Helen McEntee (Meath East, Fine Gael)
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I thank the Minister of State at the Department of Health, Deputy White, for taking this Topical Issue.

The reason I raised the matter is that since I was elected last year it has continuously come to my door. I suppose it is an issue that has been raised on several different levels. I am not the first person to raise this topic, not by a long shot.

The Department of Health is under severe budgetary constraints and the Minister, Deputy Reilly, and the Minister of State, Deputy White, are doing an exceptional job with the funding available to them. Free GP care is on the cards for everybody in the coming years, and those under six years are the first recipients of this. It does not take away from the fact that parents of children with Down's syndrome and autism are being discriminated against. Many of them do not know what they are entitled to and this is where the problem lies.

The medical card is means tested. One is not awarded a medical card on the basis of one's medical condition; one is awarded it on the basis of whether one can pay for the care that is needed. With regard to the long-term illness card, this is not the case. There is no income requirement and it is not means-tested. It allows a person to get drugs, medicines and medical appliances directly related to the treatment of his or her illness. In order to qualify for the scheme, a person must be resident in Ireland, have a PPS number, and be suffering from one of the 17 illnesses or disabilities listed.

I welcome the recent addition of ADHD to the list. The recent investigation by the Ombudsman regarding the case of a child with ADHD found that a child with ADHD or autism was discriminated against on the basis of geography, which is a whole other area. The investigation of the office found that in some areas ADHD qualified as a mental illness and the child was included under the long-term illness scheme, whereas in other areas one did not qualify. There was a lot of uncertainty. Obviously, I welcome the fact that this has been addressed. However, the same problem is, perhaps, being replicated for those with Down's syndrome and autism. In most cases a child born with Down's syndrome will need some sort of medical attention for the rest of his or her life. These people grow up and live their lives with Down's syndrome.

A child born with autism has a severe disability that affects the normal development of the brain in areas of social interaction and communication. This, too, is a lifelong disability and there is no cure. Perhaps some day medical research might be able to do something about that, but for now these children and young adults should be entitled to some sort of long-term care scheme.

Perhaps the Minister of State could clarify that up to the age of 16, children with Down's syndrome or autism can avail of the long-term illness scheme on the basis of an intellectual disability. I am not sure whether this comes under mental illness or mental handicap. Perhaps he could clarify that.

Under the mental illness category, a person is only covered up to the age of 16 years. However, a person with Down's syndrome or autism who is being cared for by his or her parents or other next of kin should not be taken off the long-term illness scheme at 16 years of age. Coverage should continue for longer as the process is inconsistent. Down Syndrome Ireland told me recently that most children did qualify, albeit in a roundabout manner. Many such families, however, have to go through an appeals process which can be draining, upsetting and unnecessary. There are approximately 3,500 people in Ireland with Down's syndrome, of whom two thirds are under 16 years. If the majority already qualify for long-term illness cards, there would not be much of a change in the provision of necessary additional funding. As families spend thousands of euro in getting their children assessed every year, this would be a way to repay and help them. Last year the Minister for Education and Skills, Deputy Ruairí Quinn, announced that his Department would review the manner in which resource hours were distributed. Could such a review also take place in the Department of Health?

Alex White (Dublin South, Labour)
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I thank the Deputy for raising this issue. The long-term illness, LTI, scheme is a non-means-tested scheme which was introduced in 1971. It provides free medicines and medical and surgical appliances for people with specified conditions. The conditions covered by the scheme are: mental handicap, mental illness - 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. Down's syndrome is classed as a qualifying condition under the mental handicap heading of the scheme. Persons diagnosed with Down's syndrome are supplied with an LTI scheme book and receive prescribed medication associated with the condition free of charge. However, autism is not a qualifying condition under the scheme.

Mental illness, under 16 years, is one of the illnesses covered under the long-term illness scheme. Previously some HSE areas regarded attention deficit hyperactivity disorder or ADHD as a form of mental illness for the purposes of the scheme, while others did not. The Ombudsman examined the operation of the scheme with reference to ADHD on foot of a complaint and issued a report to the HSE in July 2013 with recommendations for implementation by the end of October that year. In particular, the Ombudsman recommended that a uniform policy be put in place on ADHD across the country. The HSE advised the Ombudsman on 15 August 2013 that it accepted the findings made in the report and the recommendations in principle. Subsequently, it issued appropriate national guidelines for the uniform administration of the scheme. Implementation of the guidelines will ensure all children with ADHD are treated equally when they apply for a long-term illness scheme book.

There are no plans to extend the list of conditions covered by the long-term illness 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 be able to avail of a GP visit card which covers the cost of a general practice consultation. Non-medical card holders and people whose illness is not covered by the 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 embarking on 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, where there is fair access to services based on need, not ability to pay. The programme for Government commits that everyone will have a choice of insurer. Under the universal health insurance scheme, everyone will be insured and have equal access to a standard package of primary and acute hospital services, including acute mental health services. A new national insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy. Intensive work is under way on the preparation of a White Paper on universal health insurance which will provide more detail on the UHI model for Ireland, including its overall design, the standard package or basket of services, funding mechanisms and the key stages of the journey to universal health insurance.

The Government is also committed to introducing, on a phased basis, 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. Work is under way on legislation in that regard to offer a contract to general practitioners for the provision of this service.

Helen McEntee (Meath East, Fine Gael)
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Down's syndrome is classified as a qualifying condition under the mental handicap heading of the LTI scheme. In most cases that happens, but having spoken to Down Syndrome Ireland and some families affected, there are cases where families have to go through an appeals process. This is a lot of hassle for them and puts stress and pressure on them. Perhaps, therefore, this issue might be re-examined. There are different points on the spectrum of autism the autism which affects one in every 100 people in this country. One can go through his or her daily life without being affected, but those at the severe end of the spectrum should be considered for inclusion in the LTI scheme.

Alex White (Dublin South, Labour)
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I have listened carefully to what the Deputy said and take her point on Down's syndrome and the difficulties she noted in the application of the long-term illness scheme to persons classed as having Down's syndrome. I was not aware that there was a particular issue in that regard, but I am willing to examine the specific problem the Deputy has identified. As I indicated, Down's syndrome is classed as a qualifying condition under the mental handicap heading. "Mental handicap" is not a term we use nowadays, but it is taken from the 1971 scheme. We are reviewing the entire operation of the LTI scheme and the classification of different conditions may be one of the issues we ought to examine. The general operation and application of the scheme is under review and we can and will address some of the issues the Deputy has raised in the course of that review.

My general approach to the medical card scheme and the issue of access to GP care is that we should have a universal system. We should not devise new schemes based on illness or conditions, with all of the complexities that go with this. The Deputy has identified some of the difficulties, including how to define various conditions in terms of whether they fall into categories. What is the diagnostic basis and do people constantly have to undergo assessments? Is there an appeals process and do they really have a qualifying condition? None of these matters should apply in providing access to basic health services, particularly GP care. That is why the Government is committed, with the support of the vast majority of Members of this House, to having a universal system of access to GP services. In such a system we would get away from the notion of people having to demonstrate they have this or that condition under this or that category, as defined in 1971. The LTI scheme is a drugs scheme, but there should be universal access to GP care, which is what we are dedicated to achieving.