Mr. Shaun Flanagan:

There is a split of operation and policy there. I will talk about the operational side of things. The process is designed to try to capture all the possible expenses side of things that we can reasonably predict so people are asked for those automatically. The medical costs are not part of normal means test. As regards the requests for information beyond that, if someone was asked for a full medical file I ask the Cathaoirleach to come to me directly on that and I will definitely look at it because that is not what we try to do. We try to design the processes to be as slim as possible and ask for the least we can ask for. Those asks are sometimes interpreted as trying to prevent people from getting medical cards but they are generally trying to get as much information as they can about the costs people have so we can apply the most costs we possibly can to their expenses to give them the best chance of getting a medical card. We try to make it as sensitive and simple as we can. Our medical officers try to impute from what they are given to estimate what the medical costs would be. On occasion they will say there is not enough there but there has to be more information on that condition so we send a burden of illness form to the client. That involves engaging with doctors. I know it is an administrative process but the aim is to try to capture as much of the expenses as we possibly can to give that person the best chance of getting a medical card.

The Cathaoirleach mentioned motor neurone disease. My expectation would be that most people with motor neurone disease would get a medical card because of the nature of that illness. Our medical officers would know very quickly if they see motor neurone disease on an application form that, effectively, it is a terminal illness with a relatively short prognosis. We would not be going back looking for doctors to sign those forms. We try to give our medical officers as much discretion as we possibly can. He also mentioned other diseases. I can only operate the system that is set out in legislation and it is a means-test system. There is not an automatic right there, other than for cancer patients who are under 18. There is a right to a five-year medical card and various other provisions are set out in legislation around the terminal card and the end-of-life card.

I or Mr. Gloster, on our side of the table, cannot unilaterally make decisions to change those rules.