Tuesday, 3 December 2013
I put it to the Tánaiste that the Government's policy on discretionary medical cards is hitting hardest people with disabilities and children with special needs. In a survey, Down Syndrome Ireland, estimated that up to 100 people children with Down's syndrome have lost their discretionary medical cards. Up to half of the children with that syndrome have heart defects, gastrointestinal conditions and many other conditions attached to the syndrome. It is hitting them very hard. Children with very rare syndromes and conditions ordinarily had a medical card and have lost the discretionary medical card as a result of the change in policy. The Disability Federation of Ireland has raised serious concerns about the Government's medical card policy, particularly its impact on those currently receiving discretionary medical cards who have disabilities and multiple conditions. The federation makes the point that, for many people with disabilities, the costs associated with their conditions, including general medical services, therapies, transport and expensive medical aids and appliances, compromise their capacity to meet other basic costs of living. It says that removing the medical card from these people will cause their families undue hardship and stress. The Jack and Jill Children's Foundation deals with chronically ill children and works hard with them and is at the end of its tether with the struggles of many of the parents of children who attend services provided by the Jack and Jill Children's Foundation to get medical cards they lost. The director of the HSE wrote a seven-page letter to the Minister for Health about the health service plan and the Government decision to take over €100 million out of medical card services next year as a result of the budget, saying that such cuts to medical card services are being taken "against the advice of the HSE and the Department of Health". Does the Tánaiste accept the medical card policy is hitting hardest the sickest children, children with multiple conditions, children with very rare medical syndromes and medical conditions of all in the changes to the discretionary medical card system? Will he publish the letter sent by the director of the HSE to the Minister for Health in respect of the health service plan 2014?
The number of people with medical cards and access to free GP care is the highest ever in the history of the State. Almost 2 million people have a medical card or access to free GP care. Since the beginning of this year, the HSE has awarded 100,000 medical cards, of which over 20,000 are on a discretionary basis. The Minister for Health wants people to be clear on their entitlements and to reassure anyone entitled to a medical card that the person will continue to hold the medical card. With regard to discretionary cards, when Deputy James Reilly became the Minister for Health he instructed the HSE to establish a clinical panel to assist in the processing of applications for discretionary medical cards. This was to ensure medical professionals with expertise and knowledge have an input into the granting of a medical card to people who exceed the income guidelines but face difficult financial circumstances. This ensures the specific circumstances of a person with a particular diagnosis can be considered on a case-by-case basis. The discretionary medical cards are granted on the basis of financial hardship, not on the basis of a particular condition.
The long-term illness scheme covers people with certain conditions regardless of income.
Down's syndrome is one of the conditions covered under the long-term illness scheme.
As Deputy Martin knows with regard to the health service plan, there is a procedure for its consideration. It is submitted by the HSE to the Minister for Health, and that was done on 25 November. He has 21 days within which to consider that plan, running to 16 December, and between now and then the Minister will bring the health service plan to the Government. It is with the Minister and he is considering it.
The Tánaiste has not really dealt with the core point of the question. Today is International Day of Persons with Disabilities, which is why I focused on the impact of the Government's policy for children and people in general with disabilities who have lost their discretionary medical cards. The general increase in the number of medical cards is related to the economic position, unemployment and so on, but a policy change has been implemented by the Government in respect of discretionary medical cards, with a devastating impact on many people with disabilities. These are the people who are most sick; they have multiple conditions or very rare syndromes. I mentioned in the House the case of Katie Connolly, a five-year-old girl with Down's syndrome who is asthmatic and who has juvenile arthritis and a heart condition. We have also raised the case of an 11-and-a-half year old child who is one of six in the world with a particular syndrome that brings very serious issues.
That child lost a medical card as a result of the Government's policy change. The Minister of State with responsibility for these matters, Deputy Alex White, acknowledged in a reply to a parliamentary question that 10,000 such people have lost their medical cards in 2013 to date. By definition, a discretionary medical card is for people with special needs, multiple conditions or a range of other issues. These are the people who by any yardstick need a medical card the most.
The Government's policy is hitting these people the hardest. Does the Tánaiste acknowledge and accept that specific point on this, the International Day for People with Disabilities? Will the Government change that policy and approach, intervening to reverse what has been happening in order to restore medical cards to people with chronic and life-threatening conditions who have lost them?
It is. The Deputy has come in here and argued that there are fewer medical cards and that the numbers are being reduced because the policy is being changed. That is simply not true. Let us deal in facts. First, more medical cards are being issued now than at any other time. Since the beginning of this year, an additional 20,000 medical cards have been issued on a discretionary basis. That is the fact of the matter.
One euro out of every €8 of public expenditure in the State is now spent on disabilities. This Government is spending more on disability services now, in difficult times, than was spent in 2008, when Fianna Fáil was in Government at the height of the boom.
Everybody in this House knows that there have been problems in some cases with regard to the issuing of discretionary medical cards. The Minister for Health has made it very clear that the issue is being addressed. Somebody with a need for a medical card ought to have one. There have clearly been some cases in which medical cards either have been withdrawn or have not been issued when the person concerned should have had one. The matter is being addressed. It does not follow that because there are individual cases in which the wrong decisions have been made in the issuing and administration of medical cards, there is an overall change in policy. The Deputy should not come in and slap that contention in front of a Government that has issued more medical cards than at any time in the history of the State.
Tá an ciorcal órga beo fós. Tá sé tagtha chun cinn arís go bhfuil íocaíochtaí ollmhóra á dtabhairt do dhaoine le postanna ardleibhéil. Tá an rud seo ag tarlú fad is atá daoine eile ag streachailt, ina measc iad siúd nach bhfuil cártaí leighis acu. The Central Remedial Clinic, CRC, is currently the focus of ongoing controversy over so-called top-ups to senior executives, and there are contradictory claims between the HSE and the CRC about who knew what and when issues were known with regard to the topping up of payments. At a time of widespread cutbacks, it is grossly unacceptable that money donated to charity be used to line the pockets of already very highly paid senior executives. The latest revelations have deeply angered citizens across the State and there is a crisis of confidence about how donations to charities are being used, despite the fact that 95% of charities are not affected by this scandal.
Charities still need our support, not least because of the devastating effects of the Government's austerity policies. Charities also need regulation, and the Government must move with speed to create a regulatory authority, as promised in July. Does the Tánaiste accept that a full independent inquiry is needed to get the facts of the scandal? Will he factor into that the effect, arising from the culture of privilege and corruption, on the Government's credibility when it is itself in breach of its caps on the pay of special advisers? On the one hand it has railed against what is happening with these top-ups, but at the same time it has allowed top-ups in the pay of special advisers.
I agree that people who donate to charities are to be commended for their generosity, even in difficult times. That work should not be undermined by what has happened in some agencies and issues relating to the pay of senior executives. We have to bear in mind that this issue has come to the fore because the HSE has undertaken a study of the different agencies and levels of pay. It is operating on the basis of consistent application of Government pay policy.
I do not agree that we need some kind of full-blown public inquiry on the levels of pay in the different agencies, as that is quite easily established, and the HSE has sought to establish that from each of the agencies to which it provides funding. There is a dispute between the HSE and the CRC, for example, with regard to what happened and whether a level of payment was approved. I am glad the CRC has issued a statement on that and it has agreed to co-operate with the Oireachtas committee on the issue.
The process started by the HSE is continuing and it is important that it be completed. There should be transparency around levels of pay, and this is particularly important for confidence in the charitable sector and bodies in receipt of donations from the public to be restored. I believe it will be.
I see no rationale in the Tánaiste rejecting this simple, straightforward request because there is a culture of privilege and it is continuing on the Tánaiste's watch. We must be alert to the fact that this could go beyond the CRC. If I understood the Tánaiste correctly, he said the CRC is in breach of Government pay policy. However, the Government is in breach of Government pay policy and that creates a difficulty.
People are most charitable. I agree entirely with the Tánaiste’s commendation of those who give to charities but nobody who gives money for equipment to help a child or elderly person or for research into the ailments that affect sick citizens want it to be used to top up already extravagant salaries. In 2011 the Minister for Public Expenditure and Reform, Deputy Howlin, a member of the Labour Party, cleared the payment by the Minister for Health, Deputy Reilly, a Fine Gael Minister, of a salary of €195,000 to the then acting chief executive of St. Vincent’s University Hospital in Dublin to take over HSE hospitals in the west.
Is that why the Tánaiste will not agree to a full, independent inquiry into this scandal, because two of his Ministers have breached the Government’s pay policy and two Ministers have also agreed on a huge salary in defiance of all that he has just said?
There is a difference between those who cause a problem and those who solve it. There has been a problem about levels of pay in the section 38 organisations. The Government is addressing it. As Deputy Adams will recall, the issue came to light when a HIQA report was carried out on Tallaght hospital in 2012. Following that, the Minister for Health requested the HSE to carry out a complete analysis of the section 38 bodies to find out what levels of pay are being paid and whether they are compliant with pay guidelines. That is the exercise that is now under way. It is as part of the exercise that the information that has now come into the public domain about the levels of pay paid to various agencies has come to the fore. The issue is being addressed. We are determined to resolve it. To suggest that somehow something is being continued when it is being addressed is quite perverse. The problem is being addressed. It is important in so doing, in particular for charitable organisations which raise a lot of money from voluntary donations, that the confidence of the public in such organisations is not undermined but is maintained in terms of where money that has been donated goes. The Minister for Health is determined that pay in those organisations will be addressed. The issue is being dealt with, and that is why the HSE carried out the exercise in the first place. The process will continue until it has been completed.
Up to 30,000 families face eviction due to the failure of the Government to protect them. They are distressed mortgage holders who have fully engaged with the banks. They are not strategic defaulters. Their only property is their family home. They do not have buy-to-let properties. In most cases they have modest mortgages. In all cases their incomes have collapsed due to the recession. The Insolvency Service of Ireland has set out living expenses for personal insolvency arrangements. Under those guidelines a family of two adults and two children must have minimum living expenses of €24,780 per year to qualify for insolvency arrangements. Such a family on jobseeker’s benefit or allowance has an annual income of €19,364, which is significantly less than the minimum living expenses under the guidelines. A similar family with one person in employment at a wage of €9 per hour - in excess of the minimum wage - and including FIS, has an income of €23,193 per year. Again, that is less than the minimum living expenses set out under the insolvency service. Those two families have no net disposable income, as calculated by the Insolvency Service of Ireland. They have no money to give to the banks. They do not and cannot qualify for the insolvency arrangements. There are up to 30,000 such families. Paul Joyce of the Free Legal Aid Centres told us this morning that thousands of such families have had their proposals vetoed by the banks. I have letters from constituents who have been given the option of having a voluntary sale, making a voluntary surrender or being evicted. They are banks which the public has bailed out.
Last week the Taoiseach refused to answer my question on the issue but he repeatedly stated that there is a solution for everyone. Does the Tánaiste regard bankruptcy and repossession of the family home as a solution for those blameless families? Is that the reason the Government removed the legal ban on repossessions? One could ask whether that is the reason the indefensible situation has arisen whereby the Government has allowed the Central Bank to reduce the moratorium on repossessions from 12 months to two months. Will the Government ensure that the families which have fully engaged-----
I do not agree that 30,000 families face eviction. However, 30,000 families would face eviction if the Government had not taken the steps it is taking to deal with the mortgage arrears problem. That is why today, for example, the new personal insolvency legislation will come into effect that will reduce from 12 years to three years the period of time for bankruptcy. I also agree that the solution to the mortgage arrears problems experienced by many families is neither bankruptcy nor losing their home. The cornerstone of the Government’s approach to mortgage arrears is to ensure that families are able to continue living in their home. That means solutions must be found where families and households are in mortgage difficulty. The solution will vary from case to case. We have now put in place a range of measures to help families in mortgage distress. The personal insolvency legislation strengthens their hand in their discussions with the banks. The Insolvency Service of Ireland has been put in place. A range of non-judicial debt settlement arrangements have been built into the legislation. A range of measures is also in existence which will allow for engagement between mortgage holders and their lenders. To date, more than 45,000 permanent mortgage restructures have been completed. There is still more to be done. Far too many families are in mortgage difficultly and work must continue on a case-by-case basis with them to resolve their mortgage difficulties in a way that ensures they can continue to live in their homes.
The whole point is that we do not want to see people losing their homes. The very approach of Government policy is to avoid that. Probably the biggest fear people have had during the recession, which has been even greater than the fear of losing their jobs, has been the fear of losing a home. That is why we have taken the approach we have taken. We have put in place legislation and the personal insolvency service and we have set targets for the banks to engage with borrowers and to reduce the number in mortgage distress. That work must continue. There are still many families whose mortgage arrears have not yet been resolved, and work must continue to ensure this is addressed.
The Tánaiste has refused to answer the question. I have asked about a specific group, comprising families, that will not qualify for the insolvency arrangements about which the Tánaiste has spoken. He may not accept it but it is accepted widely, both within this House and outside it, that thousands of families do not qualify for the insolvency arrangements. New research by Grant Thornton Debt Solutions has found that many people seeking insolvency arrangements do not have enough income to qualify. Mr. Michael McAteer of Grant Thornton said recently on Newstalk that the only solution for these families is bankruptcy.
The Icelandic Government announced today that it will defy the banks by writing off up to €24,000 of household mortgages. Iceland obviously has real sovereignty.
Will the Government exercise sovereignty by preventing reckless bailed-out banks, some owned by international vulture capitalists, from evicting 30,000 families in this country?
We want every family and householder in mortgage difficulty to have that difficulty resolved and to avoid up losing their home. There is no family that we want to see excluded from the arrangements we have put in place to resolve mortgage arrears difficulties.
There is not a single solution that fits every case.
There are not 30,000 families facing eviction, nor will there be. However, there are 30,000 families who would be facing that prospect if we had not put in place the measures we have put in place to deal with the issue of mortgage arrears.
There is no question of their not qualifying. Every single case of mortgage arrears difficulty must be resolved, and issues must be resolved on a case-by-case basis.