I thank the Cathaoirleach Gníomhach for the warm welcome earlier for my wonderful colleague Camila. I welcome the Minister of State, Deputy O'Donnell. He is a very apt person to address this question as he comes from a distinguished medical family himself, in the present generation and in past generations.

I wish to raise an issue concerning people living with Addison's disease. Could the Minister for Health consider whether this condition should be included under the long-term illness, LTI, scheme? It is my contention that it should. Addison's disease is a serious lifelong condition that affects the body's ability to produce essential hormones needed to regulate blood pressure, metabolism, energy levels and the body's response to illness and stress. For those living with the condition, medication is not optional. It is something they depend on every day of their lives. In fact, up to 90% of cases are caused by permanent autoimmune damage to the adrenal glands, meaning patients rely on lifelong hormone replacement therapy because their bodies can no longer produce hormones naturally. Nobody chooses to live with Addison's disease. It is quite the contrary. Nobody can take a break from it, and nobody living with it can simply stop treatment and carry on as normal.

I will list the symptoms, which include severe abdominal, back or leg pain, vomiting, diarrhoea, weakness, confusion, loss of consciousness and dangerously low blood pressure. Treatments can include emergency hospital admission, intravenous steroids and fluids and ongoing monitoring. Without medication, people can become seriously ill very quickly and may suffer an adrenaline crisis and a medical emergency, involving what I just listed, that can require urgent hospital treatment and can, in some cases, be fatal. The reality is that people with Addison's disease must carefully manage their condition every day. They must take medication consistently, carry emergency medical information and be prepared for situations where illness or injury can suddenly increase their need for treatment.

We often speak about supporting people with long-term illnesses. We speak about preventative healthcare. We speak about ensuring that people receive the treatment they need before their condition becomes a crisis. That is why I believe there is a strong case for reviewing the position of Addison's disease under the long-term Illness scheme. This is not about seeking special treatment; this is about recognising the reality of a lifelong condition that requires continuous medication and ongoing medical management. I therefore encourage the Minister and her Department, through the Minister of State, Deputy O'Donnell, to engage with clinicians, patient representatives and relevant stakeholders to examine the case, which I believe firmly exists and should not take long to establish.

The current arrangements do not adequately reflect the needs. There is a compelling case to include it in the long-term illness scheme into the future. The question is not how many people are affected; the question is whether people whose health depends entirely on life-long hormone replacement therapy are receiving appropriate supports from the State.

My final contention is that there is an inherent injustice in not treating this illness comparatively and in an equitable way with other illnesses, some of which in fact do not have as grievous symptoms.

I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. I thank the esteemed Senator for raising this matter.

The long-term illness scheme was established under section 59(3) of the Health Act 1970, as amended. Regulations were made in 1971, 1973 and 1975 prescribing 16 conditions covered by the scheme. There have been no changes to the list of 16 conditions since that time.

Under the LTI scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness free of charge. While there are no plans to extend the scope of this scheme, it is important to recognise that it exists within a wider eligibility framework.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. Eligibility for a medical card is determined by the HSE, primarily based on an assessment of means. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances such as extra costs arising from illness. The HSE affords applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.

The issue of providing a patient with medical card eligibility on the basis of illness or a disability was previously examined in 2014 by the HSE's expert panel on medical need and medical card eligibility. The group concluded that it was not feasible, desirable or 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. However, over the past several years, there has been a significant focus on improving access to, and the affordability of, healthcare services. This has been advanced through substantial policy, legislation and investment to deliver expanded eligibility and services in line with Sláintecare.

Major expansions in eligibility include the following: the removal of public inpatient charges in public hospitals for children in 2022 and for adults in 2023; in 2023, the provision of free GP visit cards to include children aged six and seven, and those earning no more than the median income, and these changes had an impact on up to 500,000 people; and the reduction of the drugs payment scheme, DPS, threshold, which caps monthly expenditure for approved prescribed medicines. The DPS threshold was reduced to €80 per month in March 2022, which is a 35% reduction since 2020 when it was €124 per month. The DPS is not means-tested and is available to anyone ordinarily resident in Ireland. Taken together, these significant changes and expansions in eligibility continue to create a health and social care service that offers affordable access to healthcare to more people.

In respect of the points that the Senator made about Addison's disease, these are matters that I will bring to the attention of the Minister for Health and her Department officials.

While I appreciate the support that is available, Addison's disease a particular challenge because the medication involved is not simply therapeutic. It replaces hormones that are essential for life.

The question before us is not how many people are affected; the question is whether people whose health depends entirely on lifelong hormone replacement therapy are receiving adequate support from the State. People living with Addison's disease do not have the option of stopping treatment. Their medication is required every day for life. Ensuring reliable access to that treatment protects patients, helps to prevent avoidable medical emergencies and reduces pressure on our hospitals.

I ask the Minister of State, Deputy O'Donnell, to ask the Minister for Health, Deputy Carroll MacNeill to review this situation, to examine it once again and to look at it on equitable grounds. I do not mean to diminish any other condition when I say that this condition is grievous and is among the very serious conditions. It presents equal challenges, if not even more challenges, to some illnesses already listed. I hope the Minister of State can convey that to the Minister so this can be reformed into the future. It is something we cannot avoid looking at.

I thank Senator O'Reilly again for raising this important matter. As I stated previously, I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. I have very much taken on board the points the Senator has raised. I will revert to the Minister for Health on those specific points.

While there are no plans to extend the scope of this scheme, the long-term illness scheme exists within a wider eligibility framework. The Government is focused on expanding eligibility and improving the affordability of healthcare through a wide variety of measures. As mentioned, measures such as the substantial reduction of the drugs payment scheme threshold; the introduction of a GP chronic disease management programme, under which eligible patients will receive annual scheduled reviews with a GP and practice nurse; the expansion of access to free GP care to include more children and adults; and the abolition of all public inpatient hospital charges for both children and adults have had substantial impacts on the affordability of healthcare. These measures continue to create a health and social care service that offers affordable access to quality healthcare.

Senator O'Reilly will be aware that individuals may also be entitled to claim tax in respect of the costs of their medical expenses including medicine prescribed by a doctor or dentist with relief at the standard rate of 20%. Aside from eligibility and affordability, there remains a continued focus on improving the services available to people, as seen in the programme for Government commitments. The Senator raises important points. As I said previously, I will bring back to the attention of the Minister, Deputy Carroll MacNeill, the specific points raised around Addison's disease and the long-term illness card.

I thank the Minister of State and Senator O'Reilly. I want to welcome Una, Kathleen and Anthony Doolan and Richard and Theresa Shepherd, who are from Sligo, I think. No, they are from Roscommon and Sligo; I am offending them already. They are guests of Deputy Eamon Scanlon but he has found them a good guide in the form of Deputy Cleere who is looking after them. They are very welcome and I hope they are enjoying the tour. I imagine Deputy Scanlon is treating them to the bar and restaurant. If he is not, they will have to get onto Deputy Cleere.