Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I move: "That the Bill be now read a Second Time."

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

It is a bit like the Mary Celestein here.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Except for us, a Cheann Comhairle.

I am very pleased to introduce the Health (Miscellaneous Provisions) Bill 2024 to the Dáil. The legislation has three main aims. First, it will provide for an exemption of rent-a-room income of up to €14,000 per annum to be disregarded from the medical card and the GP visit card income assessment process. Second, it amends current legislation to clarify regulatory powers concerning the supply and administration of medicinal products. Third, it will provide for the establishment of regulations to help to deal with shortages of medicines. This will include a framework for therapeutic substitution by pharmacists in line with a clinically approved protocol or in other words, the supply of a specified therapeutic alternative medicinal product in limited circumstances where there is a shortage of a prescribed medicine.

I will begin by focusing on the exemption of rent-a-room income from the medical card and GP card assessment processes. Rent-a-room tax relief was put in place by the Revenue Commissioners in 2001. It allows participants on the scheme to earn up to €14,000 per year tax-free if they rent out a room or rooms in their home for use as accommodation by others. At present, income eligible for rent-a-room relief is included in the medical card assessment process. In such cases, this income is a contributing factor when deciding whether a person qualifies for a medical card. Exempting income eligible for rent-a-room relief from medical card and GP card assessment will benefit two groups of people: those who will now be able to apply for a medical card or GP visit card as a result of the disregard of rent-a-room income, and those who already have a medical card or GP visit card and may now choose to rent out rooms because of this increased allowable income. Currently, people with spare rooms may choose not to rent them out because that additional income would essentially put them over the threshold for the medical card or the GP visit card. The proposed exemption can help to address the shortage of accommodation in the State by making more efficient use of existing housing and by stimulating supply for renters, including of course students. This income disregard is an important addition to a much wider set of measures that have already been introduced by the Government in response to housing challenges. There are homes that are well located but which are currently underoccupied. We hope this legislation will help bring these further into use by providing greater options for people seeking to rent and those wishing to rent out rooms. This measure will assist in removing potential barriers to people benefiting from the rent-a-room scheme. It is an important step towards the Government's goal of providing additional accommodation to alleviate acknowledged challenges with the availability of residential rental accommodation.

I will outline the changes proposed to the Irish Medicines Board Act 1995, also known as the IMB Act. The IMB Act makes broad provision for arrangements for the control of medicinal products, including in relation to the manufacture, sale and distribution of medicinal products. Section 32 of the Act empowers the Minister for Health to make regulations that further the overall purpose of the Act. The House will note that the Act dates from 1995. Notwithstanding amendments that were made in 2006, updates of some provisions are advised to ensure the Act is more in line with the current needs of public health and of our health services. To that end, there are three amendments proposed to the IMB Act in this legislation.

The first of those changes concerns access to certain approved prescription medicines. During Covid, we widened the pool of health professionals who, with appropriate training and support, may supply and administer Covid vaccines. I have asked that this be retained and extended in order that we will have a permanent ability to call on a wider range of professionals to provide this service. This amendment will strengthen current legislation. It will give clarity on the professions who may administer medicinal products including, but not limited to, vaccinations. A further change, which is primarily being made to remove any doubt, explicitly includes "pharmacy" as a named location where the administration of medicinal products may take place.

On the second change to the IMB Act, the House will be aware of my ambitions for pharmacy as a profession. Pharmacists are highly trained professionals who can support a greater level of access to care for all of us in our own communities. I established a pharmacy task force last year to support this goal and its work is progressing well. This amendment will provide that pharmacists can sell and supply approved medicines without the need for a prescription. This primary legislative amendment will be subject to appropriate regulation and controls, to be set out in secondary legislation. This amendment also provides for expanded provision of vaccinations by pharmacists. It is my intention that regulations will be put in place to facilitate the sale and supply of oral contraceptive pills by pharmacists in the absence of a prescription. Such regulations will be subject to further clarity as to the appropriate framework and of course consultation with stakeholders.

The third change to the IMB Act concerns management of medicines shortages. I am proposing changes to mitigate medicines shortages nationally, and to complement work happening at EU level on medicines availability.

These measures will introduce medicines substitution protocols, MSPs, and related actions which will help to mitigate the impact of medicines shortages. MSPs allow pharmacists to supply a specified therapeutic alternative medicinal product in limited circumstances where there is a shortage of a prescribed medicine. This will be done in strict compliance with approved protocols specific to a known or anticipated shortage and for a limited time. It will enable us to be agile in our response to emerging shortages and further utilise the expertise of pharmacists.

I ask the House to note my plans that a further measure to support the management of medicines shortages and enhance security of supply, to be introduced on Committee Stage, will be included within this Bill. This will take the form of a further amendment of section 32 of the IMB Act to introduce reporting obligations for actors in the medicines supply chain and to allow for this information to be used in national medicinal planning systems. These reporting requirements, which are in line with European obligations, seek to improve visibility of the medicines supply chain to Ireland and help the management of medicines availability in Ireland. These measures will support the national system for the management and security of medicines supply and will facilitate a more proactive system for the management of medicines shortages.

Essentially, I believe that pharmacists can do a lot more than they are currently allowed do under the law. They stepped up during the Covid pandemic. I insisted at the time that the Covid vaccine programme be expanded to pharmacists. There were some who believed they would not step up; they were magnificent in stepping up. They cleared the decks through Christmas. There was one particular wave of Covid during which we had a matter of days, maybe a week or two, to get the most vulnerable vaccinated before that wave hit. If we had not been able to vaccinate those more vulnerable people, many people would have died. The GPs stepped up and the pharmacists stepped up. They were magnificent. Enhanced pharmacies are one of the things we have committed to under the programme for Government. We know they can do more. They want to do more. My Department is in discussions now with the Irish Pharmacy Union about a broad-ranging agreement. This Act will allow pharmacists - again, under strict controls - to begin to provide products that previously required a trip to the GP. GPs are very busy people. We can shift some of that work, like oral contraception, into the pharmacies. As we roll out a minor ailments scheme, there are other things - for example, conjunctivitis - where a pharmacist can very easily spot the problem but cannot provide the product because it requires a prescription. We are looking at those kinds of things to make sure that pharmacists can do more and more. We will tap into their expertise in terms of substituting certain medicines. We know there are medicines shortages around the world and we need to become more agile. There are therefore many steps we are taking with the pharmacists. This evening's Bill is an important step in providing a new legislative basis to tap into their very substantial expertise and their real appetite for doing more and more in terms of healthcare provision right across the country.

I will now provide a brief explanation of the sections of this Bill.

Part 1 is for the preliminary and general provisions of the Bill. Section 1 contains standard provisions setting out the Short Title and citation and provides that the Bill shall be subject to a commencement order. Section 2 contains the full definitions of the Acts being amended in the Bill.

Part 2 provides for amendments to the Health Act 1970.

Section 3 sets out amendments to section 45 of the 1970 Act. It states that in determining a person's overall financial situation, as provided for in section 45(2), relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment of medical cards.

Section 4 sets out amendments to section 45A of the 1970 Act. It states that in computing gross income for the purposes of sections 45A(5) and 45(5A), relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment for medical cards for people of 70 years of age and above.

Section 5 sets out amendments to section 58 of the 1970 Act. It states that in determining a person's overall financial situation as provided for in section 58(2), relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment of GP visit cards.

Section 6 sets out amendments to section 58A of the Health Act 1970. It states that in computing gross income for the purposes of section 58A, relevant sums arising to a person or a person's spouse or civil partner that qualify for rent-a-room relief under section 216A of the Taxes Consolidation Act 1997 shall not be taken into account by the HSE in the assessment of GP visit cards for people of 70 years of age and above.

Part 3 provides for amendments to the Irish Medicines Board Act 1995.

Section 7 sets out the amendment of section 1 of the IMB Act. It inserts definitions relating to the amendment of the IMB Act in Parts 8 and 9 to clarify the meaning of terms inserted for the purposes of the amendments.

Section 8 involves the amendment of section 32 of the IMB Act and provides for three additions. Under subsection 32(2)(k), it inserts "pharmacy" as a location where the administration of medicinal products may occur. It sets out explicitly that pharmacists are a profession to which regulation of the prohibition on the sale and supply of medicinal products without a prescription, and exceptions to that prohibition, may apply under section 32(2)(l) of the IMB Act. An amendment to section 32(14) specifies the health professionals who may administer medicinal products, subject to regulation. This gives clarity as to the professions who may administer medicinal products - for example, vaccinations - but does not confer new powers or scope of practice on any profession.

Section 9 makes provisions relating to medicinal products shortages by facilitating the implementation of a framework for MSPs. During a period of a specified medicine shortage, an MSP will allow pharmacists to therapeutically substitute medications where they deem it clinically appropriate to do so and in line with the protocol issued by the Minister for Health.

In conclusion, this Bill removes potential barriers to the rent-a-room scheme such that income of up to €14,000 yearly is not counted towards medical card and GP visit card assessments. This will ensure that those who utilise the scheme are not at risk of losing eligibility or prevented from getting a medical card or a GP visit card if they apply while renting a room to someone. This measure helps to progress the Government's Housing for All policy by removing potential barriers to the rent-a-room scheme to increase its potential as a source of student accommodation and, of course, other accommodation. The changes proposed to the IMB Act will enable pharmacists and other health professionals to continue to expand the supports they provide within our health services. It is envisaged that when the MSPs are in place, they will assist pharmacists in managing certain shortages of medicines in a swift manner without patients being referred back to prescribers for a new prescription. This will ensure continuity of care for patients and reduce strain on the health service.

I very much look forward to listening to Deputies' views and to working with colleagues across the House to progress this important legislation through the Dáil as quickly as possible. Given that the core objective represents positive actions to benefit students, renters, patients and families, especially in the context of the current cost-of-living crisis and accommodation challenges in Ireland, I hope to enact the legislation as soon as possible to ensure early and timely implementation. The same applies for medicines. Our pharmacists have a real appetite now to do more, and it will be great to get this legislation through both Houses. It will facilitate them in providing more and more care and more advanced care in the communities for all of us.

David Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Sinn Féin will support this Bill. I welcome in particular the provisions relating to medicines substitution protocols, which will improve the availability of products through pharmacies without a prescription. These are issues we have talked about for some time in the Houses of the Oireachtas. I have tabled a number of questions on this issue through priority and oral questions over recent years and have been raising it. I know the Minister has been working on this for some time, as have people outside of the Dáil who have lobbied very hard for changes in this area. There is more to be done in this space. I will come back to that in my contribution, but I welcome the provisions in the Bill.

The Bill, as we know, also makes provision to exclude income which is relevant to the rent-a-room tax relief from consideration of a medical card means test.

4 o’clock

Insofar as it goes, that is important and I welcome it.

I take this opportunity to raise wider issues relating to medical card eligibility and circumstances where I believe we can and should go further. The Government should have raised the medical card income threshold this year, but it also should have introduced a minor ailments scheme or what I would describe as a pharmacy-first model that would be underpinned by a minor ailment scheme, and much more. Instead, as we know, we have very limited additional funding for health in 2024. It is important to reinforce that at each and every opportunity we have this year to talk about expansion of healthcare. If the additional resources and funding are not there, then there are very limited options available to the Minister to expand services. We are pretty much trying to stand still this year when we actually had a real opportunity to accelerate what we are doing in many areas, particularly in primary care and community care in the context of pharmacies. We should build on the enhanced community care model, care in the home and care in the community and take the pressure off from our acute hospitals by providing the right care in the right place at the right time and so on. It is very difficult to do that, however, when we have limited additional resources available to the HSE. This all comes back to a decision that was made on budget day. I must also point out that Government has not reviewed the medical card income thresholds in 20 years. That is an incredible length of time for the Oireachtas and the Government not to have revised and improved access to medical cards. There has been some tinkering around the edges and some amelioration here and there, but in terms of substantial movement in this area, it has not happened.

I welcome the expansion of GP-only cards and doctor-only visit cards, particularly as I called for this. It is an important step. It was one of a number of things that needed to be done to reduce the cost of healthcare and move to a truly universal system. Some weeks ago, the Joint Committee on Health discussed the fact that there are difficulties with people understanding their entitlements and with making it available to people actually availing of it. I know that is something on which the Minister is working. I appeal to people to look at all of that, not just the income thresholds relating to the free GP card but also the other exemptions that go with it that could actually ensure somebody qualifies. Obviously, we want people to take up those opportunities. That is one part of it. I also agreed that we should freeze expanding free GP cards until we can bed in what is there and then also increase GP capacity further. We have to be conscious of pressures on GPs and we want them to do more to take pressure off the acute system. I was on board with that, which is why in our alternative budget this year we focused on 400,000 additional medical cards by increasing the income threshold by at least €10,000 per year. It was a better way to move on the issue of affordability and accessibility and making healthcare more affordable for people as opposed to more GP-only cards when we have the difficulties we have with even getting people to avail of the ones that are there.

As I said, I obviously agree with the rent-a-room relief and excluding this income from the medical card assessment. That will impact on a very small number of people, however, as important as it is. In our alternative budget, as I said, we provided for 400,000 additional medical cards. There has not been a review of medical card eligibility for two decades. Many people on what I would call very modest low incomes do not qualify for medical cards. As we also know, the medical card is a gateway to a range of primary and community care services. As a result , the more medical cards we can get to people, the greater access they have to primary and community care, which is one of the things we need to do, as I keep saying, to take pressure off our acute hospitals and ensure people are getting the right care in the right place. I also understand that none of this can happen overnight. I have been very honest about that as a lead Opposition spokesperson. All of these things take time.

I have also welcomed many of the moves that have been made in recent times, and I will do so again, including scrapping the inpatient hospital charges, additional free GP cards and the floor that exists in the context of the enhanced community care model. There are many teams providing support to people in the community, including integrated care programmes for older people, ICPOP, teams, community intervention teams and chronic disease management teams. That is really where we need to be at, and we need to be doing much more of that.

I have also to put it to the Minister that the recruitment embargo is impacting on chief officers in community services being able to recruit. An Teachta Ó Laoghaire has examples of this and will go through them later, but examples have been sent to me as well. Letters are being sent to staff in the healthcare service right across the board, particularly those in primary and community care, telling them their options of leave are now extremely limited because the services cannot hire staff to replace those who are leaving. That creates tensions within the system that really should not be there. I will make the point, however, that while I welcome the fact that we have finally moved with regard to an enhanced community care model, which the Minister put in place and for which I applaud him, there is an awful lot more we need to do. I am sure the Minister will agree.

I 100% support the moves with regard to medicine shortages. I have engaged with many people on this issue and have lobbied the Minister very hard in respect of it. I know that is something he was working on anyway. It is a really important step in this Bill today and I welcome it. However, I believe we are still only dipping our toes into the water with regard to what we can do with pharmacies. I again recognise some of the work the Minister has done this area, but there is an awful lot more we can do. I see GPs and pharmacies as comprising one of the most important gateways for people getting into healthcare. They are really important in terms of taking pressure off acute hospitals. I have always held this view. I have visited many hospitals over the last number of years as health spokesperson. I have probably been in every hospital at this point, and, I would imagine, some on more than occasion. I am very much of the view that if we continue to look solely at the problems and pressures in our emergency departments and hospitals through the lens of what is happening in those hospitals. If we just keep focusing on beds and surgical theatre capacity - these are all important and we do need to concentrate on them - we are never going to solve the problem. We have far too many people ending up in hospitals who really should be cared for elsewhere. There is a much broader issue that goes to care in the home and care in the community, but pharmacies have a role to play, and GPs have a greater role to play. We need to continue to find new and better ways of operating.

I share the Minister's concern that many dentists have still not signed up to the dental treatments service scheme. I appeal to them to do so. I appeal to them to treat medical card patients and engage in a process. I asked the Minister previously in good faith - we moved a motion in the Dáil - to commit additional resources. Those resources were committed. I am sure there is more that needs to be done. I know they are looking for a new contract, and there is a need for discussions in that regard. That is a matter for the Minister and the representative organisations. At this point, however, we have people who cannot access the service. I appeal to the dentists who have left the scheme to come back and engage because it is really important.

I have raised all the issues I wanted to raise. I will be supporting the Bill.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Aontaím leis an méid atá ráite ag an Teachta Cullinane. Tá go leor sa Bhille seo a dhéanann ciall agus go leor a bhí á éileamh ag Sinn Féin ar feadh tamaill mhaith. Déanfaidh an Bille cinnte de go mbeidh sé de chumas ar go leor poitigéirí thar timpeall na tíre, a bhfuil fonn orthu níos mó a dhéanamh ó thaobh cúnaimh de, níos mó a dhéanamh. Tá go leor eolas agus saineolas acu maidir le cúrsaí sláinte agus faoi mar atá, níl an áis sin á húsáid faoi mar ba chóir.

Aontaím freisin leis an méid atá ráite ag mo chomhghleacaí ó thaobh na leibhéil ioncam agus an tionchar atá aige sin ar na cártaí sláinte. Tá gá le méadú air sin chun na srianta a dhéanamh níos fairsing ionas gur féidir níos mó daoine a cháiliú. Tá go leor daoine atá ag obair go dian agus tá siad faoi bhrú ó thaobh a gcuid ioncam i gcomhthéacs na géarchéime chostais mhaireachtála faoi mar atá faoi láthair. Ní fhaigheann siad cúnamh agus tá sé sin an-deacair dóibh. Is cóir féachaint air sin.

I agree with Deputy Cullinane. This is useful legislation. We support it. There are a number of aspects of the Bill with which we agree.

One of the things it does is exclude income relating to the rent-a-room tax relief. We agree with that because it makes sense. The tax relief creates a bit of extra capacity and encourages people not to be incentivised, on the one hand, and disincentivised, on the other, and in danger of losing out on the medical card. I talk about this in the context credit time and housing lists. The medical card is like money in the bank for people. We should always be conscious of the potential impacts. People will rightly take conscious decisions in respect of what initiatives they take or what they do regarding employment when they are trying to protect their medical cards because, as I say, it really is money in the bank for them.

In the context of income, Deputy Cullinane made a valid point on income thresholds. We believe they need to be expanded too. I also agree that the threshold for the drug payment scheme could be reduced in order that more people who do not qualify for the full medical card could benefit from that, There are an many people who, in the context of the cost-of-living crisis, are working very hard and struggling. If people have to make two visits to a GP in a month and pay for all the prescriptions which might go with that, it is a huge blow to their income, not least if there is a need for a third or fourth visit, as can often be the case in wintertime.

I raise this matter cautiously because it is one that requires consideration but there is legislation passing through the House at the moment in respect of child maintenance and whether that should be assessable for the purposes of social welfare payments. The Minister for Social Protection has removed child maintenance from the means-tested social welfare grants, which is welcome. The rational thing to do would be to look at where there are other income tests in the system. For example, in the context of social housing income assessment, child maintenance can be taken into account. I do not think that is right. For medical card assessments, child maintenance can be taken into account. You can potentially lose your medical card if the child maintenance brings you over the limit. What is more, because the medical card extends to everyone in the family, if you have children over the age of eight who do not qualify for the free GP card, those children could also lose their medical cards on the basis of child maintenance. If we are going to be consistent in social welfare payments, then we should be looking at this as well. It is also a bit of a contradiction because if you are paying child maintenance, that can be considered a valid expense. There is a bit of a contradiction there in the context of health policy.

We have a network of pharmacies that are willing to do more. Pharmacies have been underutilised. The minor ailments scheme that we have been proposing needs to be looked at. What the Minister talked about makes sense, and we agree with that. I echo the point made by Deputy Cullinane. The recruitment embargo is having is beginning to bite in the context of services provided, people's access to healthcare and staff numbers. Housekeeping staff in Cork University Hospital have been told that leave requests will be very limited for the next few months. They have been asked to apply for leave only if it is absolutely necessary because the hospital would not be able to cover all annual leave requests due to the shortage of staff.

We talked during Covid about those on the front line and the heroes out there. That was not just the nurses and the doctors. It was everyone in the healthcare system who banded together to hold everything together. These are housekeeping staff many of whom worked very hard during that period and they are basically being told "Listen lads, you can forget your holidays for the next couple of months". That is not right, and it is a consequence of Government policy. The Government really needs to rethink the approach it is taking with this embargo because it is not fair on staff or patients.

Thomas Gould (Cork North Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I echo the comments of my party colleagues in support of this Bill. I take the opportunity to speak on it and raise a number of issues.

I acknowledge the great work done by pharmacists in my constituency and right across the State. They are often a person's first port of call. They provide compassionate, educated advice on many issues. This is invaluable.

I request that the Minister give consideration to extending the needle exchange programme. In many areas, this works really well. However, it is a postcode lottery. Will the Minister consider extending this programme to ensure that services are available in all areas? The programme is particularly important in rural areas, where people have to travel long distances to pharmacies.

I understand that only GPs can prescribe methadone. Pharmacists have a role to play in this regard, particularly as they are likely see people more often than GPs and therefore would be in a better position to help prescribe or to work with patients. This is something that could be looked at. It would take some of the pressures off GPs and place it on pharmacies. This is something that should be looked at. I am hearing about issues such as this. Some people get weekly prescriptions and others get them daily. This would give the people on the ground who know what is happening the ability to make the right decisions. Will the Minister consider naloxone as a drug that could be provided without prescription? We have seen in Dublin and Cork recently the vital work done by groups where we had a series of heroine overdoses. Because people had access to naloxone, lives were saved. Community groups and those on the ground have reacted really well. They have done Trojan work. There is no doubt that they are saving lives every week. In the current system, many services have found ways around ensuring naloxone is always available for people but groups should not have to find workarounds. This is something that the Minister and the Department can change. We know naloxone saves lives and that it has to be prescribed, but there are groups and families who would use it if they had access to it. That is something we could maybe look at with pharmacists. Perhaps naloxone might not have to be prescribed by GPs.

Deputy Cullinane touched on medical cards and the income threshold. The means test for the medical card is probably a fairer system than others, but the threshold has not been increased in 20 years. It takes into account outgoings and financial burdens that are vital to truly understand a person's means. A person's means are not always their income. What their outgoings and expenditure are has to be taken into account to have a true reflection of where a person is. When we look at the recent inflation and the cost-of-living crisis of which we are in the middle, and at the same time, there has not been a review in almost 20 years. Eight Governments have held office during that period. Just for people to try to get a grip of what 20 years is, it is a generation. We had no Facebook, YouTube, Spotify, Twitter, or iPhones 20 years ago. That is how long ago it is. If you ask anyone, they could not imagine living without any of those services or items now. That is how long it has been since we have had a review. We have had referendums on the eighth amendment and on Lisbon and we cannot increase the medical card threshold. The Minister has to seriously look at that. People's incomes have changed in 20 years and that has to be respected.

I will finish by making one further point. There are no primary care centres in Blarney, Tower, Mayfield or Glanmire, even though they were promised. I ask the Minister if those centres can be delivered, particularly as they are vital for the communities in question.

Duncan Smith (Dublin Fingal, Labour)
Link to this: Individually | In context | Oireachtas source

I informed the Whip's office that I would not be taking my full 20 minutes.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

That is fine.

Duncan Smith (Dublin Fingal, Labour)
Link to this: Individually | In context | Oireachtas source

The Labour Party and I welcome this Bill. It provides the mechanism to allow us to can make regulations that will enable pharmacists to sell and supply approved medicines without the need for prescriptions. This is a positive step in addressing the increased pressure that is placed on GPs and GP services.

During a Private Members' debate this morning, I spoke about the lack of GP services not only in rural areas but also in cities and in my constituency of Fingal. Many people still face waiting times of up to two weeks to be seen. As the Minister knows well, the pressure on the health system as a result of waiting lists is significant. There is also pressure on accident and emergency departments, and the recruitment freeze is making everything worse. I raised an issue this morning and I will raise it again now with the Minister. It relates to a new community nursing home in Nenagh. That facility has been built. It was seven years in planning and development. My colleague Deputy Kelly received a communication from the HSE last week stating that it is unsure when the home will be staffed. St. Conlon's in Nenagh is not going to meet HIQA standards, so the community retirement facility to which I refer is much needed. I raised this with the Minister of State, Deputy Butler, this morning. I raise it again now on my behalf and on that of Deputy Kelly. The recruitment freeze is an obstacle to getting this home staffed. It needs to be staffed. We had debates about long-term residential care before, and I am sure we will do so again.

Returning to the Bill, there is scope for the expansion of the role pharmacists and pharmacies play in delivering medication in communities. A change in this regard would not only improve access to essential medications, it would also ease the burden on our overburdened GP services. For many people, pharmacists are the first port of call when they have a medical issue. Pharmacists are trusted members of their communities. People have built up relationships with their pharmacists in the same way they have built up relationships with their GPs. Pharmacists are equipped with the knowledge and expertise to aid in reducing pressure on GPs but, most importantly, they have the knowledge and expertise to provide expert care either over the counter or in the consultation rooms that some of them have on site. Take, for example, the minor ailments scheme. Research commissioned by the Irish Pharmacy Union, IPU, last year shows the overwhelming support of pharmacists for expanding their role, with 96% of those surveyed stating that they were in favour of pharmacists being able to prescribe treatments for minor ailments and 94% in favour of pharmacists being able to repeat certain prescriptions without recourse to a GP. Pharmacist will obviously favour that. It will mean more business for them. I understand the financial benefit involved, it is the public benefit I am interested in. Again, it is just about trying to get access to services and to make it easier for people who are sick or who are running to the pharmacy for someone in their family who is sick to be able to get the medication they need as soon as possible. The public appetite for an expanded role for pharmacists is there. Whatever negotiations need to take place between the IPU and GP services, through the Minister and the HSE, must be brought to fruition.

The IPU has welcomed this legislation. As the Minister knows, the IPU has long advocated on behalf of patients for the introduction of these measures. The IPU feels, as I do, that the full expertise of Ireland's community pharmacists has long been an untapped resource. These service expansions will support patients to access treatments more quickly and easily. Ultimately, this is good news for patients and represents a positive step in patient care across the board.

Of course, this means that there will be significant additional work for pharmacists. They will now be responsible for providing the contraceptive pill in addition to having responsibility for being permitted to recommend clinically appropriate substitute medicines when a prescribed medication is unavailable. It is essential therefore that the supports provided for pharmacies are expanded as a matter of urgency. Pharmacies have faced a 16-year pay freeze. During that time, the rate paid to dispense medicines under the community drug scheme decreased by 24%, from €6 to €4.58, while the revenue generated by pharmacies under the community drug scheme decreased by 29%. That is not a sustainable trend, nor is it a sustainable model.

With regard to the second function of this Bill, we need to ensure equitable access to healthcare for all individuals regardless of their financial circumstances. Currently, eligibility for the medical card is based on a financial assessment conducted by the HSE. However, certain income sources, such as, for example, the rent-a-room relief scheme, are factored into this assessment, potentially disqualifying individuals from receiving or retaining a medical card. The Bill seeks to rectify this by introducing a disregard of up to €14,000 or other yearly limits subsequently set by the Office of the Revenue Commissioners for individuals with eligible income from the rent-a-room relief scheme. By excluding this income from the medical card assessment process, it is hoped that people who are actively aiding the State in addressing the housing crisis will not be denied access to the medical card for doing so. The reality is that students, people on low incomes or those with families are the primary beneficiaries of the rent-a-room scheme. If those who can access the scheme feel they will not face consequences for simply providing accommodation, that will be welcomed. This is not a handout to big landlords; it is a targeted relief scheme that will mostly be utilised by older couples who, as we know from research, are the people who, in the main, avail of the rent-a-room relief scheme. This Bill provides the requisite measures in this regard, and they are welcome. I acknowledge the Minister's work in this area. We will support this Bill.

Róisín Shortall (Dublin North West, Social Democrats)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to speak on the Bill, which the Social Democrats will be supporting. However, I have some concerns about the approach being taken in Part 2 in terms of both health and housing. I will go into detail on those matters in a few moments.

In the context of Part 3, I very much welcome the provisions to enhance the role of community pharmacists. I will begin by commenting on this matter. In November, the expert task force published its initial recommendations. I commend Minister on the speedy way in which he acted on those recommendations. It is not so long ago that it was a struggle to get any expansion of pharmacy services over the line. When it was first proposed that pharmacists would start to administer the flu vaccine, it was a real battle for them to be allowed to do that. That was the first battle. The second battle was for them to be paid fairly in line with what GPs were being paid. Thankfully, that was resolved in time. There is huge capacity within community pharmacies. It does not make sense not to exploit that capacity as fully as possible. At a time when we are struggling with recruitment and different issues in respect of the health service, it makes absolute sense to ensure that pharmacists have an expanded role. They also have the huge benefit of being located in every town and village throughout the country.

As is so often the case with healthcare policy, existing interests resisted any change to the status quo. I am very glad that the plan for the roll-out of the flu vaccine came to fruition. We saw the huge benefits of that in the context of Covid vaccines, although there was some resistance to advertising that fact and to providing details of the pharmacists that were participating in the scheme. I noticed that at the beginning. It was corrected in time, but it should have been done at the very start. Pharmacists played a huge role in ensuring that people across the country had access to Covid vaccines. It certainly feels as though there is a real momentum around expanding the role of pharmacists. I urge the Minister to seize on the opportunity to unlock their full potential.

The main recommendation from the expert task force's interim report was to allow pharmacists to prescribe for up to 12 months. From reading that report, it is clear there was general support for the three-month prescription extension introduced during Covid which allowed for the validity of nine-month prescriptions. This measure was especially well-received by patients, but it was also noted that there was limited public awareness of it. I agree with that assessment, and I believe it also applied in the context of the awareness of Covid vaccines. As already stated, that was the case in the early days. Lessons must be learned from this poor communication with the public especially as these new changes to prescription validity take effect. However, I accept that it is difficult to draw direct comparisons between this and Covid measures, particularly in view of the environment in which the relevant decisions were taken.

It is important to note that patients stressed that the overriding concern must be patient safety. While they viewed the extension of prescriptions to 12 months as a positive measure, they said that this must be accompanied by an appropriate framework. While it is accepted that pharmacists are highly trained healthcare professionals and that they require flexibility to use their professional judgment, the task force did recommend regulatory guidance and supporting educational materials to facilitate the safe application of this new process. It also recognised that it may not be appropriate to extend the prescription of certain categories of medication and that any extension should be subject to person-centred criteria.

Again, these are very welcome and necessary safeguards, and that particularly applies to medications used in the mental health area where there are separate concerns that apply to those in terms of addiction and so on. It also avoids a situation where we are too free about providing, at both doctor and pharmacy level, medications that people may end up being dependent on or that are used as a substitute for talk therapies. That is the particular area we would have most concern about with regard to not extending those exemptions.

The next phase of the expert task force's work relates to the scope of pharmacist prescribing, including empowering pharmacists to prescribe for common and minor ailments. When the Irish Pharmacy Union appeared before the health committee in March of last year, it presented a similar proposal for a minor ailment service. Under the scheme, patients with minor, self-limiting conditions would no longer have to make or wait for GP appointments. Instead, they would consult their local community pharmacist and receive an assessment of their symptoms, followed by a combination of advice, medication and-or referral to other services. According to the IPU, such a scheme would not only deliver timely care in the community but also cost-effective, safe and desired health outcomes. One would hope that the expert task force will recommend a similar proposal, and I urge the Minister to act on those recommendations soon after they are published.

Another area of healthcare that our community pharmacists could play a far greater role in is contraception. It is well reported that women would prefer to obtain their contraceptives from their pharmacists instead of their GPs. Furthermore, there is no clinical reason for the stipulation that oral contraceptives should only be supplied on foot of a prescription. Irish pharmacies have been providing emergency contraception without prescription since 2011, and there is no clinical reason this should not be extended to oral contraception. Not only would increasing their role in the dispensing of birth control medication ease the burden on overstretched GPs, it would also make contraception more accessible. Removing this barrier to prescription-free contraceptives would help reduce the number of crisis pregnancies and assist in reaching groups who are less likely to engage with health services. I understand the new women's health action plan will be launched this year, and I believe this proposal should be considered by the women's health task force.

Another area in which the role of pharmacists could be expanded greatly is chronic illness management. Given their expertise and the shortage of GPs, there is no reason our community pharmacists could not assist greatly in these areas. The estimate is that something like 70% of the workload in primary care relates to chronic illness. That puts a huge burden on our health services. The management of that or elements of different chronic illness could very easily be done by pharmacists. They are very keen to do that, so we need to be pushing the boundaries all the time on that. The kind of things they want to assist with in chronic illness management are things like weight management, blood pressure and cholesterol testing, for example. Some pharmacists are doing that already but it is very much a kind of pilot-type approach, whereas it could be done on a much wider basis, helping patients to have self-management of their own chronic conditions.

While the HSE has put a very welcome focus on chronic illness management in recent years through the introduction of various successful integrated care programmes, I still believe the role of pharmacists is being overlooked in this respect. After all, chronic diseases are becoming more common as the population ages and grows. While the prevalence of long-standing illnesses in Ireland is below the EU 27 average, it still stands at 25.7%. Given that Ireland's population is ageing faster than any other EU country, with the over-65 population having grown by 35% over the past decade alone, it is safe to assume there will be considerable growth in chronic disease. Therefore, we must better utilise the existing healthcare resources already at our disposal and pharmacists are a prime example of that.

Ultimately, there a number of measures that need to implemented to unlock fully the potential of our community pharmacists. The establishment of this task force and the changes contained within this Bill are a very welcome start but it should not be the end. On the subject of pharmacists, I note that there have been long-standing calls for changes to the fee structure, and I understand the Department is currently engaged in a review of fees. Will the Minister please provide an update on that review and the likely date by which it will conclude?

I would like to move on to Part 2 of the Bill, which relates to the disregard for rent-a-room income. While I have no objection to this measure in principle, I am concerned there is an inherent inequality of treatment in this policy. Arguably, anyone who has a room to spare in their home is in a far better position than, for instance, a 63-year-old with a chronic illness in single-room flat. The beneficiaries of the rent-a-room scheme can already let a room out without any tax implications and, soon, without any implication for the medical card. As I have said previously, there is nothing wrong with this measure per se. I just this Government's priorities are somewhat skewed. Sure, this policy should increase the supply of rental units, but it amounts to little more than tinkering around the edges. It is just another example of a Government that is bereft of ambition when it comes to the housing crisis. I will come back to that again later in my contribution, but in terms of healthcare policy, the Minister's focus should be on expanding the eligibility for medical cards. That would be a much more worthwhile and impactful measure than what is proposed here. It is frankly extraordinary that the income limits for medical cards for under-70s have not been increased for about 20 years.

For some reason, a policy decision has been taken to place the emphasis on GP-visit cards instead of medical cards. While access to GP care is obviously very important, people also need access to a whole range of other health services, especially people with chronic illnesses. There is currently a huge cohort of people being denied access to any of the therapies or public health nurse services. I am particularly concerned about people in their 50s and 60s. It is in those years that people tend to develop chronic illnesses and require access to services such as the various therapies I have mentioned and public health nursing. In view of this, I simply cannot understand the rationale for this policy of funnelling everyone into GP clinics. I accept that GPs are recognised as gatekeepers, but what happens when a patient is referred to a specialty service or therapy? They still find themselves in a situation where they have to stump up €40 or €50 to see a therapist. GPs themselves very much recognise the fact they are not the solution to all of a person's health problems, and very often it would be much more beneficial for somebody to go to a therapist or a nursing service.

Ahead of the budget, I tried to find modelling on medical card income limits but I had no luck on that at all. All the modelling from the likes of the ESRI and the Department of public expenditure related solely to GP-visit cards. A number of Deputies also raised this with the Minister via parliamentary questions, but his answers always referred to the expansion of free GP cards. If this Government is serious about providing universal healthcare based on need and not ability to pay, then it needs to provide greater access to a whole range of services in primary care in particular, not just GP services. After all, only 30.8% of the population had a medical card in 2021. That represented a 10 percentage point reduction since 2012.

In keeping with the principles of Sláintecare, that figure should have greatly increased, not reduced.

I turn now to comments I want to make about housing policy, which, rather oddly, is a major part of this health Bill. It is widely accepted that at the heart of the housing crisis is an affordability crisis. Dublin is one of the most expensive cities in Europe in which to buy or rent a home. This uncontrolled affordability crisis now extends to other cities, towns and even villages. Despite this, addressing affordability does not appear to be a priority for the Government. In fact, the focus instead seems to be on subsidising developers, the most expensive way of doing it. We are repeatedly fed the line that apartment building is not viable and that the only solution is slashed standards and subsidies. Developers say "jump" and it appears that successive Ministers ask, "How high?" Why is the approach of this Government always carrot for developers and stick for renters and buyers who are expected to pay exorbitant rents and house prices to help boost developers' bottom lines?

I would like to draw particular attention to the plight of student renters, as it is particularly relevant to this debate. While the measures contained in Part 2 are not specific to student accommodation, many students rely on digs-style accommodation, which is eligible for tax relief under the rent a room scheme. According to a recent survey by the Higher Education Authority, 19% of respondents live in digs. While there is certainly a place for this type of accommodation, I am very concerned about the lesser rights associated with these arrangements. People living in digs are regarded as licensees rather than tenants. Therefore, they do not enjoy the same legal protections as other renters. Threshold has called for a review of this category of licensee with a view to abolishing it. The USI has also been critical of the different status of digs. However, in January last year, the Minister for housing ruled out tighter regulations, claiming it would reduce supply. As ever, this Government puts the interests of landlords ahead of renters.

Taking a broader look at the student accommodation crisis, there is clearly a greater need for affordable, purpose-built student accommodation. I acknowledge that the Minister for higher education often expresses concern about the cost of student accommodation, but those words ring pretty hollow given he has sat at Cabinet since 2016, the same Cabinet that presided over, and continues to preside over, a housing disaster that has forced some students sleep in hostels, cars or tents. Last August, a Department of higher education report revealed that universities received approximately 30,000 more accommodation applications than they have beds for. That is three applications for every student bed on university campuses. According to Dr. Rory Hearne, associate professor at Maynooth University, only 15,000 student units were in the planning system last August. The majority of these were expensive, investor fund units. According to a parliamentary question reply from June of last year, of the 12,000 purpose-built student accommodation units built between 2016 and 2023, 84% were investor funded.

While I acknowledge that the Minister, Deputy Harris, has announced new funding and financing mechanisms, they are coming a bit late. According to Department projections, third-level enrolments will rise by 40,000 full-time students by the 2031-2032 academic year. In that context, far more ambitious proposals are required.

I reiterate the Social Democrats' support for this Bill. While I firmly believe this Government's priorities are not exactly in line with Sláintecare, I do not believe there is anything intrinsically wrong with the proposed changes to the rent a room scheme. However, this should not be the focus. The focus should be on expanding access to healthcare and protecting renters. It is possible to do both. I do not think we should necessarily be piggybacking on a housing crisis and trying to solve an element of that crisis by ensuring people who are already reasonably well off are further facilitated with medical cards. Access to medical cards should be on the basis of need and that should be the test. I reiterate my strong view that extending access to GP care is welcome on one level, but it just does not cut it in terms of meeting the needs of people, especially those on low incomes. There should also be the ambition to meet the full implications of Sláintecare in terms of providing access, free at the point of use, to all primary care and tertiary healthcare services.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

Next is Deputy Jennifer Murnane O'Connor who is sharing with her constituency colleague. Deputy Browne is after Deputy Murnane O' Connor.

Martin Browne (Tipperary, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I was in before her.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

Yes, but I will call you next, and if Deputy Quinlivan is amenable, I will leave him until the next Sinn Féin slot. Is that okay?

Martin Browne (Tipperary, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I should have been in before Deputy Shortall.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

Well, you should have been here then.

Martin Browne (Tipperary, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I was.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

You were not. That is why you were not called. I will not call you at all if you do not want to.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Sometimes the public gets very frustrated when we have the Opposition motions we do not agree with, but then they see the countermotion put forward that leads to a Bill like this. In March 2023, the Government approved a countermotion to a Private Members' motion regarding the eviction ban which included a commitment that the Government would extend the rent a room scheme disregard for social welfare recipients, extend the disregard into medical card criteria from 1 May 2023, and allow local authority tenants to access the scheme. Now, with this, the objective of Government is to provide for a disregard of up to €14,000 income for anyone eligible for rent a room relief. The income will not be assessed within the medical card assessment process. People come to my office and tell me that when they try to rent a room, especially in County Carlow, where we are crying out for student accommodation, they are losing their medical cards because they are going over the limit. That is so important. People now have a fear of losing their medical card.

I always say to people that a medical card is like a gold card. It is so important now to have a medical card because a visit to a doctor can now vary in price from €60 to €75. That is a lot of money. I always say, as do other people, that a medical card is like a gold card. I have long argued that medical cards need to be automatically issued to anyone with cancer. I have spoken to the Minister several times about this. I had a few cases in recent months of cancer patients who, God love them, did not qualify for the medical card. However, in the end, when they could not go back to work after many months, they did get them. This issue needs to be looked at.

The other issue is for people with dementia. Many of them are forced to jump through hoops. I especially think those on low incomes who want to better their circumstances by offering a room for rent should not lose such a vital support as the medical card because, as I said, it is so important.

The second aspect of this Bill deals with the Irish Medicines Board Act 1995 and allows pharmacists to sell and supply approved medicines without the need for a prescription. This is really good judgment. I note the medicine substitution protocols on this and that there is a time-limit basis. The other thing is that it is related to measures to best support the national system for the management of medicine supplies so that there is enough for those who need these medicines. I understand the Minister is aware of this, and it is so important. My community pharmacist in Carlow is Kevin Kelly, whom Deputy McGuinness might know. I would put all my trust in him, as I know others do. He gives advice regularly and is always very positive. I also know there are many more pharmacists around the country doing the same. This is a really positive move. As the Minister knows, because I am constantly bringing it up, we have a huge shortage of GPs in Carlow as well as throughout the country. This will be a great help and I will absolutely support this Bill.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I support the Bill and the measures contained within it. What concerns me about the development of primary care facilities and services and using the pharmacies is that, right now, they are overcome with the number of patients they have. The pharmacies are also overcome with the amount of prescriptions with which they are dealing and the amount of customers, if you like, that they have. Far greater investment is needed for both the primary care element of the Bill and for the pharmacies. We cannot put stuff into a Bill and then not match it with the amount of money that is required to make it happen. For example, all of the new faces we now have in this country, the new people who are coming in, must have access to GPs and pharmacies. We are told there is a package there so that the asylum seekers and refugees housed in different localities will have support measures in place for them, but I have not seen that. I have not seen anything extra. In fact, in my clinics, I have dealt with more people looking to gain access to a GP than I have ever seen before. They cannot get their names listed at a GP practice. That must be addressed if we are going to continue to ask those GPs to deal with the extra numbers.

If you ring a GP now, you are put on to various numbers to wait for different people. That is very frustrating for elderly people, in particular, who want, and were used to, direct access to a GP. Nurses and support staff are needed within a GP service but they are not there. GP practices are finding it extremely difficult to get replacement GPs or to get those who they need to support the services they are delivering. We need to invest more in primary care.

I again emphasise to the Minister that I have seen many pharmacists being put to the pins of the collars to deliver the extra services they provide. I appeal to the Minister to look at those on the front line, including GPs and pharmacists, and ensure there is an appropriate level of investment to allow them to develop the services, develop their own skills and talents, and serve the local communities that all of us serve. Those on the front line are under dire pressure. We have an ageing population and will have to respond with far greater speed to those people. I ask the Minister, as others in the House have asked, to please look at the medical card process for those who obviously need a card, including the cancer patients who were mentioned. The Minister can start there and work down. We really need reform to the bureaucracy of the health services, how they are delivered, the technology used and the route for patients to getting the care they need.

Martin Browne (Tipperary, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I will focus on the medical card aspect of this Bill, given the provision to exclude income relevant to the rent a room tax relief for consideration for a medical card means test. I cannot help but take issue with the fact that, as a measure, it does not treat all people equally in that property owners who participate in the rent a room scheme can have that income disregarded when it comes to medical card assessment. What about workers and families who are living in overcrowded accommodation and who do not have a spare room? Many of them cannot get a medical card and this Bill does nothing at all for them. In addition, there are many people who, because of their income, might fall just over the income threshold and do not qualify. When measures such as this are taken, how does the Minister think those families feel? We are all well aware of constituents who cannot afford doctor's fees but who fall above an income threshold that has not been reviewed for 20 years and has no relevance to today's demands. The most the Government can do is to tell them if they rent out a spare room, it will increase the limit for them. This lopsided way of skirting around an issue that needs to be dealt with is a blatant disregard of so many people. The truth is that it is getting more and more difficult for low-income workers and families to get access to a medical card. This is where the Government should be focusing its efforts and not skirting around the edges. This is what the Government should be seeking to address in 2024, as Sinn Féin has proposed to do by raising the income threshold to increase the number of medical cards by 400,000 while also reducing the drug payment scheme threshold to €60.

The Government needs to take decisions that matter to people and not dabble around for the sake of making it appear it is making a difference to the manner in which people can manage their health. It should also be taking the opportunity to implement a minor ailments scheme in pharmacies, a pharmacy first model for guidance and advice for minor ailments. These areas are where the Government needs to focus its efforts.

Community care is a key factor in addressing the demands on GP and acute hospital services, but the pathway to primary care medicines and other services is the medical card itself and, in this area, the Government is relying on an outdated threshold. It is preventing people from accessing alternative services that could prevent hospital presentations, yet in this Bill the Government is confining the change to a small group of people while leaving others to continue going without. Sinn Féin has a plan that will treat people better, take the pressure off emergency services, and can open up a range of medical services which, as matters stand, are today obscured by the obstacle of affordability.

Maurice Quinlivan (Limerick City, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Bill and its ambitions are positive. Any efforts made to expand medical card eligibility to a wider group of people is something I welcome. The benefits of a medical card are multiple and the lack of one can have a detrimental impact on someone's finances as they look to avail of hospital services, maternity services and necessary GP visits. Access to a medical card removes a barrier for those who may otherwise be reluctant to visit their GP to obtain necessary treatment. I welcome the proposal in this Bill to amend the Health Act 1970 allowing for a disregard of rental income so that rent a room income will not be assessed within the medical card application. This is a useful change. We in Sinn Féin wanted to expand the medical card to an additional 400,000 people but what is proposed in this Bill is positive nonetheless.

The other key elements of this Bill pertaining to the amending of the Irish Medicines Board Act 1995 are also sensible and may serve to reduce slightly the number of people attending hospital or GP clinics for the administration of medicines that could reasonably be expected to be administered in a pharmacy by another medical professional. This and the proposal to allow the Minister for Health to make regulations that could enable pharmacists to sell and supply approved medicines without a prescription are positive, if minimal, moves that can contribute to alleviating our healthcare crises. Any move that seeks this outcome should be welcome. It is critical to the safety of the staff and patients at our hospitals that what are otherwise avoidable presentations are offered an alternative and reliable route to appropriate care.

I say this in the context of overcrowding and capacity challenges in our hospitals, particularly in University Hospital Limerick, UHL, which is in a perpetual capacity crisis. Every day so far in February, the hospital has had, on average, 116 patients treated on trolleys every single day because no bed is available. This is appalling. With a week left in the month, we have already had 1,621 people treated in this manner at UHL, which is more than in the same month last year. More than 2,000 people were treated in those conditions in the hospital in January. Importantly, these are people deemed in need of a hospital bed and yet no bed is available to them. The impact of these numbers stuck on a hospital trolley, often in a hospital corridor, is not just on those patients and the medical professionals treating them but is felt across the hospital with the cancellation of elective surgeries, the extension of hospital waiting lists and the transferring of staff to cope with the influx of presentations at the emergency department at UHL. Being treated on a trolley in a hospital corridor is to be devoid of privacy and a minimal level of comfort during an already stressful hospital stay.

Last week, I was in contact with UHL with regard to a 71-year-old man, a recovering stoke victim, who had been lying on a trolley for eight days. It is appalling that, due to the lack of capacity, a senior citizen would have to be treated in this manner. It is appalling to hear of avoidable deaths at the hospital, with staff stretched too thin and capacity too small.

I reiterate my welcoming of the proposals contained in this Bill but they must be the precursory steps to a more ambitions change in how we approach medical care in this State. The steps contained in this Bill must be the first steps of a journey that seeks to increase capacity in our hospitals, to expand community healthcare service, to reduce the numbers being treated on trolleys and to massively expand bed capacity not just at UHL but across the State. We need a universal healthcare service that would remove all cost barriers to healthcare.

Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

Before we move to the Regional Group, I will tell Members who are watching that this debate is moving quickly if they wish to speak on the Bill. I will shortly be going to the Minister.

Seán Canney (Galway East, Independent)
Link to this: Individually | In context | Oireachtas source

5 o’clock

I welcome this Bill. The Regional Group has been campaigning for the rent-a-room relief. It made a proposal to the Government in this regard and, as a direct result, the Minister for Social Protection, Deputy Humphreys, moved swiftly to implement the relief for social welfare beneficiaries. This is notable. The agreement facilitated the extension within one month, marking a significant policy shift. For a period of two years following the amendment, individuals leasing out rooms in their homes to non-employees or non-immediate family members will be able to disregard up to €14,000 in rental income for the purpose of a social welfare means assessment. This assessment is crucial in qualifying for weekly social assistance payments, increases to qualified adult rates, the working family payment and supplementary allowances. This adjustment is of particular importance to older people, allowing them to generate a weekly income of €269 without affecting their non-contributory State pension or benefits for the spouse or adult dependant of a contributory pensioner. Furthermore, this can offer essential additional income for families in a climate of rising living costs.

Historically, the rent-a-room scheme permitted taxpayers to earn a tax-free income of up to €14,000 annually for renting out a room. However, this income was means-tested for the purpose of social welfare payments, effectively penalising recipients. This discrepancy has now been rectified as a result of the Regional Group’s intervention with the Government. I acknowledge the close co-operation of the Government with the Regional Group in getting this done.

The rent relief for social welfare has been introduced initially for a two-year period, up to March 2025, and it is hoped that this will not only provide vital housing accommodation but also benefit the older person by providing companionship. Having a person in the spare room provides an overnight presence in the home, providing security and peace of mind to the older person. I hope community groups, active retirement groups and not-for-profit organisations embrace the new incentive by assisting older people in selecting suitable tenants. This is most important.

Despite these positive steps in the reform of the rent-a-room relief scheme, challenges remain, notably in extending the changes to medical card assessments, as initially requested by the Regional Group. This oversight limits the full potential of the scheme, particularly affecting older people who could lose their medical card upon receiving the additional rental income. As a group, we have emphasised the need to address this barrier to maximise accommodation availability and support for older citizens.

A critical issue is the stagnation of medical card income limits since 2005. Despite a significant increase in the basic rate of social welfare in this period, by €83.20, the fact that the thresholds have not been increased in 19 years is now a major barrier to people in gaining employment. Everyone receiving social welfare payments is technically over the income limit for the medical card. Cards are given on a discretionary basis to people on social welfare but if they earn €1 on top of their social welfare payment, they are automatically denied the card. This must be examined. This discrepancy poses a barrier to employment and access to affordable healthcare as any additional income over the social welfare payment immediately disqualifies individuals from medical card eligibility. There is an opportunity to bring more people into the economy by making it much more attractive financially to work. However, the medical card anomaly is a barrier to work. Putting barriers in the way of people going back to work has long-term social implications. The barrier to employment is a hidden one at a time when we need to facilitate people entering the workforce. We talked a lot about this morning during Leaders’ Questions about housing and getting people back to work. There are many people whom we should be encouraging to come back into the workforce. We need to do that. It is important.

While the Bill is being considered, it is important to remember that we must provide all the back-up services needed in healthcare. I am aware that the Minister is very much aware of what is needed in Galway in the form of capital investment to ensure we have a properly running hospital for the region. I acknowledge that the Minister has done much work in pushing this. It is important that we work together for the region to ensure the infrastructure is built as quickly as possible.

This morning, I gave the example of the primary care centre built in Tuam. The Minister knows about it. An X-ray facility is to go into the centre. Some €700,000 was given for this in 2019 by Deputy Simon Harris when he was Minister for Health. It is now 2024 but the X-ray facility is still not operational. When it takes that long to put a small facility into a centre, how long will it take us to build all that is required in Galway and the region? We must consider how we can best speed up the building of the required infrastructure.

I acknowledge the investment the Department of Health has made in the Old Grove site in Tuam, where €30 million was invested to refurbish the old Bon Secours hospital to create a mental health care unit and a children’s disability network team facility. I acknowledge that the HSE has built a first-class community nursing unit with the help of €7 million from the Joe and Helen O’Toole Charitable Trust. We need the infrastructure to attract the best and keep the young people we train in healthcare working in the system for the longer term.

Matt Shanahan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

I will divert slightly from the debate and ask a question. How does independent politics work for citizens in this House? As regards the provisions the Minister has put forward in this Bill, the value of it will become eminently clear.

Social welfare assessment schemes used to take into account any and all revenues when considering applications for social welfare, working family payments and supplementary allowances. As a result, households in receipt of social welfare supports last year could not play any active part in trying to offer accommodation to anyone during the present housing crisis. My colleagues in the Regional Group of Independents and others presented a range of policy initiatives to the Government last year as part of our stance to support and deliver progressive politics. As part of our eight policy initiatives, which I am happy to say have now been almost entirely activated by the Government, we called for an initiative to allow for the expansion of the rent-a-room relief scheme to include social welfare recipients, enabling them to lease a spare room in their residences so as to increase the national stock of badly needed accommodation space. The Government's agreement to the implementation of this relief one month after it was proposed has meant that for a period of two years following the policy amendment, individuals who chose to rent a room in their house could claim up to €14,000 per annum in disregarded income for the purposes of social welfare means assessment. For households with retired owner-occupiers, this initiative means that families could avail of an additional weekly rental income of €269 per week without any effect on their non-contributory state pension. It also means the benefits applying to a spouse or adult dependent of a contributory pensioner were not affected. However rental income was being considered in a means test for those on means-tested welfare payments which effectively ruled them out of the scheme. Again, our group called for a re-evaluation of the scheme to take account of those in receipt of supplementary benefits and medical card supports. I and my colleagues are heartened today to see part of the Bill proposes the extension of the rent-a-room relief scheme to people receiving social welfare payments who rent out a room so they will not lose supplementary benefits and medical card supports. The Government recognising the Regional Group initiatives is a clear sign of the value of independent voices in this Chamber, representing the population at large.

A second provision of the Bill is to provide for an amendment to current legislation to enable more management of and access to medicinal products by the Minister. I have not read the Bill in detail, but I hope this will allow the Minister to look widely and favourably at a significant number of applications to the HSE via the Health Products Regulatory Authority, HPRA, medicines review group every year, especially in the area of orphan diseases. The Minister will be aware that a number of drugs have come onto the scheme, perhaps more than 150 in recent years. Another 150 are probably out there for specific groups of patients. This will always create a difficult economic question. We understand the conundrum if you have one patient whose treatment might cost €0.5 million in a year and you can perhaps service ten patients for €50,000 a year each. However, this affects a small number of patient groups. I met a gentleman earlier who is trying to figure out how to access orphan drug schemes and his team is only treating five patients at present. They cannot see a pathway. I heard the Tánaiste mention in the House that €20 million had been ring-fenced for the provision of orphan disease medication, assuming the medicines get reimbursement approval, but I understand that money is no longer on the table and if it is found at all, it will be found through health savings delivered somewhere else. The Minister and I both know it is very hard to create health savings in the present system. I ask the Minister to have a significant look at the orphan disease space. It involves a small number of patients. I understand there are developments in this area. I would be happy to try to support it. I know of a number of companies, as the Minister probably does, which are trying to access that programme. We have small numbers of patients, but some of them are suffering terribly. One particular disease affects very young children in their growth phase and if it does not get interdicted they do not grow, with all the obvious problems of dwarfism and so forth. That is just one other aspect.

I commend the Minister on taking on the initiatives we proposed last year and I hope he will adopt the one I suggested now.

Alan Farrell (Dublin Fingal, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to speak on this Bill. It is small but important. I thank the Minister for bringing it forward. It makes a number of important changes to expand access to and engagement with our health services. The first of the proposed changes includes the all-important change to income earned from the rent-a-room relief scheme being disregarded for the purposes of a means test as it relates to applying for a medical card or GP visit card. This is an important step in removing a barrier to people engaging with the rent-a-room relief scheme. Individuals can currently rent out a space in their homes and not be taxed on ensuing income up to €14,000.

This is a positive initiative for those who may wish to take up the opportunity to rent out a room in their home. This Bill rightly recognises the need for joined-up thinking in Government services so that no person involved in the scheme is negatively affected when applying for other services such as the GP visit card or a medical card.

As all Members of the House are acutely aware, we continue to experience significant demand for housing of all types. While I am encouraged by figures emerging from the housing sector in recent months, we must make it easier for people to engage with solutions. Therefore, this is an appropriate step at the appropriate time. While the rent-a-room scheme is not appropriate for everyone, it can provide valuable solutions for some people. I am particularly thinking of students who may be travelling to Dublin or elsewhere for some of the week and may not require a full-time lease in the area. Just under 200,000 students were enrolled in full-time third level education in the 2022-23 academic year. This figure is expected to grow to approximately 239,000 by the beginning of the next decade. This is particularly relevant to students, given that the cost of rent increased by 37% between 2016 and 2022. This poses a difficult challenge for those who are in education and cannot engage in the labour market as freely as others. A total of 19% of students who responded to a recent HEA study said that they were living in digs-style accommodation.

I also commend the Minister for Further and Higher Education, Research, Innovation and Science on the work of his Department in seeking solutions to the financial pressure on students. This includes an increase in the amount of student accommodation, with 938 spaces being provided for through public funding for the 2023-24 academic year and over 2,000 through private means. This has also been coupled with increases in the student support grant, a reduction in the student contribution fee and reduced public transport fees for young people as developed by the Department of Transport. These measures will make it easier for students to meet their needs.

This Bill will also make important changes to the functioning of pharmacies, expanding the ability of pharmacists to renew prescriptions for up to one year. I commend the Minister for Health most sincerely on taking this step at this time because I believe it will make access to medicine and to healthcare easier, with such care being provided in the community by people known to the individual. This is particularly important given the current pressure on accessing GP appointments across the country. By facilitating an increase in the period during which pharmacists can renew prescriptions - the previous period of six months is being doubled - we can ease pressure on services and provide better and quicker access for patients. I commend pharmacists on taking on this extra work, something I know they have indicated for quite some time they are prepared to do.

Expanding the list of occupations that can administer things like vaccines will also ease pressure on existing services. We do not have to cast our memories back too far to see how an expanded number of vaccine administrators can contribute to immunising the population or vulnerable groups. Indeed, recent attention has rightly been given to the potential for a measles outbreak. There is a current programme to facilitate catch-up vaccines for those who have not previously availed of the vaccine. I believe the health authorities and Deputies in this House have a body of work to do to reassure people that vaccines are safe, particularly those tried and tested over decades of use. By expanding the number of people who can provide vaccines, we can reduce the potential wait time for vaccines and thus encourage greater take-up of them.

I compliment the Minister on the work his Department has done on this Bill. It has been welcomed by the Irish Pharmacy Union, which highlighted the benefits the Bill will have for patients. Indeed, it also highlighted the need for adequate resources for pharmacies and staff. I hope the Minister and his team will work closely with service providers to ensure the efficient implementation of this Bill.

As previous speakers took the opportunity to be parochial, I will join in momentarily. The provision of healthcare in north Dublin, which is one of the youngest and fastest-growing communities in Europe, remains less than what it could or should be. I know the Minister is acutely aware of that and has been working for a number of years to try to improve it. At the end of the day, we are in year 4 so we have to look at the horizon and think about the provision of some of the facilities in the HSE's capital plan. In particular, a hospital for north Dublin has been earmarked, as the Minister well knows. I could also mention the expansion of primary care services within the constituency, not just in its current iteration of Dublin Fingal but also the future constituencies of Dublin Fingal East and Dublin Fingal West. The Minister will be acutely aware that there are places where there are some pressures, particularly with regard to accessing GPs. When additional services are provided, it sometimes negates the necessity for individuals to go to accident and emergency departments or even to their GP. I encourage the Minister to redouble his efforts to try to deliver on the commitments in the HSE capital programme and the programme for Government.

Ruairi Ó Murchú (Louth, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

We support the Bill, but we really need to get down to brass tacks when it comes to medical cards. I do not think there is anybody in this building who will not have heard of cases, some of which are very sad, involving people who cannot avail of a medical card and are in really brutal circumstances. I have a limited amount of time so I will go directly to an example. One of these examples luckily got dealt with but I have said here many times - even yesterday to the Minister - that it is a failure of the system when someone comes to a politician in the first place. The case involved a single mother with a number of children who was not working and had been diagnosed with breast cancer due to a genetic mutation. She had the BRCA1 and BRCA2 genes, was on very aggressive chemotherapy, had to have a chemically induced menopause, was looking at the possibility of a double mastectomy and had been refused an emergency medical card. There was an awful lot of toing and froing when we dealt with the PCRS. We were told by one of the medical officers that her case was not enough of an emergency. I am not sure what an emergency would look like on that basis. In fairness, that issue was dealt with but that is not the way we need to do that sort of business.

Because it is in the public domain and I am talking about breast cancer, I would like to comment on what was brought up by Alison McCabe and others on RTÉ about post-mastectomy products. I think everyone will have heard about this. We are talking about women who have been through breast surgery. They are fearful of changes in the scheme. They are saying that it has been halved to €60. Could the Minister give some sort of update about that because it sounds outrageous? He might have updated information about it. That would need to be disseminated as soon as possible.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Deputy has strayed nowhere near the Bill, which I am not complaining about. He has raised an issue that is causing a lot of concern. I know we are about to adjourn the debate, but if it were possible to stretch the order to respond to that point, it would be very helpful because there is a lot of worry around the country based on incorrect information.

Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

I am afraid we are going to finish at 5.30 p.m. Deputy Mattie McGrath is waiting to speak, but he is not going to get in. I gave some leniency regarding the subject, which nobody has really-----

Ruairi Ó Murchú (Louth, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

We are talking about health.

Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

The Deputy is out of time anyway, as is Deputy McGrath. If Deputy Ó Murchú wishes to give over one minute of his time to the Minister to clarify-----

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Or even 30 seconds, if it is in order.

Ruairi Ó Murchú (Louth, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I will be raising the issue again.

Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

We are wasting time. If he wishes to give the Minister a minute, that is fine. I will give the Minister one minute. Deputy McGrath is not going to get in.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Thank you, a Leas-Cheann Comhairle. I appreciate your flexibility on this.

I was made aware of the issue raised by Deputy Ó Murchú yesterday. A policy measure has been proposed in terms of supports for people who have had mastectomies. The proposal emanating from the HSE was that in some areas, supports would increase but in some areas, supports would decrease. I am not allowing that to happen. I know there was a programme on it today. Those involved were told well ahead of the programme that I would not be allowing this to happen but, unfortunately, they did not lead with that.

Therefore, a lot of people are quite worried right now.

I want to give a clear commitment that while I absolutely will support an increase in supports, I will not be signing off on any policy that decreases supports for anyone in the country. I am pretty annoyed that someone thought that they could announce this and go ahead with it. I have already intervened and told the HSE we will not be proceeding.

We will increase supports. We absolutely will not reduce supports. I thank the Deputy for raising it and thank the Leas-Cheann Comhairle for her flexibility on that.

Ruairi Ó Murchú (Louth, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I will bring up the 14 other issues later.