Christopher O'Sullivan (Cork South-West, Fianna Fail)

I welcome the national school from County Cork. It is my county. I welcome them to Seanad Éireann.

I thank Senator Lynch for raising this important issue. In her contribution she covered it all, including that the long-term illness scheme is dated and has not been updated in a long time. In terms of her hope that the condition would be covered, the best opportunity would be a review. I am answering this on behalf of the Minister for Health. However, from listening to what she said, I think that is the way forward. I will outline some of the supports that are available, which the Senator is already well aware of. She knows all this already.

The long-term illness, LTI, scheme was established under section 59 of the Health Act 1970. Regulations were made in 1971, 1973 and 1975. They prescribed 16 conditions to be covered by the scheme, but there have been no additions or deletions to the list since that time. That is a long time and there has been such change to people's health, diets, quality of life and so on. It seems a bit rich and it is high time for a review. That is just me speaking. I will outline the position of the Department of Health. Under the LTI 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, it is important to recognise that the LTI scheme exists within a wider eligibility framework. 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 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, so that is a potential avenue. The HSE affords applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and fully takes account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses. The issue of providing a patient with medical card eligibility on the basis of illness or 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 nor 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. However, over the past several years, there has been a significant focus on improving access to, and the affordability of, healthcare services. This has been advanced through the substantial policy, legislation and investment to deliver expanded eligibility and services in line with Sláintecare. Major expansions in eligibility include the removal of public inpatient charges in public hospitals, for children in 2022 and for adults in 2023, and the provision of free GP visit cards to include children aged six and seven and those earning no more than the median income. These changes impact up to 500,000 people. The reduction in the drugs payment scheme, DPS, threshold, which caps monthly expenditure for approved prescribed medicines, was reduced to €80 euro per month in March 2022. Other measures have been introduced to try to increase accessibility and affordability.

It comes back to the main point the Senator made. The long-term illness scheme was developed a long time ago. The prescribed illnesses were decided on decades ago. I appreciate that the prepared response states there is no plan to review that. However, in my view, that would be the prudent thing to do. It is all well and good for me to outline the other supports available, but the Senator is talking about a specific condition that seems to me to merit inclusion. That, of course, is up to the Minister for Health.