Dáil debates
Thursday, 16 February 2023
Saincheisteanna Tráthúla - Topical Issue Debate
Medical Cards
4:55 pm
Pat Buckley (Cork East, Sinn Fein)
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We are here to discuss just exactly what this enhanced medical card will be for the survivors of mother and baby homes. I know the issue has been ongoing for a long time. Unfortunately, when I say it has been going on for a long time, I mean that none of these people are getting any younger. I am being constantly asked when this enhanced medical card is going to be given to survivors, what it covers and more importantly, what it does not cover. I am being asked for an actual date for its release. I contacted the Minister for Children, Equality, Disability, Integration and Youth a number of days ago because elderly people are contacting me about the matter. One issue that was mentioned in relation to the enhanced medical card was cataract operations. Unfortunately, I have been told by the Minister for Children, Equality, Disability, Integration and Youth that that is not going to be covered.
As I said, I am here today to try to get clarity for those people who will have underlying conditions, whether it is diabetes or whatever else. I am trying to get clarity for them in order that they will know, without fear, what they are actually covered for with this enhanced medical card. It is putting stress on people. Indeed, some of the people I have spoken to have said they are holding back in the hope that the card will come sooner rather than later. Of course, these people do not have a lot of money and probably do not have the means to travel under the cross-Border healthcare directive for specific treatment. I said that I would raise the matter here in the Topical Issue debate to try to get clarity on what is coming down the road and to alleviate any fears for these people. I look forward to hearing the Minister of State's response.
5:05 pm
Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this important issue, which I am taking on behalf of the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman. He sends his apologies but he had to attend a meeting.
I thank the Deputy for raising this important health benefit for discussion. The Mother and Baby Institutions Payment Scheme Bill will provide financial payments and an enhanced medical card to eligible people in recognition of the suffering they experienced in a mother and baby or county home institution. The enhanced medical card will provide those eligible with a statutory entitlement to a range of health services. It will ensure the provision, without charge, of the following primary and community health services: GP services; prescribed drugs, medicines, aids and appliances; dental, ophthalmic and aural services; home nursing; home support; counselling; chiropody and podiatry; and physiotherapy.
As well as the above services, cardholders will not be required to pay the €100 emergency department statutory charge or the €80 public hospital statutory charge. It is estimated that through the scheme around 19,000 people will qualify for an enhanced medical card. Many people who spent time in these institutions now live outside Ireland. The scheme has been designed so that all those eligible to receive an enhanced medical card will have the option to receive one, even if they are not resident in Ireland. This means that while they are visiting Ireland or if they ever move back here, they can avail of health services using the card, which will be provided by the HSE. Alternatively, they can choose to receive a once-off payment of €3,000 in lieu of a card. This payment is in recognition of, and a contribution towards, their individual health needs. While acknowledging the challenge that healthcare costs can vary significantly across different individuals and different jurisdictions, a payment of €3,000 would represent a practical measure of acknowledgment for those who are living overseas and choose not to avail of the enhanced medical card.
Eligibility is based primarily on a minimum of six months spent in a former mother and baby or county home institution. This was approved by the Government on foot of the publication of the final report of the commission of investigation. This qualifying timeframe means the benefit will largely accrue to those who were residents prior to 1974, who likely experienced harsher conditions and who are more likely to be at the older end of the broad spectrum of survivors. This ties in with ensuring that access to health services is determined on the basis of need. It is important to note that outside the mother and baby institutions payment scheme, the overall Government response to the commission of investigation also includes the provision of counselling support, free of charge, to all survivors and former residents. This is provided through the national counselling service in the HSE.
I am acutely aware of the sense of urgency surrounding the establishment of the mother and baby institutions payment scheme. Ensuring it is open for applications as soon as possible is a key priority for the Department and the Minister, Deputy O'Gorman. It should be noted that this scheme will be the largest of its type in the history of the State in terms of the number of potential applicants. Therefore, the work required to deliver the scheme for applicants is significant. The legislation for the scheme is currently on Report Stage in the Dáil. In parallel with the legislative process, intensive work is under way on the development of the structures needed to administer the payment scheme, including an independent executive office situated in the Department of Children, Equality, Disability, Integration and Youth.
Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State. I am disappointed by that response. The Minister of State said, "Alternatively, they can choose to receive a once-off payment of €3,000 in lieu of a card". To remove two cataracts costs €3,000. That payment is a one-stop shop. A survivor receives that one-hit payment for a life's suffering. That is an absolute disgrace.
I understand the offer of counselling and so on. We will be talking about mental health later. Many of these people do not want that counselling. I welcome the offer of the dental and other services the Minister has listed. However, I am worried. Survivors were promised an enhanced medical card. The Minister of State made reference to "those who were residents prior to 1974, who likely experienced harsher conditions and who are more likely to be at the older end of the broad spectrum of survivors". The survivors envisioned that the enhanced medical card, while not a get-out-of-jail card, would deal with all their medical needs. GP services are offered but most of the survivors already have a GP because they are lucky and were in the system many years ago.
There is something to the offer of dental services because some people have lost out in that regard. I know people who have spent a lot of money on dental services. I also welcome the offer of chiropody and psychotherapy services, and so on. I wanted to find out the date that these enhanced medical cards will issue but we are not going to get it. I understand there is a bit of work involved. I ask for more urgency on this matter because people are not getting any younger. I would like to see a bit of compassion and an assessment on a case-by-case basis. I acknowledge that is a big ask but surely there must be some leeway allowed if someone needs something like a cataract operation. Such procedures should be covered under the enhanced medical card. We do not have a date for the introduction of the scheme. I encourage the Government to speed up the process as much as it can.
Anne Rabbitte (Galway East, Fianna Fail)
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I again thank the Deputy for raising this matter. I want to clarify one point. I said earlier, "While acknowledging the challenge that healthcare costs can vary significantly across different individuals and different jurisdictions, a payment of €3,000 would represent a practical measure of acknowledgment for those who are living overseas and choose not to avail of the enhanced medical card". That €3,000 refers to the overseas piece. I want to be clear about that.
The enhanced medical card is a critical component of the payment scheme and will provide significant benefits to an estimated 19,000 former residents of mother and baby institutions. It provides a statutory basis for access to more services than the standard medical card, including, physiotherapy, chiropody, counselling and home help. In addition, cardholders do not pay a prescription fee, receive enhanced dental services and can attend their GP of choice, once the GP is registered. The statutory entitlement to those services is significant in that these services are guaranteed.
As well as general payments, the work-related payments for those who are eligible, an €800 million payment scheme, represents a genuine effort by this Government to recognise and acknowledge the harsh conditions, emotional abuse and all forms of mistreatment, stigma and trauma that may have been experienced by former residents of a mother and baby or county home institution.
I take on board what the Deputy has said. An enhanced medical card scheme is intended to be exactly that - enhanced. It is to cover all aspects of healthcare. A person who has been waiting for access to cataract treatment for nine months would qualify for that treatment under the National Treatment Purchase Fund, which is reimbursed.
Pat Buckley (Cork East, Sinn Fein)
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Survivors do not have access to that money.
Anne Rabbitte (Galway East, Fianna Fail)
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The assessment is covered. Exactly as the Deputy said, if a prioritisation needs to be expedited, everybody will work to ensure that happens.
Pat Buckley (Cork East, Sinn Fein)
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I will follow up on that. I thank the Minister of State.