Robert Dowds (Dublin Mid West, Labour) | Oireachtas source

I am due to speak on the Local Government Bill in the Chamber. I have one question about discretionary medical cards. I note that approximately 5.5% of medical cards are awarded on a discretionary basis. Mr. O'Brien gave some explanation as to how the HSE decides on discretionary cards. This issue was raised at my party's parliamentary party meeting and there was considerable anger expressed by certain Deputies over the fact that those decisions on discretionary medical cards were not made locally because at a local level people can be much more aware of the actual situation of the individuals and families concerned. A further note of anger which I want to convey to the witnesses is that when dealing with the office in Finglas which makes the decisions, it is not possible to deal with the same person when discussing an ongoing case. It would be much more satisfactory if the process is being administered centrally that at least one was able to deal with the same person on any subsequent discussion. This is part of the same issue. Could such decisions be made at local level? If they have to be made at central level, could one at least be able to deal with the same person rather than have to deal with different people all the time? One of the problems of centralising everything is that the patient is faceless. That is one of the biggest problems with public service and the Civil Service, that if one is not dealing with people on a face-to-face basis, it is very easy to forget that they are human beings.