Joe Costello (Dublin Central, Labour)
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While I was hoping to have the opportunity to listen first to the Minister for the Environment, Heritage and Local Government, Deputy Gormley, this is an important issue that must be dealt with. I cannot see a relevant Minister on the other side of the House to do so.

Brendan Howlin (Wexford, Labour)
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The Minister of State at the Department of Health and Children, Deputy Barry Andrews, is present.

Joe Costello (Dublin Central, Labour)
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Very well. The issue is that the Irish Family Planning Association, IFPA, has been obliged to suspend all its family planning services for the remainder of the year. The Minister of State will be aware the Irish Family Planning Association provides a national service to medical card holders and the reason it has been obliged to suspend its service for the final quarter of the year is that the Department of Health and Children has failed to provide the necessary funding. Moreover, that Department has failed to increase the level of funding for the past two years.

No family planning services will be available as a result of the failure to provide an increase in funding. Second, the number of medical cards has increased substantially. An additional 78,000 medical cards, as well as a number of GP-only cards, have been granted to citizens in the past 12 months. When the quantity of medical cards increases, the service providers should have ample funds to deal with the services required by such medical card holders. However, exactly the same sum of money has been made available. The annual allocation from the HSE to the IFPA is a meagre €290,000, which has not increased for the past couple of years. As the IFPA is a not-for-profit charity organisation, it has no means of fundraising and must bear any over-expenditure on its annual allocation itself. At present, it is €60,000 over budget and has no means of paying off that money. It now faces a bleak winter of being obliged to turn away medical card holders. It is a catch-22 situation.

The IFPA provides its services to the most vulnerable people in Ireland, such as young people, particularly in respect of teenage pregnancies, the unemployed, people with a disability, minority groups, ethnic women, single parents and those on low incomes. Such services are essential in reducing the numbers of unwanted and unplanned pregnancies and in providing women with family planning and primary health care. The services are provided on a national basis and their suspension will result in many women being unable to access family planning services for the next three months.

Cost-effective analyses indicate that for every euro spent on providing family planning services, more than four euro is saved on maternity services. The experience of the IFPA is typical of the dysfunctional manner in which the Government goes about its business. It makes a Cabinet decision to increase the number of medical cards but expects the service providers to operate with the same budget and staff numbers.

The budget will be announced next Tuesday and the budget increase must reflect the rising cost of providing comprehensive family planning services, the recent increase in the number of medical card holders and the increase in annual inflation rates. Something must be done immediately to ensure the HSE will increase the IFPA's budget in order that the necessary services and care will be provided for women and young people with medical cards between now and the year's end.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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I will be taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's commitment to the provision of family planning services.

Under the provisions of the Health (Family Planning) (Amendment) Act 1992 and the Health (Family Planning) Regulations 1992, the Health Service Executive is obliged to ensure that an equitable, accessible and comprehensive family planning service is provided nationally. The legislation requires health boards, now the Health Service Executive, to make available comprehensive family planning services, either directly or by way of an arrangement with another body. The Department of Health and Children issued guidelines to the health boards in 1995 on the provision of family planning services for all persons in their respective areas who needed such services. These services are provided primarily through general practitioners, non-governmental organisations and, to some extent, maternity hospitals and units.

The Irish Family Planning Association is one of a number of bodies offering a range of services designed to support reproductive choice. The Health Service Executive grant aids the Irish Family Planning Association on an annual basis to supply a quantum of service for this funding. The executive has indicated that arrangements are in place with the Irish Family Planning Association for the provision of family planning services to medical card holders at their centres in Cathal Brugha Street and Tallaght in Dublin as an alternative to the normal GP services.

The level of funding is limited to an agreed allocation discussed at various local service level agreement meetings throughout the year. The HSE has indicated that the IFPA was advised in July of this year that additional funding would not be made available to address expenditure overruns and that the association was requested to review the service to ensure that it remained within its available budget allocation. However, it is understood from the HSE that the IFPA has exceeded its budget in recent years, despite clear agreements in place for funding. Clearly, the HSE and those bodies funded by the HSE must operate within the resources made available to them in any given year. The HSE remains available to work with the Irish Family Planning Association to prioritise service provision within the allocated budget agreed to operate the service.

Family planning services continue to be available free of charge to medical card and GP-only card holders through their GPs. If a GP does not provide family planning services, he or she is obliged to refer a patient to a GP who will provide such services.