Mr. Peter Tyndall:

In the majority of cases. It is impossible to say how the original decision was taken. Therefore, it is difficult to see whether there is something in the new decision that was not taken into account previously because we simply do not know what was taken into account previously.

There are other aspects of the work of the HSE in dealing with discretionary medical cards that I have addressed in my notes. Clearly, the failure to place detailed explanations on the files as to why discretion was not exercised is a concern. We have obtained agreement that they will now be included, although the review has been suspended. However, we obtained agreement and they were being included prior to the suspension of the review. That is in the nature of the recommendations we made that were accepted.

The reason people are going to Oireachtas Members rather than to us is they probably realise some of the changes do not relate to process. Clearly, discretion was being exercised in different ways in different parts of the country and when the process was centralised and a more a rules-based way of doing it was applied, inevitably some people who had been awarded medical cards in the past were not awarded them. Our role as an office is simply, first, to look at whether this complies with the legislation and, second, whether it is fair. That goes beyond whether it complies with the legislation.

We had concerns that the way in which discretion was being exercised was too rigid. From an Ombudsman's perspective, if people choose not to exercise discretion in every case, that will be classed as maladministration, even if it is not in breach of the legislation. There is discretion which should be exercised in the way the Deputy described in looking at hardship because, as she said, the people concerned were above the income thresholds.

Those are the kinds of issues that we raised. Some of them relate not to how the scheme was being administered but to people's concerns about whether the criteria, which are purely income based and hardship based - it was felt that further pressures on people's financial situation should be looked at - were the appropriate ones. Those have been properly pursued in another domain and will, I am sure, continue to be vigorously pursued in the weeks and months ahead.