Ulick Burke (Fine Gael)
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I welcome the Minister of State to the House. All of us are fully aware of the trauma and anxiety undergone within a family when one of its members has been diagnosed with cancer of one type or another. While many health board CEOs in the past have used their discretion to grant medical card services to identified cancer sufferers, anxiety could be allayed at what is a difficult time for families if the Minister for Health and Children would grant access to full medical card services for all cancer sufferers. There is often a delay in processing an application, which may or may not be successful. The anxiety undergone by cancer sufferers in those situations is unacceptable and can be easily remedied. Unfortunately and tragically, many people who have been identified as cancer sufferers tend to have a short life expectancy beyond that point. While there is improvement in the overall cure rate, statistics clearly indicate that by and large people tend to survive for only a relatively short period after diagnosis. For that reason it would not be costly to the Exchequer to give such cover to this select group of patients.

The same applies in the case of asthmatics. The Minister of State will be aware of the concern within the medical profession over the increasing number of people suffering from asthma. Whether it is lifestyle, food, the environment or whatever, greater numbers of young people are now suffering from asthma. It is most important that they have readily available to them the medicine prescribed by their general practitioners. Very often they need inhalers and these can be and are becoming increasingly expensive. Due to the concern of parents for their asthmatic children's welfare and the need for constant access to inhalers, this group would benefit enormously from the extension of the medical card service. I am sure the Minister of State will agree that preventive medicine is always better than the cure. If asthma is allowed to develop there can be serious consequences for the sufferer, which could be far more expensive, whereas constant control and monitoring is much better than allowing a chronic condition to develop.

Finally, I want to raise the matter of coeliacs. Again, because of the nature of their condition, an expensive individualised diet must be provided. Whereas an ordinary loaf of bread costs approximately €1, the cost for coeliacs is €4 and more, and likewise in the case of other food they may require. Once a person is diagnosed a coeliac he or she must be constantly vigilant as regards food intake, whether in the home or outside. They are under constant threat giving rise to enormous expense in some cases.

I am suggesting to the Minister of State that these groups be identified as people who automatically merit medical cards, whether cancer patients, asthmatics or coeliacs. Such an initiative would eliminate the need for far higher costs when their conditions reach a chronic stage and hospitalisation is required, as is the norm.

When one considers the statistics on people admitted to hospital through accident and emergency units with chronic illnesses for lack of access to inhalers, in the case of asthmatics, or proper diet as regards coeliacs, this is far more expensive for the Exchequer than issuing medical cards. In the case of cancer sufferers, I reiterate and emphasise the importance of alleviating the suffering of patients and their families. The situation for those concerned is sufficiently traumatic without adding to it. For that reason I ask the Minister of State to request the Minister for Health and Children to grant automatic entitlement to those particular categories. We do not begrudge access to medical cards for people over 70. However, many people in that category have sufficient resources to avail of private medicine if they so wish. In the categories I have mentioned, undue hardship and anxiety may arise, to add to the trauma of the particular condition.

Paschal Mooney (Fianna Fail)
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I remind Senators that the duration for contributions on the Adjournment is five minutes. This is something we all forget from time to time.

Ulick Burke (Fine Gael)
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I thank the Acting Chairman for his leniency.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I thank Senator Ulick Burke for raising this matter. Eligibility for health services is primarily based on residency and means. Under the Health Act 1970, determination of eligibility for medical cards is now the responsibility of the Health Service Executive, other than for persons aged 70 years and over, who are automatically eligible for a medical card.

Medical cards are issued to persons who, in the opinion of the HSE, are unable to provide general practitioner medical and surgical services for themselves and their dependants, without undue hardship. It is open to all persons to apply to the chief officer of the relevant HSE area for health services if they are unable to provide these for themselves or their dependants without hardship. The setting of income guidelines is a matter for the HSE.

The HSE has discretion as regards the issuing of medical cards and a range of income sources is excluded when assessing eligibility. Despite some persons having an income that exceeds the guidelines, a medical card may be awarded if the HSE considers that a person's medical needs or other circumstances justify it. It is open, therefore, to cancer sufferers, asthmatics and coeliacs to apply to the HSE for services if they are unable to provide them for themselves or their dependants without undue hardship.

The sum of €60 million was provided in the 2005 Estimates for health to improve access to primary care by providing for up to 30,000 additional persons to become eligible for a medical card, and free access to GP visits for up to 200,000 additional persons on low incomes through the introduction of a GP visit card. Parents on low incomes should no longer have to worry about the cost of bringing their child to a doctor. The estimated full-year cost of this initiative is €50 million. My Department is currently considering the nature of the legislative changes required to enable effect to be given to the decision to introduce "doctor-only" medical cards. Legislation on this will be introduced as soon as possible, with the view to the cards being made available in April. The additional funding provided enabled the former CEOs of the health boards to agree new medical card guidelines which came into effect on 1 January 2004. The guidelines were increased by on average 7.5% and for those on low income, the income allowance for each of the first two children was increased by approximately 20% and approximately 30% for the third and subsequent child. Medical card holders are entitled to a full range of services including general practitioner services, prescribed drugs and medicines, all inpatient public hospital services in public hospitals including consultants services, all outpatient public hospital services including consultant services, dental, optical and aural services and appliances.

For those who do not qualify for a medical card, there are a number of schemes which provide assistance towards the cost of medication. I am sure Senator Burke is familiar with the terms of the long-term illness scheme. Non-medical card holders can also avail of the drugs payment scheme. This scheme protects such individuals from excessive drug costs. Under this scheme, no individual or family unit pays more than €85 per calendar month towards the cost of approved prescribed medicines.

Since 1997 there has been a total additional cumulative investment of approximately €710 million in the development of appropriate treatment and care services for people with cancer. This investment has enabled the funding of an additional 109 consultant posts in key areas of cancer care such as medical oncology, radiology, palliative care and general surgeons with specialist interest in breast surgery. The funding has provided for the appointment of 245 cancer care nurse specialists across the regions. Approximately €90 million in capital funding has been invested in oncology infrastructure, including specialist equipment in radiation oncology, mammography, radiology and pathology.

The health strategy includes a whole series of initiatives to clarify and expand the existing arrangements for eligibility for health services, including recommendations arising from the review of the medical card scheme carried out by the health board CEOs under the PPF. These recommendations include: streamlining applications and improving the standardisation of the medical card applications process; providing clearer information to people about how and where to apply for medical cards; and seeking out those who should have medical cards to ensure they have access to the services that are available.