Ms Celeste O'Callaghan:

I am pleased to have the opportunity to update the committee on the medical card scheme. I am joined by my colleagues, Ms Emma-Jane Morgan, principal officer, eligibility policy unit, Mr. David Noonan, principal officer, GP services, Mr. Finian Judge, principal officer, community pharmacy, dental, optical and aural policy unit, and Dr. Dympna Kavanagh, chief dental officer.

Eligibility for health services is determined in accordance with the 1970 Health Act. The Act provides that if an individual who is ordinarily resident in Ireland is deemed unable, without undue hardship, to arrange GP medical and surgical services for him or herself and his or her dependants, that individual is considered to have full eligibility and receives a medical card as evidence of that. Guidelines are in place relating to the income level at which undue hardship would be expected to arise. People whose income is assessed by the HSE as being at or below the thresholds receive a medical card. This system of financial means assessment is considered to offer an objective and equitable approach to determining eligibility, ensuring those with the lowest level of means in society can access healthcare when needed. More than 1.5 million people currently hold medical cards and the vast majority of these are awarded on the basis of a financial means assessment. However, it is recognised that only looking at a person's income level might not provide a full picture of hardship, so where a person's income might be above the thresholds, if there is a significant cost or burden associated with his or her illness, that person may be awarded a discretionary medical card on the basis of undue hardship.

The provision of medical cards for those who are at the end of life is a particular situation where cards are provided on a discretionary basis. Until recently, these cards were provided for individuals who were considered to have a prognosis of up to a year. A clinical advisory group was established by the HSE in 2019 at the request of the Minister to consider the issues arising in extending medical cards for those with a terminal illness. The report was published in November last year. The group included both clinicians and patient representatives, and its report made a number of findings and recommendations. In particular it affirmed that patients in the last 12 months of life are likely to have significant medical needs and to face undue hardship if they do not have a medical card. It also found that patients with a longer prognosis may have medical needs, but those needs might not be at a level that would satisfy the legal test of undue hardship. It identified that estimating a prognosis is challenging and becomes more accurate when an individual's expected timeframe is, sadly, shorter. The report also recommended that if the current prognosis timeframe were to be extended, it should be undertaken on the basis of legislative change rather than via the current discretionary process, but it also found, however, that developing a definition for that purpose would be challenging. Following on from the report and related Government decisions, the Department is working on the development of legislation to underpin that extension but in the interim an administrative extension to award medical cards to people with a prognosis of 24 months or less has been implemented this month.

Legislation was enacted in 2020 to extend free GP care to children up to the age of 12. In terms of considering a date for commencement of the measure, it is important as always to ensure that an expansion of free GP care does not limit the capacity of general practice to meet the needs of all patients in the community. That is particularly important at this time given the impact of the pandemic in terms of increased demand on GPs. For that reason, a suitable commencement date remains under consideration.

The Health Act 1970 requires the HSE to make dental treatment and dental appliances available for medical cardholders. These services are provided under the dental treatment services scheme, DTSS, by independent private dentists contracted by the HSE. The Minister has acknowledged that the DTSS has not kept pace with today's preventative approach to dental intervention and he is committed to a root-and-branch review of the scheme. A new national oral health policy was launched in 2019 and provides the policy context within which a review of the DTSS would be undertaken. However, the pandemic and the immense disruption it caused to the work of the health services and of the Department of Health has caused the roll-out of that policy to be delayed and the proposed contract review to be deferred. The Minister has acknowledged the challenges that contracted dentists have faced during the pandemic and the efforts of the dental community in continuing to provide services in a challenging environment.

He accepts that the profession has concerns about the current contract and is keen to ensure the sustainability and viability of contractual arrangements in order that all eligible persons can continue to receive the services to which they are entitled from their local dentists.

In conclusion, overall, the range of measures in place, including those that have been introduced in recent years to expand access to medical cards and GP care, means that today, 2.1 million people, or just over 42% of the population, have access to free GP care. While every effort is made to ensure the medical card system is responsive to those who need it most, as challenges arise, and they do, the Department will continue to work in collaboration with the HSE to address these.

I thank the committee. I am happy to address any questions members may have.