Dáil debates
Wednesday, 16 May 2012
Topical Issue Debate
Medical Cards
4:00 pm
Ciarán Lynch (Cork South Central, Labour)
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I thank the Ceann Comhairle's office for allowing me to raise the inordinate delays that can occur when medical card applications need to be reviewed.
On 22 February, in reply to a Topical Debate on the processing of medical card applications, the Minister of State told the House she expected the backlog of applications to be dealt with by the end of April. I would be grateful if the Minister would update the House on whether this target has been met. My office, which is in regular contact with the primary care reimbursement scheme, reports a considerable improvement in the ability to make contact with the PCRS staff and an improvement in the through-put of applications.
It appears, however, that there are still anomalies in the system that relate specifically to situations where applicants supply additional or revised information to the PCRS. In those cases, it takes an extremely long time to have the application reviewed. It is not the application that is the problem but if a review process is started, it creates a delay that can go on for an indefinite period.
In one case that prompted me to raise this issue, the most recent phase of one constituent's application for a medical card began in February of this year. Subsequent evidence was requested and supplied. That evidence related to home improvement loans needed to upgrade the heating to the standard necessary given the spouse's medical condition. This person had a circulatory problem and the central heating had to be installed to address this. It took a month to review the submitted information, which was ultimately rejected as evidence of a home loan.
This creates an anomaly. The reason the loan was refused was that the person had the central heating installed by the gas company instead of getting a loan from the credit union. Because the gas company was involved, it was not classified as a home loan and was therefore outside of the assessable means. It is strange that if someone gets the gas company to install central heating, the PCRS staff do not classify that as a home loan but if the person goes to the credit union to pay for the installation, it is classed as a home loan. I hope this anomaly will be corrected.
The second problem arose regarding the household income. The person got home help hours but ceased working as a home help and because of this another review was required. Proof was provided that the household had no income other than social welfare payments and receipt of this information was acknowledged on 25 April 2012.
However, some 15 working days later the promised review had not been completed and, to my knowledge, it has still not been completed as of this afternoon. This highlights a second anomaly. The HSE website suggests a medical card application can be processed from start to finish within 15 days. However, an apparently simple review cannot be completed in that time. Between my contacts and those of the staff in my office, we have made 25 separate contacts with the Primary Care Reimbursement Service during April and May on this single case. Although not as extreme, similar delays have occurred with other applications for review.
I emphasise that this is not an exercise in criticising the HSE or the PCRS. Rather it is an attempt to relieve the distress of a couple who urgently need the benefits of a full medical card. It is also an attempt to highlight the anomaly in the system. Is the planned provision of general practitioner visit cards for patients with a long-term illness on schedule? Ultimately, there is an anomaly and I would be grateful to hear how the Department will respond to it.
Róisín Shortall (Dublin North West, Labour)
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I thank the Deputy for raising this issue as it provides me with an opportunity to report on what is taking place in the processing of medical card applications. Members will be aware that a decision was made some years ago to centralise the processing of all medical card applications. This was to be done on a phased basis. Last July a decision was taken by the HSE to centralise the records of the country overnight. I took the view that this was an unfortunate decision. The mistake was to do it overnight rather than to phase it in and build capacity. We have spent a good deal of time since dealing with the fall-out of that decision and trying to resolve the issues that have arisen.
For the first time in the State's history, a single, uniform system of application processing has been put in place. This system replaces the various systems previously operated through more than 100 local offices throughout the country. Among the changes introduced are the online service on the www.medicalcard.ie website and the standardisation of medical card assessments. Ultimately, the new arrangement should provide for a more accountable and better managed medical card processing system. I am aware, however, that there have been many serious difficulties with the centralisation project which have given rise to a large backlog and long delays for both new applicants and medical card renewal applicants. Several factors have given rise to these problems, including the processing of medical card applications being centralised before the necessary resources were in place. That was the key mistake made. The system was not geared up to deal with the significant increase in volume. There was already a significant backlog prior to centralisation. There has been poor communication with medical card applicants and the public. There has been limited support from local health offices and poor communication between local offices and the centralised system. Poor practices and procedures in the handling, filing and processing of medical card documentation have been a feature of the system. There have been problems across the board.
These issues were a source of serious concern for me and I held several meetings with the HSE during the past six months to express my concerns. As a result, the HSE has introduced several changes to the administration of the medical card application system in recent months. These changes include increased staffing levels in the centralised processing service to the full complement; improvements to the way medical card renewals are assessed and the frequency with which they are assessed; increased flexibility for GPs to add certain categories of patients to their GMS list; and the fast-tracking of backlogged cases and cases in which documentation has been misfiled.
I emphasise that in no circumstances should a medical card holder who genuinely engages with the review of his or her medical card have his or her entitlement withdrawn before the review is complete and a decision made. Some such cases were brought to my attention and these occurrences are unacceptable. The HSE is taking steps to ensure this rule is properly implemented.
While several customer service and communication issues remain to be addressed, the HSE has made significant progress in eliminating the backlog and preventing further backlogs from occurring. I am pleased to note that a backlog of 58,000 applications from last year has been completely cleared. Typically, the HSE receives up to 50,000 applications for medical cards each month. More than 90% of complete applications are processed within 15 working days. A review of medical card application processing has been undertaken by PricewaterhouseCoopers. It contains several recommendations which the HSE is addressing. I continue to monitor the situation and meet representatives from the HSE on a regular basis to discuss the quality of service provided for the public and address issues which may arise. I will be happy to take up the specific issues raised by the Deputy to ensure they are addressed.
Ciarán Lynch (Cork South Central, Labour)
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I thank the Minister of State for her comprehensive response and acknowledge the commitment she has given. Her efforts have been clearly demonstrated in rectifying many of the processing difficulties that have arisen. On the whole, my experience and that of the staff in my office of the processing of fresh applications indicates that the process is working well. Applicants receive text messages stating their medical card is in the post. As I have outlined, the difficulty lies in the review process. It almost makes sense in some cases for people not to request a review but to make a fresh application and enter the information already submitted for review as part of a new application. I call on the Minister of State to re-examine the review process with a view to rectifying the difficulties that have arisen to make the process run smoothly. Anomalies remain, including one whereby a loan received from one agency is not categorised as a home loan because it has not been received from a lending institution but from a service provider.
Róisín Shortall (Dublin North West, Labour)
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While a good deal of progress has been made in recent months in clearing the backlog, glitches remain in the system. There are particular difficulties with document handling and filing and these must be ironed out fully. We are working on these issues and there is now a good quality control system in place. I accept the Deputy's point that sometimes it is easier to start from scratch. However, the figures I have received indicate 90% of applications are turned around within 15 days. These are cases in which all the documentation has been sent in and is complete and uncomplicated. However, issues remain where people are trying to interact with the PCRS to explain certain information, for example, the source of a home loan. These remain to be ironed out. I fully accept that there are customer service issues which have not been fully resolved. However, we are working on them. I will be happy to pursue the case referred to.