amendments.

I again thank the Joint Committee on Health for waiving pre-legislative scrutiny. I look forward to today's discussion.


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