Mary Butler (Waterford, Fianna Fail)

I thank Senator Byrne for raising this very important issue. The long-term illness scheme was established under section 59(3) of the Health Act 1970, as amended. Regulations were made in 1971, 1973 and 1975 prescribing 16 conditions covered by the scheme. These include acute leukaemia, mental handicap - which is not wording we use any more, I have to say, when I think about it- cerebral palsy, mental illness in a person under 16, cystic fibrosis, multiple sclerosis, diabetes insipidus, muscular dystrophies, diabetes mellitus, Parkinsonism, epilepsy, haemophilia, spina bifida, hydrocephalus and conditions arising from the use of Thalidomide. There is no mention of Crohn's disease or any form of inflammatory bowel disease. I take on board what Senator Byrne said about that young person. When people have bowel conditions, it is very debilitating. That person will probably spend a lot of time in the comfort of her own house because of the condition.

As we know, under the scheme, patients receive drugs, medicines and medical and surgical appliances directly related to the treatment of their illness free of charge. While there are no plans to extend the scope of the scheme at present, it is important to reflect that it exists in a wider eligibility framework. The Government has put a significant focus on improving access to, and the affordability of, healthcare services, advancing substantial policy, legislation and investment to deliver expanded eligibility and services in line with Sláintecare.

As we are all aware, public inpatient charges in public hospitals have been removed, first for children under 16 years of age in 2022 and then for adult public patients in 2023. We have also focused on reducing costs in primary care, delivering the largest expansion of GP visit cards in 2023 to include children aged six and seven and those earning no more than the median income.We have also focused on reducing costs in primary care, delivering one of the largest expansions of GP visit cards in 2023 to include children aged six and seven and those earning no more than the median income. This enabled these patients to visit their GP free of charge. These two GP access measures provide eligibility to approximately 500,000 additional people.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. Eligibility for a medical card, as we all know, is determined by the HSE, primarily based on an assessment of means. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. There are about 80,000 discretionary medical cards in the mix now. The issue of providing a patient with eligibility on the basis of illness or a disability was previously examined in 2014 by the HSE expert panel on medical need and medical card eligibility. The group concluded it was not feasible, desirable or ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the expert group’s advice, a person’s means remains the main qualifier for a medical card.

In respect of medications, there has also been a focus on reducing costs for families. As we know, the drug payment scheme threshold was €124 per month in 2020. It now stands at €80 per month - a reduction of over 33%. I am not sure if the response addresses the issue the Senator raised in relation to a young person with a disease such as Crohn's disease or other difficult bowel conditions. I will certainly raise this aspect with the Minister to see if there is any consideration that can be given. The regulations were made more than 40 years ago, so maybe it is time for them to be looked at again.