Dr. Ray Walley:

Senator Burke has said that. The IMO appeared before the health committee four years ago in March 2010. We spent a year and a half advising there was a problem with medical cards and we found it very difficult to get engagement but thankfully, the Oireachtas committee invited us to come to a meeting. We had a 17-point plan much of which was applied and improved. The HSE-PCRS envisaged that we would replace them in registering medical card-holders. If we are doing their job we cannot do our own job. We are a scare resource. In the case of children, because we were finding that it was constraining us in immunising children as children in deprived areas were not being registered, we were able to register the child but we informed the HSE-PCRS that we would only do so with the minority of children rather than the majority because, ultimately, that is the role of the HSE-PCRS, the reason it exists and it is its job. We asked for certain other things, such as that there would be a responsible service for the homeless and more responsible provision of services for cognitively impaired persons.

I note that one of the promises - we will see if the promise is maintained - is that there will be possibly a named person to deal with a cognitively impaired person. That did not happen four years ago. If we are aware that somebody is being assessed we can certainly extend the medical card. Many of these people who are cognitively impaired are aged over 70 and they are on income assessments. We are not necessarily aware whether this is the case. However, our job is to address the position of the minority and the seriously compromised individual. It is not a small number as it is happening in the case of tens of thousands of people. We have asked that the HSE-PCRS err on the side of safety whereby it asks the GP - this formed part of our submission four years ago - whether there is any reason the person should not lose his or her medical card, having made its decision that the person should lose the card. However, they did not do that. There is no reason that this cannot be done.

We do not have the resources to monitor what the HSE-PCRS does. I returned from the UK in 1998. Sixteen years later, the difficulties with medical cards have not been resolved because ultimately, I am afraid, it is like trying to nail down a cat - one cannot get an answer as to what is happening. The system for registration of medical cards has always been flawed because it is not patient-centred. Those administering the system do not err on the side of safety. A number of years ago I had six patients who were cognitively impaired. I had to threaten to report them to the elder abuse officer because I was fed up with the fact that they were losing their cards. Unfortunately, that worked and those people were given extended medical cards.