Mr. Tony O'Brien:

A cultural issue. It is manifestly clear that there is a commonly held belief that discretionary medical cards have been granted, should be granted or are granted in the context of the mere existence of a medical condition. This is a widely held perception which is only really being challenged now in terms of the public understanding of it. Indeed, this perception has been reflected to some extent during these proceedings. It also seems clear that there is a widely held misconception to the effect that because these cards - like credit cards - include an expiry date, once one qualified when one applied, one has an entitlement up to that expiry date. By means of the centralisation, standardisation and communications processes, we are clarifying what constitutes true eligibility. We were asked earlier about the cost-benefit balance and the amount of resources we invest. In circumstances in which we genuinely do not believe - unless a barn-door case appears - that there is any prospect of being able to prove that someone set out, with criminal intent, to falsely obtain a medical card, we do not take action. The resources we would be obliged to allocate in order to follow up every instance in which a person is identified as having held a medical card when it was clear that they should not have had one would be completely disproportionate to the benefit. Our resources are much better deployed in ensuring that medical cards are held appropriately. Where they are not so held, it is probably because someone has exceeded the threshold probably without even realising it. At that point, we end their eligibility.

As we move forward with the process and reach a point at which we expect that people should have a better understanding and at which we have communicated with them clearly, we will be seeking to do two things in circumstances in which we can prove retrospectively that someone has falsely obtained a medical card. The first of these is to ensure that the matter is referred to the appropriate authorities with regard to the offence committed, in respect of which there is a small fine. The second is that in the context of the greater amount of money involved - namely, the cost to the public purse through capitation fees, free entitlement to medications, etc. - in providing that medical card, we might well be in a position to consider taking civil action to recover that cost.

We do not believe that we have got to that point yet.