Seymour Crawford (Cavan-Monaghan, Fine Gael)
Link to this: Individually | In context

I thank the Ceann Comhairle for allowing me the opportunity to raise the important issue of funding for the Health Service Executive, HSE, in the north east.

The population of counties Cavan, Monaghan, Louth and Meath, in what was then the north-eastern health board region, has increased more than in any other region between 1971 and 2002. The most recent figures available show that between 1996 and 2002 there was an increase of 12.7% as against an 8% rise in the overall population. From 1971 to 2002 the population increased from 250,000 to almost 345,000 in the north-east region and that trend has continued at a significant rate to date.

Unfortunately funding for health services in the north east, even this year under the new HSE, has not taken into account the massive population increase. The most dramatic increase is in the 25 to 44 year age group. There is also a massive increase in the number of persons aged 65 years and over, many whom have to be dealt with by the HSE through home help or home care and nursing home structures with the support of subvention. The demand for the services provided by the HSE continues but unfortunately funding does not match. Funding is based on the funds supplied when the health boards were established in 1971. It was not adjusted to take account of the massive increases in population in the region. Having raised the issue before, I appreciate arguments will be made that the north east benefits from the services provided by hospitals in the Dublin region. However, the same can be argued regarding the midlands, the west or any other region.

My problem and that of the people I represent is that we find out the services available in other areas are completely different. For instance, only recently I came across a seriously handicapped person having to use a wheelchair. She had lived in Donegal were she was receiving 12 hours home care per week, yet because her husband's involvement brought him to Monaghan she now receives only two hours.

In another case I dealt with, a constituent from Cavan-Monaghan was put into full-time care in the western region to be near some of her family members. However, the owner of the home could not believe the difficulties he had in getting the subvention agreed initially and then getting payment of that subvention from the time the person entered the nursing home. He told me that there would not be the same financial pressure in his region.

Another issue of serious concern is the fact that almost 10,000 people in the constituency of Cavan-Monaghan have lost their medical cards since 1997. That figure is out of a population of 109,000 people with an average income, according to Government statistics, of approximately €14,500. By comparison, only 8,000 people lost medical cards in the county and city of Cork, with a population of 550,000, although the figures suggest the average income there is around €16,000.

Out of a national population of 4 million, 100,000 medical cards were lost. This clearly shows a totally unacceptable and uneven distribution of access to free medical care, with Cavan-Monaghan at a serious loss. This loss was even more clearly highlighted to Oireachtas Members from Monaghan who, with the deputation from the VEC, met the Minister for Education and Science, Deputy Hanafin. They were advised that the only reason Ballybay College in County Monaghan was not classified as disadvantaged was the fact that parents of the children did not have medical cards. That means they would have to pay for bus services, if such were made available. In addition, they do not benefit from the free book scheme or the back to school clothing allowance.

This is the reason I am not just asking but begging the Minister and the Health Service Executive to treat the people of the north east on equal terms, like everyone else, for funding. They are not seeking better terms or asking for any advantage. Wherever they live, elderly persons should have the same services available to them. A low-income couple with a young family should have the same right to a medical card as those elsewhere. I urge the Minister to ensure that a per capita sum is made available nationally, rather than being based on some historical and irrelevant numbers that bear no relation to the current situation.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

I thank Deputy Crawford for raising this matter on the Adjournment and I wish to reply on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

The aim of the home help service is to enable people, who might otherwise need to be cared for in residential care, to remain at home where appropriate. It is recognised that the home help service is an essential support to family and informal carers. In line with the Government's continued commitment to community support for our older people, an additional €33 million was allocated in the budget to the home help service —€30 million for 2006 and €3 million for 2007. The additional investment will provide 1.75 million home help hours this year and is being implemented in a flexible way by the HSE.

By its nature, the home help service is a flexible service which responds to clients' needs. As a result, therefore, the level of service required in individual cases will fluctuate from time to time. To ensure effective prioritisation of the service, assessments are undertaken at local sector level and carried out in all cases by the Health Service Executive's public health nursing services. The service is targeted at high and medium dependency clients in accordance with their assessed needs. The Health Service Executive is responsible for the implementation of the home help service on a national basis. The HSE has advised the Department that it is currently implementing the national rollout of the additional €30 million allocated to the service for this year.

In addition, €55 million was also allocated in budget 2006 for home care packages. It is planned to have an extra 2,000 packages in place by the end of 2006, almost trebling of the current service. Home care packages will deliver a wide range of services and in many cases these will also include an element of home help.

In the case of the particular example cited by the Deputy, the HSE has indicated to my Department that it would be happy to review this case if requested.

Under the Health Act 2004, the determination of eligibility for medical cards is the responsibility of the Health Service Executive. Persons aged 70 and over are automatically eligible for a medical card without reference to their means. Assessment guidelines, having account of both income and allowable outgoings, are used by the HSE to assist in the determination of a person's eligibility. These guidelines are not statutorily binding and in cases where a person's income exceeds the guidelines, a medical card may still be awarded if the HSE considers that his other medical needs or other circumstances would justify this.

Information supplied to my Department by the HSE's primary care reimbursement service for March 2006 indicates that there are 1,168,273 persons covered for services under the general medical services scheme. This is 23,190 more than the comparative figure for January 2005. A further 10,034 people hold GP visit cards.

Funding of €60 million was provided in 2005 to the HSE to provide an additional 30,000 traditional medical cards and a further 200,000 persons with GP visit cards. Since the beginning of 2005, significant improvements have been made to the way in which eligibility for medical cards and GP visit cards is assessed. In January 2005, the income guidelines were increased by 7.5%. In June 2005, the means test for both medical cards and GP visit cards was simplified. It is now based on an applicant's and spouse's income after tax and PRSI, and takes account of reasonable expenses incurred in respect of rent or mortgage payments, child care and travel to work costs. This is much fairer to applicants.

In October 2005, the income guidelines for both medical cards and GP visit cards were increased by an additional 20%. This means the income guidelines are now approximately 29% higher than they were at the end of 2004. It will be noted that the income assessment guidelines used for GP visit cards are 25% higher than those used for medical cards. The HSE has publicised these changes to encourage people to apply and has made the application process as simple as possible. The HSE has also provided a national information helpline. My Department and the HSE will continue to monitor the number of cards issued and will examine any further changes to ensure the targets of an additional 30,000 medical cards and the provision of 200,000 GP visit cards are met.

Records show that between June 1997 and March 2006 the number of medical card holders recorded by the HSE has reduced by approximately 76,000 — that is, from 1,244,459 to 1,168,273. However, these changes may largely be attributed to the increased number of people in employment and the improved economic situation nationally with people on higher wages. The ongoing management and review of medical card databases has also been a factor which has improved data quality in the HSE's databases.

Regarding counties Cavan and Monaghan, current information for March 2006, provided by the HSE, shows that there are 35,540 people with medical cards compared to 34,752 in March 2005. Thus, over the last year, the number of people with medical cards has increased by 788. Furthermore, including GP visit card holders, there are 1,191 more people in counties Cavan and Monaghan who now have free access to GP services under the general medical services scheme than this time last year.