Mr. John Hennessy:

-----but do not qualify now when there does not appear to be any significant change, certainly in medical circumstances even though there can be changes in financial circumstances which need to be taken into account. That relates to an earlier point that all cards are subject to review. All cases are subject to review and there are actually changes in circumstances that are taken into account by deciding officers and by the medical officers who are examining the cases on a case-by-case basis.

What has changed? In the pre-PCRS time, we had a lot of local schemes being administered, by and large, on a stand-alone basis, for which we came in for very heavy criticism from the political system and the Ombudsman at the time. There was a sense of bewilderment at how somebody could get a medical card in Cork but not in Kilkenny or in Donegal, but not in Wexford. We had to deal with that, which we did, in a way that established a standard consistent system of application with a single rule set and a process for assessing hardship in a consistent manner with standard operating procedures - essentially, all of the good practices one would expect in a statutory national scheme from a public body. We now have that in place.

The consequences of that change are throwing up the type of cases to which the Deputy referred. As I said, thankfully, the number is quite small. We are working with each of those to try to provide supports around them. One of the things that became very clear to me from talking to the medical officers is that they actually take into account the fact people qualify for other services, such as the long-term illness card, and supports under the Disability Act, which can be quite significant, in some instances, for people, irrespective of whether they have a medical card.