Alex White (Dublin South, Labour) | Oireachtas source

I thank the Deputies for a lively and engaging debate on our health service in the context of the 2014 national service plan. It is an issue of vital importance to us all. Throughout the deliberations, there has been, understandably, considerable focus on the financial constraints within which the HSE has been required to deliver its service plan commitments over recent years. These constraints apply again this year. Notwithstanding these constraints, the HSE and its workforce are to be commended on their continued focus on minimising the impact on front-line services by utilising their reduced resources in a more efficient and effective way.

The delivery of services by the HSE has, as a consequence, focused over recent years on the dual challenges of protecting patient outcomes and reducing costs. This has required increasing emphasis on models of care which treat patients at the lowest level of complexity and provide safe quality services at the least possible cost. Despite unavoidable resource reductions, successive plans have managed, to a very significant extent, to maintain core services while also supporting growing demand resulting from population growth. Deputy Ó Cuív needs to have regard to that when he shows that the overall budget has not changed over a period of years. We have had population growth, increased levels of chronic disease, increased demand for drugs, a higher number of medical card holders, which is up by 590,000 since 2008, and new costly medical technologies and treatments. The HSE, in its 2014 national service plan, has again sought to minimise the impact of constrained financial resources on front-line services and to maintain patient safety in line with the Minister for Health's stated overriding priorities for the service plan.

I will not have an opportunity to address many of the issues raised, but perhaps I might touch on one or two. In regard to medical cards, several Deputies claimed that I stated there is no such entity as a discretionary medical card, and they are correct. I said that in reply to a parliamentary question because it is true. There is only one medical card. Medical cards provided on the basis of means or where discretion is involved are identical and provide access to the same set of health services. The contention that there is a major policy change in the awarding of medical cards on a discretionary basis, even to the extent of "erasing medical cards from the system", as has been suggested, could not be further from the truth. Such spurious and unfounded comments only serve to cause concern and distress.

I have consistently said, as have my colleagues in the HSE, that the assessment procedures used to determine eligibility for medical cards and GP-visit cards have not changed. The scheme continues to operate in such a way that those who suffer genuine financial hardship as a result of a medical condition receive the benefit of a medical card. It is important to note discretion is not a stand-alone exercise. Exercising discretion has been, and remains, an integral part of the assessment process for a medical card. In previous years, there was a decentralised process across 100 locations throughout the country. This meant people may have been awarded discretionary medical cards in some parts of the country while they would not have been in others because of the lack of a centralised and standardised approach.

Deputy Calleary raised a number of compelling and thoughtful points in his contribution but he made the point in regard to discretionary medical cards that there was always such a thing. The particular example he gave related to people suffering from cancer. The only basis on which the HSE can award eligibility to any individual in the State must be on the basis of a statute and we have a statutory provision in the 1970 Act. It is very clear that a medical card can be awarded on the basis of undue hardship.

I understand the humanity of the case Deputy Kelleher and others, including many in my party, make that persons who become ill suddenly are in a situation of great need and great stress. The fact is that the system put in place in 1970 determines eligibility on the basis of financial means. The medical situation only enters into the equation when a person's medical situation affects their financial means. Deputy Kelleher knows that is what the law states. If we are to change that, we would have to look at the medical illnesses for which we would give an individual a medical card. Would there be any medical illnesses for which a person should not have a medical card? We would end up adding illnesses and adding conditions to the law all the time.

What I would prefer to do is to look to introducing universal access to GP services. Again, I invite Deputy Kelleher to support me and the Government in this regard. The programme for Government refers to universal access to GP services. We are starting this process and I will meet the medical organisations this Friday. We will introduce this within the lifetime of the Government and we are starting on the long road.

No one has shown in this debate, and there have been many interesting contributions, how the HSE could manage the resources it has in a better way. There have been many criticisms but nobody has shown a better way to manage the resources the HSE has, and it is doing this admirably.

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