Mr. Shaun Flanagan:

Effectively the Keane report boiled down to the fact that it is very challenging to award medical cards on anything other than a means basis with discretionary awards because - this wording may sound clumsy so I apologise if it does - the alternative almost involves asking who is in the worst case position vis-à-visdifferent conditions. My memory of the Keane report was that it almost advised against awarding cards on the basis of medical conditions and felt that notwithstanding all its challenges, means testing was ultimately a reasonably fair approach. Means testing is fairly intrusive. We recognise that it is not a pleasant process for anyone to go through. We try to make it as fair and compassionate as we can. In the round, it comes down to means testing being probably the fairest approach. I am a pharmacist by training and my understanding is that a lot of health issues are related to people in lower socioeconomic groups who have less income so there is an alignment. You are targeting medical cards towards the communities that need them most.

Since then, we have tried to make the discretionary part of it more sensitive and take learnings from the Keane report. There have been three clinical advisory groups since then. We have a communications working group that works with stakeholders such as Citizens Information, the Irish Hospice Foundation and the Irish Cancer Society and we try to listen to what people are telling us. The regional health forums play a part as do engagements here. We try to improve and standardise some of the discretionary bits. We have developed a burden of illness questionnaire that enables us to capture costs that may not be as obvious on the initial medical card application form. It allows us to find those people who really should have a medical card where it is not as clear during the first look at their income and outgoings so we try to standardise our burden of illness process around that.