Mr. Tony O'Brien:

In regard to the issues of discretionary medical cards and the fair deal, on which I will ask Mr. Healy to comment, as we made clear in this committee, and at the Committee of Public Accounts previously, there is only one type of medical card. It confers one set of eligibility. The discretionary medical cards granted on discretionary grounds build upon the primary entitlement. Entitlement is not based on medical condition but on financial hardship and in the case of discretionary medical cards we take into account, with input from medical assessors, the costs that arise from a medical condition. The overall financial means of a family is still the fundamental building block. The only changes that have occurred, as per budget 2012, are that certain allowances in relation to weekly travel to work and the cost of home improvement grants became disallowed. The second change which occurred in recent years is that whereas decisions related to discretion were essentially all local decisions effectively, á la the former health board structure, with centralisation a consistent single set of rules apply. Those things combined can have the effect, together with the family circumstances, of meaning that while people's medical circumstances have not changed their entitlement to a discretionary medical card may have.

We are also conscious that the medical card is sometimes more valuable as a passport to other services than it is in terms of its primary design purpose which is access to GP care and medication. As the Minister referenced, we are looking to see – in particular with regard to those with long-term needs in the 0 to 18 category – what we might do to address those other things which were accessed through the passport rather than the direct purposes of a medical card. I will ask Mr. Healy to address that as well as aspects relating to the fair deal.