Ruairi Quinn (Dublin South East, Labour)
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Question 85: To ask the Tánaiste and Minister for Health and Children if the position of chiropody services for medical card holders and the possibility of chiropodists charging top-up fees to medical card holders will be clarified; and if she will make a statement on the matter. [35480/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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There is no statutory obligation on the Health Service Executive to provide chiropody services to General Medical Service patients. However, in practice, arrangements are made to provide these services. Prior to the establishment of the HSE, the nature of arrangements for chiropody and the level of service provided were matters for individual health boards and variation in practice developed over time. Priority is usually given to certain groups of people, including people aged 65 years and over who are medical card holders. In several regions the service is provided by private chiropodists by arrangement with the HSE.

It is inappropriate for private chiropodists who provide services on behalf of the HSE to charge patients a top-up fee, and I have conveyed this view formally to the HSE. My Department recently requested the HSE to initiate a review of the fee arrangements in place for the provision of chiropody services with a view to ensuring that such additional fees would no longer be levied on persons in receipt of this service. I am preparing new legislation on eligibility and entitlement which will clarify patients' entitlements, especially in the GMS.

Liz McManus (Wicklow, Labour)
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I thank the Tánaiste for her reply. She has made great play on her commitment to care of the elderly. Does she agree that one of the most basic and important services one can provide to generally healthy older people is a chiropody service? Does she have a response to the fact that the Health Service Executive sought sanction for an increase in the uniform charge to a level rate throughout the country for domiciliary chiropody services to people in nursing services? Why has the Tánaiste not sanctioned this? Is she aware that a second visit by a chiropodist to a nursing home only accrues €7.03, according to an answer given last month to a parliamentary question? Does the Tánaiste intend to increase charges, outlaw these top-up charges and ensure sufficient chiropodists in the scheme to meet the requirements? She may be aware that elderly people have difficulties in accessing a chiropodist within the scheme.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am concerned about this area, particularly as we move towards providing more community-based services. Even within the hospital system, some of our largest hospitals have too few chiropodists and major issues arise. The fee must be realistic to provide a service. While I am not in favour of patients paying a top-up fee, unless appropriate fees are paid, chiropodists will not provide the service.

Entitlement and eligibility legislation will clarify who is entitled to services of this kind. A separate issue arises regarding those with diabetes and vulnerable groups such as the elderly. If we do not put in place preventative measures and chiropody services, more serious issues will arise which will be not only more severe for the patient but also more costly from the perspective of the health service. This is one of the areas in which major change must occur in the way we provide services at community level in particular.

Liz McManus (Wicklow, Labour)
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The Tánaiste did not answer my question. The HSE has requested an increase in fees for chiropodists. I have a list of chiropodists in the scheme and approximately one third of them are unavailable. I presume they are unavailable because they do not make enough money. It is not a case of entitlements legislation. We have been waiting 20 years for that. What is the response to the HSE's request to increase the fee?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I will not respond to that question because we must consider it in the context of the provision of services. One cannot have one without the other, if that does not sound like a cliché. There are large deficits at community level in chiropody services. I will shortly examine the issues which arise regarding fees. Confusion also arises on who is eligible for what and no statutory basis exists for that. All these matters must be dealt with. I am anxious to ensure that vulnerable groups of patients, in particular elderly patients, have regular access to appropriate chiropody services. In so far as the fee influences that, it must be reviewed.

Liam Twomey (Wexford, Fine Gael)
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Regardless of who is eligible for the service and other issues the Tánaiste wishes to tidy up, is it illegal to charge a medical card patient a top-up fee if the fee, no matter how small, is already paid by the HSE? Whatever about the patient offering the provider a gratuity payment, is it illegal to seek a payment from any patient provided a service in the GMS?

Mary Harney (Dublin Mid West, Progressive Democrats)
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As I stated in my reply, it is not part of the GMS. That is the issue.

Liam Twomey (Wexford, Fine Gael)
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How does the system work?

Mary Harney (Dublin Mid West, Progressive Democrats)
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It evolved on an ad hoc basis and varied from one health board to another. That is one of the issues that needs to be clarified. IMPACT represents the chiropodists and discussions and negotiations will take place between the Health Service Executive, the employer representative group and IMPACT on fee issues.