Ms Laverne McGuinness:

The first thing to note about the medical card issue is that we now have the highest number of medical cards that we have ever had. There has been a 75% increase in medical cards since 2005. Now, we have 2 million people covered by our medical cards and general practitioner visit cards, which amounts to 44% of the population.

As the Minister of State, Deputy White, stated, to get a medical card the assessment is, in the first instance, a financial assessment. If a person or a family qualifies under the income guidelines they will be granted a medical card. If they do not comply with the income guidelines and if they have got a medical condition whereby additional expenses would be incurred or where there are other social factors - it does not necessarily have to be medical factors that are taken into account - they can apply for a medical card on a discretionary basis.

The assessment is carried out by a team of doctors headed up by one of our public health doctors, Dr. Johanna Joyce. The team is empathetic and applicants are listened to compassionately. If additional information is required the team will engage directly with the applicant. It is not a case of being marginally over the threshold, as one might think. All factors are taken into account, especially the outgoings in respect of the particular medical condition. If that is the case then the applicant would be granted a medical card.

Deputy Ó Caoláin referred to cases involving the terminally ill. There are special circumstances whereby if someone is terminally ill and we learn of it, then within a short period of 24 hours of confirmation of that by the medical doctor we can grant what is known as an emergency medical card. The emergency medical card can be automatically granted. I am using the word "automatic" because it means there is no financial assessment if it is confirmed that a person is terminally ill. These cards are usually issued for a period of up to six months. That is different to a life-limiting case. Life-limiting relates to a longer period. Applicants with life-limiting conditions can apply under the discretionary process and if there are significant medical costs and if the family in question are over the financial guidelines, then they would be so granted a card. There is no automatic entitlement because there is no list to state an applicant will automatically qualify for a discretionary medical card or emergency medical card. There are exceptional circumstances in respect of emergency medical cards as well, for example, if a person is homeless, but we still have to confirm the financial position in such cases. The difference applies to those who we know are in an end-of-life state and in such cases a card is issued for six months and no regard is taken of their financial assessment. That is really the distinction.