Ms Anne Marie Hoey:

I thank the Chairman and the members of the joint committee for inviting us to attend today's meeting. The Primary Care Reimbursement Service and national medical card unit delivers a wide range of primary care services across 12 community health schemes, including the medical card scheme, to a population of over 3.66 million. These services are provided by more than 7,000 primary care contractors and involve 77 million transactions, with an associated expenditure of €2.397 billion, each year. As of 1 December last, some 1,729,000 medical cards and 409,000 GP visit cards were in circulation. Since 1 December 2005, there has been an increase of 573,273 people with eligibility under the GMS scheme. This represents an increase of 33.2% on the 2005 level. Since 2011, the national medical card unit has provided a centralised medical card assessment and processing service. This enables a single uniform system of medical card application processing. The unit replaced the different systems that previously operated through more than 100 offices across the country. It enables a streamlined and standardised work process and ultimately ensures a more consistent and accountable medical card processing system.

It is important to note that the administration of the health service requires achieving a balance between ensuring those who meet the criteria for full or limited eligibility under the GMS scheme receive their medical cards or GP-visit cards in a timely manner and are treated in a sensitive and compassionate manner at all times, and ensuring there are processes and controls in place to ensure there is robust accountability for the expenditure of public funds. In the summer of 2014, the HSE commissioned two reviews: the medical card process review, which was undertaken on behalf of the HSE by Prospectus-Deloitte; and the report of the expert panel on medical need for medical card eligibility. Both reports were publicised in November 2014 by the Minister for Health, Deputy Varadkar, and the Minister of State with responsibility for primary care, mental health and disability, Deputy Kathleen Lynch.

I will confine my opening remarks to a short update on the progress in implementing the recommendation of those reports. This will be of particular interest to the committee. The recommendations contained in the reports fall broadly into a number of key areas, the first of which relates to communications. During 2015, the national medical card unit has engaged in communications to gain a full understanding from our customers of their experience of making an application for a medical card. A randomised survey was undertaken in June involving 900 customers who had made applications for medical cards in the previous 12 months. Some 75% of those surveyed were granted eligibility and 25% of them were not.

The overall summary of the responses demonstrated a very good level of satisfaction with the service. The majority of respondents, regardless of their outcome, found the information on the medical card website appropriate and helpful. Respondents found the advice they got from local health offices supportive and found their telephone interaction with the national medical card unit, NMCU, to be very good. The survey found that 86% of applicants completed their application form without assistance. Of those who required assistance with the application process, 14%, the main sources of assistance was the HSE local health office, the GP surgery, the public representative's local office or by direct contact with the NMCU contact centre at lo-call 1890 252 919.

In responding to the findings of the customer survey and the national medical card process review report, the NMCU has commenced a further series of briefing sessions on the medical card scheme with public representatives and their staff, local health office staff, medical social workers and allied health professionals within the acute hospital groups and with GPs and their staff. These briefings will continue throughout the country in 2016. Briefing sessions have also been undertaken to date with a number of other stakeholders, including each of the four regional fora and the national patient forum. The findings of the customer survey will inform the development of a strategy for the NMCU which will be finalised in the first quarter of 2016 following a public consultation process.

The second area I want to touch on relates to the medical card application process. The medical card process review report of 2014 made a number of recommendations to improve the processing of medical cards at the NMCU. In implementing these recommendations, the NMCU has carried out a review of the processing of medical cards at all stages using a Lean methodology, and the NMCU continues to implement recommendations arising from this initiative. The unit has introduced real-time analytics to enable the unit to manage effectively the throughput of applications and amendments required by applicants to their applications, which can include change of doctor and the addition of new babies, and we receive up to 19,500 pieces of post per week. The NMCU has developed a quality control division, undertaken continuing training and development of its staff, and extended its utilisation of information technology through initiatives such as an online registration process for GP-visit card schemes and the internal scanning of customer documentation.

On information technology, our ICT systems are continually being improved and refined to support the processing of medical card applications. The NMCU has initiated two major ICT-based projects to be delivered in 2016. The first of these is an enhanced online application system whereby applicants will be able to apply online and attach any supporting documentation required. The turnaround time for applications received online will be enhanced. This service development will significantly improve the overall experience of customers. The second project relates to the enhancement of the interface with the Department of Social Protection in regard to payments made by that Department to medical card applicants, obviating the need for customers to provide details of Department of Social Protection payments with their applications in future.

On the clinical advisory group, CAG, following a recommendation in the report of the expert panel on medical need for medical card eligibility to consider medical conditions and their prioritisation or suitability for medical cards, the CAG was established by the director general of the HSE in January 2015. The group is working on developing an assessment approach to support the existing medical card application process which will enable the medical officers and deciding officers at the NMCU to gain a more comprehensive understanding of the burden of illness on an individual or a family. This refinement is being tested and validated with customers with a view to it being recommended to the HSE in the first quarter of 2016. Since September 2014, the number of medical cards awarded on the basis of the exercise of discretion has risen from 71,222 to 95,887 on 1 December 2015. Eligibility awarded on the basis of the exercise of discretion is currently not reviewed, pending advice from the clinical advisory group.

Further recommendations from the report of the expert panel have been implemented, including the granting of a medical card and a GP-visit card to the individual with the index condition only in the family. Eligibility granted to applicants certified clinically as being terminally ill is no longer subject to an eligibility review. Medical cards for children under 18 with a diagnosis of cancer and where a means test is not conducted were introduced in July of this year. Three further new schemes were introduced at the NMCU in 2015: the GP-visit card scheme for children under six, the GP-visit card for people over 70, and eligibility in accordance with the Redress for Women Resident in Certain Institutions Act 2015. A user-friendly online registration system is available for the GP-visit card scheme for children under six and the GP visit card for those over 70. To date 204,251 children and clients have registered for the under-six scheme and 47,594 people have registered for the GP over-70 scheme.

I thank the committee for its continued support of the HSE’s efforts to improve the medical card system. I and my colleagues will endeavour to answer any questions the committee may have.