Séamus Healy (Tipperary South, Workers and Unemployed Action Group) | Oireachtas source

I welcome the HSE representatives and thank Ms Hoey for her presentation. As the public representative with the highest number of contacts with the medical card unit, I wish to compliment the staff there. They are always courteous and helpful and that applies across the board. As a former public servant and as a trade unionist who represented public servants for more than 30 years, both locally and nationally, I would expect no less.

This service should never have been centralised. It is uniquely appropriate that this service would be locally based. The public, applicants and their representatives should be able to have face-to-face access to officials dealing with the applications. This is the biggest difficulty with the current system. There is no method for an applicant or anyone acting on behalf of an applicant to have direct contact, be it face to face or over the telephone, with the official dealing with an application. This should be possible and, if available, would solve a huge amount of the current problems affecting the system. Is this being considered by the HSE?

I welcome the clinical advisory group and the examination of the burden of illness on an individual or family. The issue of applications for a discretionary medical card on the basis of medical need has been difficult from the beginning. There is no doubt the situation has improved but this area of the system needs to be dealt with urgently. I would like to see the proposal being brought forward sooner rather than later. It is still one of the areas in the system which is particularly difficult for applicants and their families. Currently, when dealing with the renewal of a medical card, a review form is sent to the medical card holder. It would be helpful if a medical certificate could be forwarded with the review form where the application was granted previously on a discretionary basis given the medical need. This would short-circuit the need to send the certificate later and avoid further delay.

The system whereby cards are made available to individuals with a terminal illness is working well but it can give rise to difficulties for applicants, their families and some doctors who do not wish to certify an illness as being terminal. The situation could be helped by having direct personal contact between GPs or individuals acting on behalf of applicants and the person dealing with an application. This has occurred in the past because I have been involved in such cases. I was able to speak to officials and the process was accelerated and the applications in question ultimately proved successful. This contact is vitally important and its availability needs to be widened.

There appears to be a difficulty in terms of the self-employed, particularly those with small incomes. The delegates may not have an answer to my question today but they might revert to the committee with it. I understand the HSE takes one view but the Revenue Commissioners take another one and, to date, the twain have not met. The Revenue Commissioners say the form 11 is a single-sheet form but the HSE say it is a multi-sheet form and we have stalemate. Perhaps the delegates will examine the issue and revert to the committee on it.

I understand the unit gets 19,500 items of mail per week but I receive regular complaints about information not being received even though they have been sent by registered post.

What is the situation in that regard?

Like Deputy Ó Caoláin, my understanding is that thresholds have not been increased since January 2006. They need to be reviewed.

We raised the question of refunds for the taking of bloods by general practitioners, GPs, with the former Minister for Health, Deputy Reilly, who solved the problem and medical card holders who were charged for the taking of blood by their GPs were refunded. That seems to have come to a halt again. Could that be clarified?