Róisín Shortall (Dublin North West, Labour)

I thank the Deputy for raising this matter. I, too, am very dissatisfied at the level of service being provided for the public by the HSE in respect of medical cards, especially renewals. I am engaging on an almost daily basis with the HSE to get to grips with the problem. The indications are that as a result of changes made in recent weeks, there is an improvement, but there is still some way to go. What has been happening in recent months is unacceptable and I hope it will come to an end shortly.

As the Deputy is aware, medical cards are provided for persons who, under the provisions of the Health Act 1970, are in the opinion of the HSE unable without undue hardship to arrange general practitioner, GP, services and other health services for themselves and their dependants. The assessment for a medical card is, therefore, determined primarily by reference to the means, including income and expenditure, of the applicant and his or her partner and dependants. Under the legislation, there is no automatic entitlement to a medical card for persons with a specific illness such as cancer. There is, however, a provision for discretion for the HSE to grant a medical card in cases of "undue hardship" in which the income guidelines are exceeded. The HSE recently set up a clinical panel to assist in the processing of applications for discretionary medical cards where there are difficult personal circumstances.

With regard to the fast-tracking of medical card applications for certain categories, it is important to point out that the HSE already has a system in place for the provision of emergency medical cards for patients who are terminally ill or seriously ill and in urgent need of medical care that they cannot afford. Emergency medical cards are issued within 24 hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. This can be initiated through the local health office by the office manager who has access to a dedicated fax and e-mail contact within the primary care reimbursement service, PCRS. As a result, there are no plans to establish a new unit.

While stressing that these arrangements are for cases of emergency only, it is necessary to better publicise these arrangements and I have asked the HSE to put together an information pack on these and other procedures for the public, health care professionals and Members of the Oireachtas in order that emergency cases can be dealt with properly and in good time. I am not sure why social workers in the local offices would not be aware of this facility. They certainly should be.

With the exception of terminally ill patients, the HSE issues all emergency medical cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual, with a limited eligibility period of six months. The arrangement is slightly different for persons with a terminal illness. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure the person receives the medical card as quickly as possible.

If there are specific details in the case of patients with a terminal illness, it is important that they be brought to our attention. As I said, there is a facility in place to deal with this issue, although it is not sufficiently well known. I am insistent on there being a very fast turnaround in such circumstances.

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