Seán Haughey (Dublin North Central, Fianna Fail)

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. In assessing eligibility, the HSE uses guidelines based on people's means, which includes their income, certain allowable outgoings and the effect of other factors which may impact on people's ability to meet the cost of general practitioner, GP, services for themselves and their families. Notwithstanding the above, the HSE may issue a medical card on a discretionary basis if the applicant would otherwise be caused undue hardship in providing general medical and surgical services for himself or herself and any dependants. The executive takes all medical issues into account in determining whether undue hardship exists.

If a person is refused a medical card and is not satisfied with the decision, he or she may appeal the decision to the appeals office of the local HSE area. The office will conduct a reassessment of the application. This reassessment is conducted by HSE staff who were not involved in deciding on the original application. If the applicant is still not satisfied following the appeal, he or she may contact the Ombudsman's office.

The HSE has produced national medical card-GP visit card assessment guidelines for its staff. These are regularly updated to provide a clear framework for decision makers to assist them in making reasonable, consistent and equitable decisions when assessing people under the General Medical Services, GMS, scheme. As part of the HSE's ongoing programme to provide a more responsive and cost-effective service, the HSE is centralising the processing aspect of medical card applications to its facility at the Primary Care Reimbursement Service, PCRS, in Dublin. Under the centralisation plan, the HSE's local offices will continue to provide the public with assistance and information locally in respect of medical card eligibility and making an application. They will also provide information on the current status of their applications or reviews.

In June 2010, the HSE introduced a new website - www.medicalcard.ie - which enables people anywhere in the country to apply for a medical card through a simple and efficient application process. As the centralisation process continues, more initiatives will be introduced. The current initiatives will continue to be enhanced as the HSE receives feedback and continues to engage with advocacy groups, staff, public representatives and primary care contractors.

The HSE has advised the Department that there is no general policy in place that requires all applicants in the Kildare-west Wicklow area to provide sworn statements in support of medical card applications or appeals. In cases where an applicant cannot produce evidence of income, a sworn affidavit can be useful to progress the application more speedily because it can be difficult, in certain occupations, to establish the applicant's income. I understand the HSE has been advised by its legal advisers that it is difficult to apply legal recourse where a statement countersigned by a Peace Commissioner is subsequently found to be untrue. Therefore, an affidavit sworn before a Commissioner for Oaths is a more compelling document when produced in support of an application.

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