Pearse Doherty (Donegal, Sinn Fein)

I move amendment No. 10:

In page 13, between lines 23 and 24, to insert the following: “Report on relief on medical expenses

5. The Minister shall, within one month of the passing of this Act, prepare and lay before Dáil Éireann a report on the inability of persons without the adequate tax liability to benefit from relief on medical expenses, making reference to the substantial burden facing individuals using home dialysis.”.

I brought this amendment forward on Committee Stage of the Bill. It deals with the issue and unfairness that exists in relation to individuals with health challenges. I am involved with this issue because a connected person, a family member of mine, is on home dialysis. I will declare that in the first instance, even though they would not benefit from this amendment if it were there. It did get me thinking about the number of people who are on home dialysis and how the State supports some of them but does not support others. I made the point to the previous finance Minister that, rightly, the Houses of the Oireachtas identified that those who are participating in home dialysis needed support from the State and the support was offered through the taxation system.

Currently, there are 344 people who avail of home dialysis. This could also be replicated with other issues like continuous ambulatory peritoneal dialysis, CAPD. You could argue that the support provided through Revenue for a parent with life-limiting conditions where the travel expenses are also provided as flat rate expenses could also be affected.

For the sake of this argument, I will focus on home dialysis. There are 344 individuals who are currently involved in home dialysis. We probably think that is not a huge number of people in the State. However, the fact that they are doing dialysis at home saves the HSE €10 million per year. It is a huge amount of money being saved as a result of the fact that technology and healthcare have changed and allow for that care to be provided at home. It prevents 51,000 visits to our hospitals, hospitals that are already clogged up and overcrowded in many cases. It saves the individuals 300,000 hours of their time either travelling to the hospital, waiting in the hospital, getting dialysis in the hospital and so on. Those 344 individuals include 16 children. The issue is that, through the tax code, there is a flat rate expense regime that recognises that if you are availing of home dialysis, there is an additional cost burden on your household. You have to be hooked up to the dialysis machine for between and eight and nine hours depending on your circumstances. It is running through electricity and pumps. Therefore, there is a flat rate expense of €4,425 provided. There are also issues with laundry and clothing. For that reason, there is a €2,305 flat rate expense provided for individuals. There is also a €370 flat rate expense for telephone calls. Overall, there is a flat rate expense of €7,100. You do not obviously get all of that. It depends on your tax rate and, therefore, you get a portion of that. However, you can get up to close to €3,000. That helps people, particularly as electricity prices are going through the roof. The problem is that if you do not have a tax liability, you get nothing, and that is wrong.

I started the conversation by saying there was a recognition, even though it is a small number of people, that they should be supported through the tax code. They are supported to the tune of a couple of thousand euro per year, and rightly so. That is a huge saving to the State. However, if you are the mother and full-time carer of one of the 16 children getting home dialysis and you do not have a tax liability, or you are working but it is part-time and you do not have a tax liability, you get nothing. There are two problems here. Maybe the tax code is not the way to support these individuals and it should be done through direct grants, which I think there is a strong argument for. I understand why we would introduce credits like this, in that they are better than nothing. You could introduce a scheme that allowed for these types of support to be refundable, which is within the gift of Revenue, which is an excellent organisation and refunds taxes all the time. I did my tax returns recently, and I encourage people to do them. You get a nice amount into your account. Most people overpay tax and do not claim health expenses and so on, so I encourage people to do that.

Going back to this issue, these are big numbers. It is saving the State €10 million. It is 51,000 visits to the hospital. We are dealing with 344 people. Most of those are able to avail of the tax benefits, but others are not. That is not right. The system is not fair for those individuals. Within the collective wisdom of this House, we are surely able to recognise that it is appropriate to give people support, and we now need to make sure everybody availing of this scheme is able to benefit from it.

The reason it was brought to my attention is a family member is doing home dialysis, but through networks and the rest, you hear that some people are not able to get any support because they are part-time working or they might be too sick to work. They may be waiting for that transplant and may be at a weak stage. There needs to be something done. I argue strongly that we make this tax relief refundable. It would not just apply to dialysis. CAPD obviously has a similar situation. Most people do not even claim this relief. However, if you have a child with a life-limiting condition, there is an expense for the trips you do to your hospital appointments, which are unfortunately too frequent for many of these parents. Some of these parents are the full-time carers of the kids and do not have a tax liability.

On the tax code, if it is not refundable, it is not the way to sort this and we should move it to a grant system, for example, in terms of the living donor scheme, which is part of this legislation. The living donor scheme is administered by the HSE with a grant available for expenses if you miss work and so on. The taxation code exempts that payment from income tax. We need to do something with regard to that.

See this speech in context