Éamon Ó Cuív (Galway West, Fianna Fail) | Oireachtas source

The first question I have is to seek information. Some like to go to support workers of their own sex when seeking advice and so on. Are there many more women than men acting as Traveller-led support workers? I suspect so. Is it working better with women? Do we need to ensure more men are engaged as support workers to get men to engage? I do not know the answers; I am taking the questions out of the sky. Obviously, we want to get all Travellers to engage with the health services. Is there a disparity between the number of women engaging and the number of men engaging through Traveller-led services? Is there a disparity between the number of women leading the services and the number of men leading them? We need to examine this. The delegates might tell me whether this is an issue.

I always believe in taking something positive from any meeting. Many very interesting issues can be raised, and many good suggestions have been made. I wish to focus on an issue that keeps coming up, namely, the bureaucracy encountered in gaining access to a medical card. The medical card office is the most unforgiving in the country for anybody dealing with it. It is utterly unforgiving. If one does not answer a letter within a 28-day deadline, one must start all over again on the 29th day. People lose heart as a consequence. Those who are most remote from the system lose heart fastest.

I am interested in getting a little more feedback on the number of Travellers who are issued with letters but who do not act on them because they have moved on or who throw them aside because they are removed from the system. Many people, including settled people, throw them aside also. The more removed a person is from the system, the more likely it is that the letter will be thrown aside as a bother and will be forgotten about. In such circumstances, a person will go to the general practitioner only to be told the card has expired. How significant is this issue?

I will go through all my questions. The second issue I wish to raise concerns the statistics we have been given. They indicate that 13% of Travellers finish secondary school and that 57% of male Travellers only get a primary education. Ordinary literacy skills, such as reading and writing, are an issue. We all come across this. The older the cohort, the greater the issue. It matters when trying to fill out a complicated medical card form and such documentation. Is there information and evidence indicating people simply give up?

I do not believe this has just to do with ordinary literacy skills. We often ignore what I call bureaucratic literacy skills. This involves a higher level of skill. I know a Department that made a very clever move in this regard. Where a form was developed on one side of the Department, clerical officers or executive officers on the other side were asked whether they could fill it out without knowing what it was about. If, with their bureaucratic literacy skills, they could not fill it out, it was no good giving it to a member of the ordinary public, or even a member of the public with third level education.

I wonder to what extent there is a problem with the two levels of literary skill. I refer, in particular, to what I call the bureaucratic literary skill, that is, for form filling and so on. I have been contacted by all sorts of people who find filling forms to be increasingly challenging. To what extent is accessing documents a problem? The volume of documentation required nowadays for the simplest tasks is frightening. I spent a fair bit of time yesterday with somebody who wanted a supplementary grant for a house. The person is a Traveller who was trying to provide information. It seems that the system is more concerned with catching one person who might get something he or she should not get than the 1,000 people who might have got that to which they were perfectly entitled but just could not get the paperwork together. Society seems to have become rigid in that regard.

I do not know how many people have studied the medical guidelines, although they may have done if they deal with medical cards. There are two ways in which one can obtain a medical card, the first of which is according to strict financial guidelines. I heard a case yesterday of a 65 year old who happens not to own their own house. A Traveller could own a caravan, however, and would have no rent. The guidelines, even for those over the age of 65 years, specify maximum weekly earnings of €298. Even on jobseeker's allowance, the basic rate is higher than that. I am sure our guests will tell me that without means, one can obtain the card on a concession, but the guideline figures are very low. The normal ways they help people are with mortgages; rent, although if one has a caravan, that does not count; and childcare, although in some cases the parents take care of the children and do not pay for commercial childcare. The only other way of obtaining a medical card is in the form of a discretionary one, but the applicant will have to be good with a pen to know what is an eligible expense for a discretionary card. I am highlighting the barriers.

When we take it all together, to what extent is the medical card challenge an issue? One receives a nice little plastic card with a date on it. If a credit card has a date, I know that it will be good until then. In the case of a medical card, however, it might specify an expiry date of 2021 but halfway through 2019, I might be told I will be called for a random check. How much of a help would it be if the cards were issued for five years and the expiry date was the expiry date, unless one could be proven to have defrauded on a massive scale one's entitlement to a medical card? As the man says, the medical card is not worth all that much.

The issue of Traveller self-identification was raised. The concept is nice but I can see the layers of bureaucracy that will apply. There are two problems with self-identification, on which I would like our guests' views. People do not necessarily want to self-identify. Some do but others do not. Some are proud but others are not. Some feel cowed because of what life has taught them. The other point is I can imagine the HSE adding another five pages to the forms to tie one up in that regard.

If our guests consider some of the issues I have raised to be valid, would it be worth our while asking the medical card section to appear before the committee and take a grilling on the issues? That is my punchline. Are our guests facing such issues and if so, should we present those issues to representatives of the medical card section? I am sure our guests could raise other issues.