Willie Penrose (Longford-Westmeath, Labour)
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Question 50: To ask the Minister for Health and Children the role her Department plays in interdepartmental actions to reduce the effect of poverty on health outcomes; if there is a strategy in this regard; and if she will make a statement on the matter. [10419/10]

Mary Harney (Dublin Mid West, Independent)
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There is increasing recognition that health outcomes are influenced by income, housing, educational attainment and other factors that fall outside the remit of the health sector. Within that sector, there is also a need to develop policies and services that address the particular needs of specific groups, such as Travellers, homeless adults, drug users and prisoners.

My Department participates in the senior officials group on social inclusion, which operates under the aegis of the Department of the Taoiseach and aims to improve the position of lower socio-economic groups and others at risk of social exclusion. It also works with the HSE and other agencies to provide more effective health services to marginalised groups.

By way of example, my Department established the Traveller Health Advisory Committee and has commissioned the all-Ireland Traveller health study, which we will have to hand later this year. It has also contributed to the development of the homelessness strategy published by the Department of the Environment, Heritage and Local Government in 2008 as well as working with the HSE to improve the provision of health services to homeless adults. It works closely with the Department of Community, Rural and Gaeltacht Affairs on the implementation of the national drugs strategy and with the Department of Justice, Equality and Law Reform in terms of forensic mental health services. It has also developed a policy on service users' involvement, with a particular focus on marginalised groups. It works with the HSE to ensure this is fully implemented.

The Department maintains a close working relationship with the Institute of Public Health in Ireland, IPH, which has a specific remit in respect of health inequality. The Department has just nominated the institute to be its representative on a three-year EU joint action programme on health inequality.

Reducing the effect of poverty on health outcomes is a common challenge for health systems around the world. My Department is committed to working with other stakeholders to tackle and reduce health inequality.

Jan O'Sullivan (Limerick East, Labour)
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While we discuss the ins and outs of the health services, the greatest factor in whether a person will be healthy is the area and the type of family into which he or she is born. We do not spend enough time addressing the relationship between health and poverty.

I take the point that the Minister's Department is involved with other Departments and so on, but how does she get the other Departments to prioritise issues that affect people's health? I attended the launch of a document published by the Galway Travellers Movement regarding a particular halting site in Galway. The movement assessed the effect of the site's conditions on the health of those living there. In this context, to what extent can the Minister for Health and Children influence, for example, the Minister for the Environment, Heritage and Local Government to address these issues?

Mary Harney (Dublin Mid West, Independent)
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At Cabinet level, it is co-ordinated by what is broadly called the social inclusion sub-committee. The officials group, which involves several Departments, works on the social inclusion agenda, including health.

Regarding Travellers specifically, I recently attended a similar launch in my constituency. In recent years, we have funded a number of primary care workers for the Traveller community, where they are having a significant impact on health issues. We do not have the results of the recent census to hand, but it will provide us with a considerable amount of information, not only on the health status of the Traveller community, but on relevant matters. I hope to have the report quickly.

Our involvement with the Departments of the Environment, Heritage and Local Government and Community, Rural and Gaeltacht Affairs has been concerned with the drug strategy. The HSE provides many services that are sometimes policy priorities for other Departments, including direct health services to homeless people. As the Deputy stated, the health needs of the most disadvantaged will not simply be dealt with by the health Ministry. Housing, sanitation, education and the child immunisation programme have important roles to play in health outcomes.

Brendan Howlin (Wexford, Labour)
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I want to allow supplementary questions from other Deputies.

James Reilly (Dublin North, Fine Gael)
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I want to make a few points.

Brendan Howlin (Wexford, Labour)
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Questions, please.

James Reilly (Dublin North, Fine Gael)
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Will the Minister assure the House that the funding put in place to address the issue of Traveller health will be used for that purpose? Previously, money had been siphoned off into other areas. As alluded to by my colleague, Deputy Jan O'Sullivan, the HSE has a hold on policy in that when money is not spent in a policy directive area, it can use it elsewhere. There are ways and means to not spend money. We have seen it not only in this case, but in terms of palliative care and mental health services.

Given that income plays a large role in health outcomes, does the Minister intend to change the income threshold for the medical card, which currently stands at a little more than half the minimum wage? Anyone who is prepared to work full-time is not entitled to a medical card. Sometimes, part-time workers are not entitled to it.

Mary Harney (Dublin Mid West, Independent)
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In the current circumstances, the answer to the last question is "No". The reality of the economic situation in which we find ourselves is that an additional 200,000 people have recently acquired medical cards. If memory serves me correctly, as I do not have the data in my brief, 1.48 million people are covered by full medical cards and 98,000 have doctor-only cards. These figures constitute a large portion of the population. The cost of providing services to our medical card community is substantially higher than it is, for example, across the Border. This influences the amount of cover we can provide in any one year. To be realistic, in the current financial circumstances, I do not anticipate changing the threshold.

The resource allocation group, which will report later this year, is examining all of the issues in respect of how to allocate health resources to get better outcomes for patients. Where Travellers are concerned, we have provided a great deal of additional money. We have also provided an extra €33 million for health projects for the homeless community. A priority of mine is that we continue with investments in these areas, where the most marginalised have bad health outcomes.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What specific actions has the Minister and her Department taken on the back of the report published last October by the National Economic and Social Council, NESC, entitled, "Well-Being Matters: A Social Report for Ireland", which found that we were joint seventh last on the list of the 27 EU member states in terms of access to hospital services? In that report, some 76% of EU citizens recorded ease of access to hospital services, yet only 65% of citizens in this State recorded ease of access. It was clear that the 35% who did not respond were from the least well-off in our community.

The IPH and the Combat Poverty Agency's 2008 report recommended that greater health equity and reductions in health inequality needs to become Government policy and be fast-tracked as priorities. It called for a health impact assessment to be done in respect of key Government policy. What has the Minister done on the back of this report, which is working towards being two years in situ?

Mary Harney (Dublin Mid West, Independent)
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I am not certain that proofing every policy would deliver the types of result the Deputy anticipates. Currently, every memorandum that goes to the Government must be gender proofed, poverty proofed, competitiveness proofed and North-South proofed. There is a considerable amount of proofing. We also conduct regulatory impact assessments of all new policies and legislation. We must bring much of this together.

We have universal access to hospitals. We do not have universal access to primary care free of charge and the hospitals apply a small charge. The issue with hospitals is the length of time it takes to access services. A central feature of the new consultants' contract is that access to diagnostic services for consultants' outpatients is to be on the basis of medical need and nothing else. The resource allocation group, which is examining in an in-depth and robust way the manner in which we allocate resources not only to hospitals, but between hospitals and community care and so on, will provide us with good insights into this matter.