Mr. Tony O'Brien:

The immediate reaction is that this is a simple response to the fact that some medical cards held by patients, whether granted on a discretionary basis or otherwise, are being withdrawn following review. The response to this is understandable and there seems to be a general view that the medical card scheme should operate on the basis that where certain medical conditions exist, medical cards should be granted. However, as we explained earlier, that is not the way the medical card scheme operates.

The guidelines on how we apply discretion have not changed, but over the years there have been some changes to the primary qualification process for medical cards. This obviously has an impact on the discretionary guidelines above that. However, the primary change has been that the centralised process, the consistent application of the guidelines and an active process of review have led to a situation where a significant number of medical cards held previously are no longer held. Individuals have significant concerns about the impact on them and have expressed those concerns and society in general and the media are reflecting the concern that results from that.