Alan Kelly (Tipperary, Labour)
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105. To ask the Minister for Health when a terminal illness card will be provided for persons with less than two years to live will be delivered; and if he will make a statement on the matter. [42343/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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Under the Health Act 1970, eligibility for a medical card is based primarily on means. The issue of granting medical cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that 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.

The HSE has however a compassionate system in place for the provision of medical cards when it is informed that a patient is receiving end of life treatment – that is when patients’ unfortunately have a prognosis of less than 12 months. These applications do not require a means assessment nor are they reassessed. There are currently almost 1,800 such medical cards awarded. Separately, terminally ill patients who do not meet the end of life criteria may also qualify for a medical card under the general assessment processes. Every effort is made by the HSE, within the framework of the Health Act 1970, to support applicants in applying for a medical card and to take full account of the difficult circumstances, such as extra costs arising from an illness.

Furthermore, since 2015 medical cards are awarded without the need of a financial assessment to all children under 18 years of age with a diagnosis of cancer.

It should also be noted that the Programme for Government ‘Our Shared Future’ contains a commitment to extend discretionary medical cards to those with a terminal illness. A HSE Clinical Advisory Group (CAG) was established in December 2019 to review eligibility for medical cards in cases of terminal illness. The final Report of the CAG was recently submitted to my Department and has been published. The Report notes that there are practical and legal challenges with extending eligibility for medical cards for terminally ill patients within the framework of the current process.

However, I wish to assure the Deputy that I am committed to ensuring that terminally ill patients have access to the services they need.  In that regard, my Department has devised a work programme which has been initiated and which will look to address the policy and legal findings of the Report and deliver on the Programme for Government commitment. This will include an examination of potential options on a legislative framework to extend eligibility in such cases, which will begin immediately. In parallel to the legislative work, officials will also consider proposals that would enable those with a terminal illness to access services without necessarily requiring a medical card.

Bernard Durkan (Kildare North, Fine Gael)
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106. To ask the Minister for Health the extent to which the Sláintecare programme is being enacted; the progress to date in this regard; the targets achievable in the next 12 months; and if he will make a statement on the matter. [42501/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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Notwithstanding the ongoing challenge of COVID-19, considerable progress continues to be made on Sláintecare implementation. The principles of Sláintecare, such as the patient being paramount; timely, needs-based care; prevention and public health; and engagement with citizens and staff, were clearly demonstrated through the COVID-19 response.

Important lessons have been learnt from COVID-19 and applied to the ongoing implementation of Sláintecare throughout the service. In particular, the telehealth access to GP services for COVID-19 symptoms, the integration of services across acute and community, the focus on managing as much care as possible in the community and the rapid deployment of e-health solutions illustrate what is possible and the extent to which the pandemic response has helped to demonstrate in practice the Sláintecare vision.

Key programmes that have progressed during 2020 include commencing the implementation of improving population health-based planningand developing new models of careto deliver more effective and integrated care,especially in relation to:

- Innovative integration programmes that support people to live independently at home, promote self-empowerment, and have a focus on preventing illness, across 122 sites all around the country;

- 96 Sláintecare Community Healthcare Networks based on populations of 50,000 people, and Specialist Hubs for Older People;

- the agreement with General Practice to deliver a national Chronic Disease Management (CDM)Programme; and

- Patient Prescriptions e-Scripts between GPs and Pharmacies through the secure Healthmail system. Since mid-April, almost 900,000 prescription messages were sent through the platform with over 550,000 messages in the month of May alone, averaging almost 20,000 prescriptions per day.

The new context has provided opportunities for implementing Sláintecare at pace, and the very large investment in Sláintecare for 2021 will support this. Three priority programmes have been identified to drive Sláintecare implementation at pace, with a focus on the next three years:

1. Keeping people well at home or near home, out of hospital, living independent lives, by implementing agreed end to end care pathways between GPs, Community and Hospital services, through Community Healthcare Networks and Specialist Hubs and a variety of related projects.  Healthy Ireland is a key enabler of this programme.

2. Helping achieve waiting list targets, through implementing the Capacity/Access Plan including devising a multiannual waiting list plan and commissioning ambulatory-elective centres in Dublin, Cork and Galway.

3. Devising a Citizen Care Masterplan for universal eligibility and multi-annual funding using a population-based planning, segmentation, needs and gap analysis approach, by Region, supported by five frameworks:1) clinical governance, 2) workforce planning, 3) capital planning, 4) eligibility/entitlement, 5) funding.

Budget 2021 allocated €1.353 billion specifically to Sláintecare-related initiatives, including €467 million for increased acute and community bed capacity, €425 million to provide enhanced community, social and primary care services and €318 million to improve access to care. In addition, the investment will provide for an increase of approximately 16,000 additional staff in the health service, 5 million more hours for home care, and allocations of €100 million for disability services, €50 million for mental health services, €153 million for eHealth and €20 million for Healthy Ireland.

The allocation demonstrates the strong commitment by Government to the Sláintecare vision and will enhance the permanent capacity of the health services, substantially increase the workforce, expanding the scale and range of service to be provided in the community and introduce targeted measures to improve access to care in 2021.