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 Header Item Building Regulations Application (Continued)
 Header Item Medical Card Reviews

Thursday, 27 February 2014

Dáil Éireann Debate
Vol. 832 No. 3

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(Speaker Continuing)

[Deputy Barry Cowen: Information on Barry Cowen Zoom on Barry Cowen] The Minister acknowledged that developers should lodge a bond with the local authority. This should be a mandatory rather than discretionary requirement, as is currently the case. The bond should not be returned until such time as the council is satisfied that the development is complete and meets the required standards. Under the current process, it may be too late when the council initiates proceedings.

I ask the Minister to give serious consideration to the four or five proposals I have made before proceeding as intended on 1 March. We must not misconstrue or misrepresent some of the comments we have heard on the public airwaves and elsewhere in the past week or two. Many members of the public honestly believe there are means and methods to strengthen the process the Minister proposes to enable us to stand over them. We need certainty that the system will not fail to achieve the objectives set for it, as it did in the past with detrimental results.

Deputy Phil Hogan: Information on Phil Hogan Zoom on Phil Hogan I do not know for how long or how often people have been refusing to listen and acknowledge that we are proceeding with new building regulations on 1 March 2014. The new regulations have been the subject of consultation with all of the people involved in the construction industry for the past two years. I am prepared to establish an oversight group, as suggested by Deputy Cowen, to monitor the implementation of the regulations. I concur with him that the implementation of a new regime inevitably gives rise to teething problems. Nevertheless, comprehensive consultation documents have been published, including a document strengthening the building control system, a document to inform public consultation on the draft Building Control (Amendment) Regulations 2012, which sets out the context in which the reforms will operate and their regulatory impact for building owners and industry stakeholders. This document remains available on the Department's website.

The arrangements being introduced for the control of building activity may result in some additional costs. Certification will be required if one proposes to build to a higher quality design or have a risk-based inspection system. It is not expected that single houses in rural areas will require many inspections. However, inspections will be required for blocks of apartments and commercial developments, as we know from the past. The costs will be modest compared to the outcome.

A register of builders will be established on a voluntary basis in 2014 and will be made statutory in 2015. I am proceeding with this measure, with which the Construction Industry Federation agrees.

Owners and developers who are worried about these matters, for example, draughtsmen, who tend to work in rural communities, will be able to proceed as present on a direct build basis. They will, however, be required to have an architect, building surveyor or chartered surveyor sign off the job to certify it has been done properly. This requirement has always been in place but was not always complied with. If individuals who do a good job want to register with the professional bodies, I appeal to them to do so. I have commissioned a report from the chairman of the architects admissions board, Mr. Garrett Fennell, to examine how to make it easier to register with the professional bodies. I will immediately implement Mr. Fennell's recommendations to enable people to become the assigned certifiers in respect of the regulations.

I assure Deputy Cowen that all of the nonsense on RTE this week is absolute misinformation to the extent that it is being claimed that the cost of building a house by direct labour in a rural area will increase by as much as €50,000. Additional compliance should cost between €1,000 and €3,000, depending on market forces and where the best deal can be secured. I encourage small business professionals, such as draughtsmen, to register with the professional bodies in order that they can act as assigned certifiers. I will careful monitor the position to ensure the regulations are implemented fairly.

Medical Card Reviews

Deputy Catherine Murphy: Information on Catherine Murphy Zoom on Catherine Murphy The issue I raise relates to reviews of medical cards which have been granted on medical hardship grounds. Reviews are frequently carried out soon after the medical card has been granted. I am aware of a number of cases where reviews are being done of medical cards that were allocated until April 2015. A problem arises because the evidence provided by medical card holders is not retained and is, therefore, not available to the officials carrying out the review. This means the medical card holder must gather this evidence again as part of the review, which can be costly, especially if they need to visit a general practitioner or consultant. While data protection issues may well arise in these circumstances, these could be overcome if medical card holders were asked to sign a data protection waiver.

I will illustrate the problem I describe by citing a number of cases with which I am dealing. One case involves a young father aged in his 30s who has experienced kidney failure and is being maintained on medication. He is not yet on dialysis. The young man has a mortgage to pay and was awarded a medical card on medical hardship grounds. As part of the review, he must again gather all the evidence he provided for the initial application. His medical card has been withdrawn and he has lodged an appeal. It will not be in anyone's interests if this man cannot afford his medication as the cost to the health service will be higher.

Another case involves an eight year old child with profound disabilities who is in a wheelchair and is fed through a tube. She has the mental age of an eight month old baby and while her parents would love her medical diagnosis to change, that will not happen. The child was awarded a medical card until April 2015 but an early review was initiated, with the result that the parents must go through the whole process of gathering the evidence again because it is not retained by the relevant officials. The same problem arises in respect of another child with a heart problem, which is not likely to change.

In another case, a man in his early 60s who is receiving chemotherapy treatment is unable to work because his condition has worsened. The family do not want to get a letter stating his condition is terminal because they want to hold out some hope. He, too, is being put through a rigorous review.

While I understand that people's financial circumstances change, the medical conditions of many of the individuals in question are unlikely to change. I ask that the rules governing medical card reviews be relaxed to assist people who genuinely need a medical card for reasons of medical hardship. They should not have to endure the torture of having to repeatedly gather certain information given that their health condition will not change.

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I thank the Deputy for raising this issue.

Under the Health Act 1970, eligibility for a medical card is founded primarily on the undue financial hardship test. Under the legislation, determination of an individual's eligibility for a medical card is the responsibility of the Health Service Executive. The 1970 Health Act obliges the HSE to assess whether a person is unable, without undue hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure. If an applicant's means are above the financial thresholds for eligibility for a medical card or a GP visit card, as set out in the national guidelines, the HSE examines for any indication of medical or social circumstances, which could result in undue financial hardship. However, even where a person exceeds these financial thresholds, eligibility may be granted on a discretionary basis if these circumstances are such that a person cannot access general practitioner or other medical services without undue financial hardship. In these cases, social and medical issues are taken into consideration by the HSE when making a decision on eligibility.

It is important to note that discretion is not a stand-alone exercise. Exercising discretion remains an integral part of the assessment process for a medical card.

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