Alex White (Dublin South, Labour) | Oireachtas source

There are two areas I wish to address. First, I will address the question of dental services and then I will say something about the medical cards issue which has been raised by several members.

Deputy Ó Caoláin raised the issue of dental services and I wish to give some context to my reply. It is worth pointing out that in the year to date, that is, to April 2013, of the 1.4 million people eligible for care, some 170,684 patients have received care, an increase of 10,000 on this time last year. That is an important context. Having said that, I agree with Deputy Ó Caoláin that this area of dentistry, which includes primary care, preventive care, early checks and all these important areas of care in dentistry, is vital.

I have met the Irish Dental Association on more than one occasion. They are very good about this and they are dedicated professionals. The organisation is fully engaged in this process and I am keen to engage with those involved. Let us be straight: it is an area where we have seen the impact of the financial constraints we are under. We have be unable to move on with initiatives as quickly as we would have wished. However, I am seized of the importance of dentistry and of proper and well-developed dentistry services and I will continue to engage with the Irish Dental Association in this regard.

The HSE has commissioned an independent review of the services and this has been referred to in the response to Deputy Ó Caoláin's comments. The outcome of that review will give us guidance on what changes are desirable to provide the best model of care that we can provide, regrettably, I must say again to the committee, within the constraints of the resources available to us. It is regrettable that we have been unable to do more although we have done a good deal in recent years, as Deputy Ó Caoláin has fairly acknowledged. We want to do more and I see it as a priority area for attention once we move on from the stringent financial constraints we are currently under. I wish to give the committee the assurance that it will be a priority because I am fully convinced of the importance of dentistry not only in terms of its direct impact but for broader health care. It is a highly important area in health care. There are synergies between what dentists do, what they can advise on, the way they can assist, treat and care for their patients, and other areas of primary care. I regard this as important and I agree with Deputy Ó Caoláin in this regard.

Deputy Kelleher raised the issue of medical cards initially and Deputy Healy referred to it as well. A written response to Deputy McLellan deals with the issue of medical cards being granted to people on medical grounds. At the risk of annoying the committee or irritating people, I believe it is important to point out that our system awards medical cards on the basis of material circumstances. That is the system we have had since 1970. The entitlement to a medical card is based on an assessment of whether the individual can provide for his care other than with undue hardship, the phrase used in the Act. Sometimes it sounds rather harsh when I give the response that it is all to do with material circumstances. Naturally, there is a concern for people who become ill quickly and people who get cancer or other illnesses and there is a concern that they should be cared for and dealt with in a sensitive way. However, the system we have awards medical cards on the basis of material circumstances and income. That is the position. There is, however, a discretionary medical card application system. I wish to respectfully disagree with Deputy Kelleher, who suggested that it has ground to a halt or that it is not working. That is not so. There are more than 59,000 or almost 60,000 live discretionary medical cards in the system at the moment and approximately 20,000 general practitioner visit cards granted on discretionary grounds live in the system.

It is a difficult area. There has been some debate about this in the media in recent days. Sometimes in the debate on this issue there is a public expectation or belief that medical cards are habitually granted on the basis of medical condition but they are not. Perhaps there could be a debate on whether that should be so, but that is the system we have. We have a centralised system, the primary care reimbursement service. I am a Deputy as well as a Minister of State. We all hear responses to particular cases, including some particular and genuine hard cases, but the fact is that the system is working well. It has become a little more technocratic and sometimes bureaucracies appear harsh but I believe it is working rather well.

In circumstances where there is an application for a discretionary medical card, as we indicated to Deputy McLellan in the written response, the medical officer considers the medical condition and the financial circumstances of the applicant on a case-by-base basis. Great care is taken in these applications and I believe it is done in a sensitive way.

Deputy Healy asked a question about where an assessment is being made for continued eligibility for a medical card and he said that people were being written to. I support the HSE in doing this and I will explain why. I want to ensure we maintain the resources we have for the people who need them and for the people who qualify for them, a view shared, I imagine, by everyone in this room. We have constraints on resources. The Minister for Health, Deputy Reilly, is absolutely right. We have extended tens of thousands more medical cards in recent years and I have no quibble with that. People have found themselves in particular circumstances in which they need a medical card and they get a medical card, but the resources we have should be kept and preserved for when they are needed. There are circumstances in which people qualified for a medical card for a period but then their circumstances changed. If that is the case then-----