Frank Feighan (Fine Gael)
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I wish to raise the need for the Minister for Health to explore the possibility of reviewing medical card guidelines for people with spinal injuries who wish to take up work but who see the potential loss of their medical card as a significant disincentive to taking up employment. I thank the Minister of State, Deputy Finian McGrath, for taking this matter today.

This important issue has been raised with me by several constituents. From my discussions with them, it is evident that those who have suffered spinal injuries face ongoing medical challenges for a lifetime which come with a high cost. Those medical challenges can include pain, urinary tract infections and pressure sores which need to be kept in check by doctors and nurses. These can also present significant financial challenges. Without a medical card to help offset significant medical costs, people with spinal injuries may not receive the vital care and attention they need.

In the context of this discussion, it is clear many people with spinal injuries are caught between a rock and a hard place. Currently, those who want to seek employment fear losing the medical card. If they are not working, they face being caught in a poverty trap. It is not just about the cost of living, keeping food on the table, a roof over their heads and paying the bills. Associated health supports and services, essential to their everyday living, also need to be considered. Without a medical card, there are many costs to be covered such as medicine, physiotherapy, wound dressing, regular visits to the GP and the National Rehabilitation Hospital in Dún Laoghaire, along with medical equipment such as wheelchairs, shower chairs and having this equipment serviced. As one person with a spinal injury said to me, they are nervous about taking up employment because they fear losing the medical card. This can be a great cause of stress.

A spinal injury, unfortunately, is an injury for life, presenting ongoing challenges which I have outlined. These concerns relating to employment and holding on to a medical card were highlighted in the 2017 Government report, Make Work Pay for People with Disabilities. The report identified the main barriers which impede people with disabilities from fulfilling their employment ambitions. Not surprisingly, the potential loss of a medical card was identified as the single most significant disincentive to taking up employment. While people on a disability payment for at least a year can retain a medical card for a further three years when they return to work, the report confirmed that those with lifelong conditions generally do not see this temporary retention as sufficient in that it does not offer security of continued access to the medical card and the vital supports it brings.

I strongly believe we must explore the possibility of reviewing the medical guidelines for people with spinal injuries. These are people who want to work and to contribute economically. However, the potential loss of the medical card creates a significant barrier for them to take up employment.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Feighan for raising this very important issue because the Government and I are very committed to ensuring that persons with a disability are supported in order for them to fulfil their employment ambitions and to address those barriers that might prevent them from doing so. I visited the headquarters of Spinal Injuries Ireland two weeks ago on foot of an invite to open its new office and centre. It is something of which I must be supportive. The issue of medical cards arose with all the residents and patients there. They were all very enthusiastic about getting into the workplace. There were a lot of talented people in that room and it had a lasting impression on me.

The Senator will be aware that an interdepartmental group was established under the comprehensive employment strategy for people with disabilities to address the issue of making work pay for such people. The group's Make Work Pay report, which was published in April last year, found that the single most significant barrier to taking up employment or increasing the number of hours of employment for people with disabilities is the potential loss of the medical card. Essentially, there is agreement on that particular issue. To address this, the report contained two key recommendations relating to medical cards. First, it recommended that the medical card earnings disregard be increased from its current level of €120 for persons in receipt of disability allowance or partial capacity benefit. To that end, the Department of Health, the HSE and the Department of Employment Affairs and Social Protection have been examining proposals to give effect to this recommendation. Officials are working to finalise the proposal and the Minister for Health expects to be announcing details of how this change will be implemented in the coming weeks. The second recommendation regarding the medical card was to remove the requirement that work undertaken for the medical card earnings disregard must be of a rehabilitative nature. I am happy to confirm that this measure was implemented by the HSE last year.

Implementing both of the measures to which I refer will ensure that persons in receipt of disability allowance will now be in a position to have greater earnings capacity and can do so safe in the knowledge that their medical card, which enables them to access many vital health services, will be retained. Support is also provided for persons who have been on a relevant welfare payment for a year and who then take up employment. Such individuals can retain the medical card for an initial three-year period after taking up employment. That is another important feature. At the end of the period, cardholders will be assessed under the normal rules of the medical card scheme. Should a person's income be above the relevant limit, he or she will be considered for a discretionary medical card, or a GP visit card, which takes account of the extra costs that arise from an illness or a disability.

The Make Work Pay report contained a range of recommendations right across the span of Government, all of which are all intended to help those with disabilities to fulfil their employment ambitions. Working together, we will ensure that persons with a disability are afforded every opportunity to maximise their employment potential, which will be beneficial for their own lives and society generally. I feel very strongly about spinal injuries and I am completely in agreement with what the Senator said.

Frank Feighan (Fine Gael)
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I thank the Minister of State for his interest in this very sensitive, complex and difficult subject. I welcome the recommendations. I am anxious that the increase in the medical card earnings disregard from €120 would be quite significant but, obviously, we will know in the coming weeks. I also thank the Minister of State for the work that has been done. Our job is to ensure that persons with disabilities are afforded every opportunity to enter the workplace and maximise their employment potential. With a growing economy, everything should be done to ensure that this will happen. Once again, I thank the Minister of State for his interest and reply and I wish him well in the coming weeks.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Feighan for his comments but note this is a serious issue and I absolutely take on board his views. On meeting people with spinal injuries, one hears some of the personal stories about how their lives changed in a matter of seconds, whether they fell off a ladder in a building site, had a car crash or had some sort of injury. All of a sudden, these wonderful people who were active find themselves disabled. That is the tough side. It undoubtedly is a tough disability to have but the thing that blew me away that evening two weeks ago in Dún Laoghaire was their courage, positivity and determination to get back to work. They wanted to contribute to society and some of them had very valuable skills. That is something I will be pushing because if we are talking about making work pay for people in any kind of report, we must ensure that people with spinal injuries are included in that group.