Seanad debates

Thursday, 27 October 2016

Commencement Matters

Primary Medical Certificates Eligibility

10:30 am

Photo of Paul CoghlanPaul Coghlan (Fine Gael)
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I again welcome the Minister of State at the Department of Health, Deputy Finian McGrath. You are becoming a frequent visitor to the House.

Photo of Rose Conway WalshRose Conway Walsh (Sinn Fein)
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I thank the Minister of State for taking the time to come to the House this morning. The tax relief scheme for the purchase of adapted vehicles for disabled drivers and disabled passengers is instigated by the granting of a primary medical certificate. This is an excellent scheme which makes a huge difference. It is the difference between many disabled people actively participating in their communities and being prisoners in their own homes. It is also the difference between disabled and elderly people being able to attend hospital appointments and not.

In rural constituencies, such as the area I come from in Mayo, there is rarely the option of using public transport. Travelling to University Hospital Galway is a six-hour round trip while travelling to a Dublin hospital is a ten-hour round trip.

I have some simple questions. Why do profoundly and permanently disabled people continue to be discriminated against in the criteria for accessing this scheme? Why are people with upper body disabilities excluded from the scheme? Is equal access to hospitals and other services not important for them?

I can outline three cases that come to mind. The first involves a woman whose arm is amputated to the shoulder. It is not going to grow back. She needs a specially adapted vehicle to get around just as much as if she had lost her leg. She lives on her own and has no other means of transport. Is she not as entitled to access the relief scheme as somebody who has a disability in their lower limbs?

The second case is an eight year old boy who is PEG fed and has severe scoliosis. He is not strong enough to undergo the operations he desperately needs. His parents make frequent trips to Crumlin and other hospitals. They need an adapted vehicle for the long and tiresome journeys they must undertake. Why are they refused access to the relief scheme?

In the third case, Deirdre is a 12 year old girl with a condition called Cornelia de Lange syndrome. She is non-verbal and has complex physical and mental special needs. As Deirdre cannot speak, I will speak for her and her parents, a fisherman and a housewife living in a remote rural area. Given Deirdre’s multiple health problems, they must make continual trips to hospitals and services, such as speech and language therapy, paediatrics, orthodontics, neurology, urology and genetics. Why in heaven's name did they get a letter stating, "Due to the strict criteria laid down for the primary medical certificate you were unsuccessful in obtaining same"?

I beg the Minister of State to put an end to the humiliation and struggle Deirdre and others with profound permanent disabilities are faced with when refused transport simply because their main disability is in their upper limbs. The Minister of State is a man of compassion. He is now in a position to right this wrong. I ask him to re-examine the criteria for this tax relief scheme with the Minister for Finance and stop the discrimination against people with upper limb disabilities. When will the motorised transport grant scheme, which was closed in February 2013, be reinstated?

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Senator Conway-Walsh for raising this important issue. I am well aware of her strong support for all people with disabilities. As the new Minister of State with responsibility for disability, I appreciate any support from all the parties because there are times when one must really fight to demand services and also fight for the rights of people with disabilities. I thank the Senator for her support.

My colleague, the Minister for Finance, operates a tax relief scheme for the purchase of adapted vehicles for disabled drivers and disabled passengers. He is also responsible for setting the eligibility criteria for this scheme. The disabled drivers and disabled passengers tax concession scheme, to give its full name, provides relief from VAT and VRT up to a certain limit on the purchase of an adapted car for the transport of a person with specific severe and permanent physical disabilities, payment of a fuel grant, an exemption from motor tax, and an exemption from toll bridge charges. To qualify for the scheme an applicant must he in possession of a primary medical certificate. To qualify for that certificate an applicant must be permanently and severely disabled within the terms of the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994 and satisfy a range of conditions. The extent of the involvement of health personnel relates to making a professional clinical determination as to whether an individual applicant satisfies the medical criteria. This determination is undertaken by senior medical officers for the relevant local HSE administrative area on behalf of the Department of Finance and the Revenue Commissioners. However, these HSE personnel have no role in setting or amending the criteria. That is the kernel of the issue.

A successful applicant is provided with a primary medical certificate which is required under the regulations to claim the reliefs provided for in the scheme. An unsuccessful applicant can appeal the HSE senior medical officer’s decision to the disabled drivers medical board of appeal, which is under the auspices of the Minister for Finance. The appeals board makes a new clinical determination in respect of the individual. This medical board of appeal is independent in the exercise of its functions to ensure the integrity of its clinical determinations. That is an important point.As Minister of State with responsibility for people with disabilities, I can have no role to play in the exercise of these functions. I have been informed by the Department of Finance that the criteria to qualify for the scheme are necessarily precise and specific. After six months a citizen may reapply if there is a deterioration in her or his condition. It should also be noted that the scheme represents a significant tax expenditure, with a cost of over €50 million to the Exchequer in 2015, up from over €48 million in 2014. We have to keep our eye on that. There are other people with another agenda in respect of that €50 million.

The Minister for Finance has informed me that he recognises the important role the scheme plays in expanding the mobility of citizens with disabilities. He has managed to maintain the relief at current levels throughout the economic crisis, despite the requirement for significant fiscal consolidation. He has also informed me that from time to time he receives representations from individuals who feel they would benefit from the scheme, but who do not qualify under the six criteria. While he has sympathy for these cases, given the scale and scope of the scheme, he has no plans to expand the medical criteria beyond the six currently provided for.

I am pleased to inform the Senator that the programme for partnership Government acknowledges the ongoing drafting of primary legislation for a new transport support scheme by the Department of Health. Work on the policy proposals in this regard is at an advanced stage and I anticipate this will be brought to Government shortly.

Photo of Rose Conway WalshRose Conway Walsh (Sinn Fein)
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Is the Minister of State saying that we need to change the legislation and, if so, what part can he play in changing it? I appreciate the role of the Department of Finance but we need to get to the bottom of this. If legislation needs to be changed we need to bring that forward. My party will prepare that if it is necessary but I would appreciate the Minister of State's guidance on that. The Minister for Finance's sympathy is of no use in trying to get sick and disabled people to a Galway or Dublin hospital from Mayo. All the sympathy in the world will not do that. We need him to act.

How many appeals have been received by Dún Laoghaire in the past 12 months and how many decisions have been overturned in favour of the applicant? I appreciate it will take some time for the Minister of State to get that information. Time and again people go to Dún Laoghaire and are dismissed. The people who have appealed at the end of the six-month time limit ask what is the point in dragging a sick child all the way to Dún Laoghaire again to be refused. When will the heads of the motorisation grant Bill be produced? Will that be before Christmas and how long after that will it be before a decision is made to make that grant available again?

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Senator Conway-Walsh for raising this important issue. I accept her point about the families and the ten-hour trips. She mentioned three genuine cases. Part of my role as Minister of State with responsibility for people with disabilities is to reflect and bring that view in. This issue is covered by the Department of Finance. I have an internal debate going on about that. If legislation needs to be amended that would be part of my remit. My focus is on the person with the disability such as the three cases the Senator mentioned. This is not a question of sympathy but of equality and justice for these families. I have to try to get around the problem. My gut feeling is that the legislation needs to be changed. That would be part of my portfolio. I will follow up on that for the Senator.

I will find the precise information about the appeals and will come back to the Senator with it. I do not have an update. I managed to get the motorised grant into the programme for Government. It is on page 71 and it states: "Work is underway on the drafting of this new legislation for the introduction of a new mobility scheme to assist those with a disability in meeting their increased mobility costs." There are 3,000 or 4,000 people who would fit into that category. I am hopeful of getting that done in the next couple of weeks but the officials are saying before Christmas, to be safe. I want it in the next two weeks but the officials say it will definitely be before Christmas.

We are trying to reinvest in and rebuild the health service. We have had a rough couple of years and the focus has to be on rebuilding the service but as Minister of State with responsibility for people with disabilities I want to get my slice of the cake to progress the issues the Senator raised this morning. I thank her for raising them.

Sitting suspended at 11.16 a.m. and resumed at 11.30 a.m.