Michael McCarthy (Cork South West, Labour)
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I thank the Ceann Comhairle for selecting this issue. It has been well publicised in recent years that the incidence of chronic illnesses such as Crohn's disease has significantly increased, yet the long-term illness scheme has not been updated since 1970. It is time for it to reflect this increase and I am asking the Minister to relay to his colleague the need to provide some assistance for people suffering this blight on their health. It is a very unpleasant condition.

Crohn's is a serious, chronic inflammatory disease of the gastrointestinal tract that affects approximately 5,000 people in Ireland. There is no medical or surgical cure for it and there are few treatment options for patients suffering with this chronic condition. Crohn's disease affects people of all ages, but it is primarily diagnosed in adolescents and young adults, with onset typically between the ages of 15 and 40 years. It can have a devastating impact on the day-to-day lives of people and commonly occurs during a time of life when people are most active such as when they are in school, going to college or having a family. It can limit personal choices, resulting in many dropping out of third level education, working part-time rather than full-time, or working closer to home to reduce travel time. Many opt for low stress lifestyles and less pressurised careers. The condition poses challenges for those who wish to travel and some are also fearful of starting a relationship or family. It varies in an acute or chronic form and can be characterised by flare-ups and periods of remission. The severity of symptoms, the times without illness and the length of flare-up vary from person to person and there is no identified cause for its occurrence and little public understanding of the pain and chronic suffering with which patients cope every day.

People with long-term illnesses have a heavy load to bear in terms of the cost of treatment, the effect on their lives and their ability to and availability for work. The costs incurred in having an inflammatory bowel disease can have a huge effect on family finances. With Crohn's disease, the issue is not just medication, there is also the matter of consultant fees, the cost of GP blood tests and other procedures that mount up. Sufferers face a lifetime of medication, GP sessions, blood tests, endoscopy and regular consultant visits. As such, a Crohn’s disease patient may spend thousands of euro per year in managing the condition, with little potential for State support via the provision of tax relief at the standard rate.

Symptoms which patients can experience include abdominal pain and cramps, diarrhoea and blood loss, exhaustion, loss of appetite, nausea, fever and weight loss. It is a horrible illness. Crohn's disease patients are often treated with immunosuppressant drugs, resulting in infections being contracted on a regular basis. As a result, expensive visits to the GP are a requirement. Furthermore, one of the common side effects of Crohn's disease is joint pain, which means a trip to the physiotherapist is also a necessity. There is also the cost of health insurance and the drugs which are not available on prescription but which are also a necessity for treatment. These include paracetamol, medication for heartburn, anti-inflammatory gels, vitamins, etc.

Many patients suffering from Crohn's disease are prescribed steroids in times of flare-up. These drugs are extremely harmful to bone density and often lead to the onset of another long-term illness, osteoporosis, which is not covered by the scheme either. Does the Minister agree that by including Crohn's disease in the long-term illness scheme, it would help keep patients well and manage their conditions? I am sure the Minister is well aware of the affliction I have described and people suffering from the condition. I would appreciate it if we could, in straitened economic times, spare a thought for those who must endure this severe illness on a daily basis and deal with the associated cost.

Ruairi Quinn (Dublin South East, Labour)
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l am taking this issue on behalf of my colleague, the Minister of State at the Department of Health, Deputy Alex White, and thank the Deputy for raising it.

The long-term illness scheme is a non means-tested scheme introduced in 1971 which provides free medicines and medical appliances for people with specified conditions. The conditions covered by the scheme are mental handicap, mental illness for those under 16 years only, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, conditions attributable to the use of thalidomide, multiple sclerosis, muscular dystrophies, Parkinsonism and acute leukaemia. There are no plans to extend the list of conditions covered by the scheme.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process the Health Service Executive can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still he able to avail of a GP visit card which covers the cost of general practice consultation. Non-medical card holders and people whose illness is not covered by the long-term illness scheme can use the drug payment scheme which protects against excessive medicine costs. Under this scheme, no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines. In addition, non-reimbursed medical expenses can be offset against tax.

The Government is committed to a major reform programme for the health system, the aim of which is to deliver a single-tier health service, supported by universal health insurance, UHI, where access is based on need rather than income. Under UHI, everyone will be insured and have equal access to a standard package of primary and acute hospital services. An insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy. The Department is preparing a White Paper on universal health insurance which will provide further detail. The Government is also committed to introducing, on a phased based, a universal GP service without fees within its term of office, as set out in the programme for Government and the future health strategy framework. It has been agreed that a number of alternative options should be set out with regard to the phased implementation of a universal GP service without fees. A range of options are under consideration, with a view to bringing developed proposals to the Government shortly.

Michael McCarthy (Cork South West, Labour)
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It is widely speculated that in the next budget the Government will extend free GP cover to those under five years, which would be a wonderful initiative that could reduce the increased burdens on families struggling to deal with the current economic recession. We should also bear in mind the people I have described. We owe it to such persons to consider them in what I know are very difficult economic circumstances. They are trying to survive and not blessed with good health; therefore, we must do our best to ensure any significant financial burden can be offset in as much as it can be, given the straitened economic times in which we live.

Ruairi Quinn (Dublin South East, Labour)
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I understand the Deputy's concern about the matter. I also understand that not only are the physical consequences of the disease debilitating and very painful in some cases, but that they can also generate emotional turmoil because of a sense of helplessness. That is an additional burden that the people concerned and their immediate families must carry. I will convey the remarks made by the Deputy to the Minister of State, Deputy Alex White.