Seán Sherlock (Cork East, Labour)
Link to this: Individually | In context

Question 45: To ask the Minister for Health and Children the progress she has made to date in drafting legislation to clarify eligibility for health and social services; and if she will make a statement on the matter. [20210/10]

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

The current legislation governing eligibility for health and personal social services has been in place since 1970. The 1970 Health Act contains the now outdated concept of undue hardship as the basis for providing full eligibility for people who cannot arrange health care for themselves. It is time to move to more modern concepts for the basis of public health care such as'financial, medical or social need.

Since 1970 there have been many developments in services with a growing emphasis on the delivery of care in community health rather than institutional settings. For example, both in respect of public and privately funded services, the area of chronic disease management in the community is being given a higher profile than before. To support this change, and better care for all patients, we must develop both the eligibility rules for public benefits and the minimum benefits regulations for health insurance. Both of these, together, should be aligned towards the objective of better primary care and much better and more cost effective chronic disease management.

It is important that people have clarity about what they can expect in public benefits and from health insurance policies, and that both these support best health care and outcomes for everyone. The review of eligibility therefore dovetails with the development of minimum benefits for private health insurance. Work in this area is at an advanced stage and I hope to bring proposals to the Government as soon as possible in the coming months.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

It is useful to tease out what will be contained in this legislation which is extremely significant in terms of people's rights regarding health care. We in the Opposition would prefer if it were decided that everybody, whether privately insured or not, has the same rights in the area of health care. How comprehensive will the legislation will be? Will it deal with the mental health area, including, for example, the right of access to community mental health care within a particular timeframe? Will the legislation specify timeframes within which people will be entitled to receive care? They have just left the Gallery but I intended to welcome the guests of the cross-party group on mental health who have come from several different countries. They would be particularly interested to know whether mental health will be covered..

Will the legislation include dental services? People's right to dental care has been slashed even though, as I understand it, there is a right to comprehensive dental health care under the 1970 Act.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

I join the Deputy in welcoming the guests who have just departed. I hope they will learn from us just as we learn from them. The legislation will be as comprehensive as possible. Although we have had some recent legislation on medical cards and long-term residential care, and legislation is imminent on prescription charges, there is clearly a need for comprehensive legislation on eligibility. There are significant issues to be addressed.

I do not share the Deputy's view, even in the case of primary care, that there should in the short term be free access for everybody to everything. If we were to send Deputy Reilly to negotiate with the Irish Medical Organisation, as he has done in the past, I do not like to imagine the costs he would come back with. Within the available resources we must ensure that those at the bottom have access to all the services they require.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

The Adelaide Hospital Society has said it would require only an additional €217 million to provide universal free access to primary care.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

I asked the society whether that figure was based on negotiated costs.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

The society has done its figures, although the Minister disputed that in The Irish Times.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

I did not say the society had not done its figures. I simply said that nobody had negotiated with doctors as to what it would require to provide free access to primary care. I have checked that out with a number of practitioners and have been shown salary levels that would frighten us all if I were to mention them here, salaries far in excess of what we earn.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

A set figure has been indicated for every medical card patient.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

We should bear in mind the cost of introducing medical cards for all those aged over 70 years. I am simply saying that if we are going to move to salaried GPs, we must know what it will cost.

The Deputy asked whether the Bill will include dental and other services. The intention is that it will be as comprehensive as possible. I personally favour the concept of tiered benefits, with those at the bottom entitled to everything free of charge, those at the top paying the greater portion of their health care costs and those in the middle entitled to such facilities as the doctor-only card. On dental services, contrary to comments made in this House and elsewhere, the figure for 2010 is the amount we spent in 2008. For Deputies to suggest that represents a return to the Dark Ages is unfair and inaccurate.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

On the last point, there is tremendous confusion as to dental entitlements. Dentists have been told by circular and other means, in very obtuse terms, that they are to examine patients, and if it transpires that emergency treatment is required, then they will be paid, but they cannot know this until the examination is done. That is a farce.

On the substantive issue of eligibility, the Minister referred to chronic illness care. There is no primary chronic illness care in this country other than the very limited Heartwatch programme. We are paying lip service to the changes required in the community in order to ease the situation in hospitals and to change the way we deliver care, changes we all agree are necessary. However, lip service does not provide services to patients. The front page of the Irish Medical News indicated recently that there are two-year waiting lists for respiratory patients in Cork University Hospital. Even the smallest hospital has a respiratory physician, yet people are waiting two years in Cork University Hospital. The Minister wants to shove everything into that hospital. Everything is being taken out of St. Mary's orthopaedic hospital and shoved into the South Infirmary hospital, with facilities being closed left, right and centre.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

The discussion is straying from the issue of medical card eligibility.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Eligibility must be real rather than virtual, as is the case at present.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

It will be real and will recognise the financial resources under which we must all operate and which some of the Deputy's policies do not appear to recognise.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Yes, they do.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

The Deputy speaks as if we have an unlimited budget for an unlimited number of consultations, procedures and diagnostics.

On the Deputy's specific question, the legislation is long overdue. It is, however, a major piece of work on which considerable work has been done in my Department. The proposals will be brought to Government shortly for decision.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context

Under the health strategy of 2001, a commitment was given to produce new legislation in 2002 to provide a legislative framework guaranteeing the entitlement to health care and personal social services of every citizen across the State. The 2001 strategy indicated legislation would be produced in 2002. Eight years later, why have we only received the Title of the Bill? We are told in the new legislative programme that the heads of the Bill have not been agreed and it cannot be indicated when the legislation will be published. Noting the Minister's response, I must ask whether there is any real intent on the part of the Government to publish the eligibility for health and personal social services Bill. To clearly state the entitlements of citizens would run totally contrary to the Government's entire policy of promulgating a two tier health system that provides for those who can afford it and denies to an ever growing number of people who simply cannot afford it.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

I totally refute the Deputy assertion. Everything we have done, including the new consultant contract, medical card arrangements, screening programmes and the establishment of the fair deal, was precisely to deal with people who did not have appropriate access to public facilities. It remains my determination to continue to improve access to our public health services on the basis of medical need, rather than any other basis. If we were to have a free-for-all, those at the bottom would not receive that to which they are entitled.

On the specific question on the legislation, we remain determined to introduce the Bill and I hope a major advance will be made during this calendar year.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context

Where can people be given a clear indication of their entitlements on the medical card system?