Róisín Shortall (Dublin North West, Labour)

I thank the Deputy for raising this issue as it provides me with an opportunity to report on what is taking place in the processing of medical card applications. Members will be aware that a decision was made some years ago to centralise the processing of all medical card applications. This was to be done on a phased basis. Last July a decision was taken by the HSE to centralise the records of the country overnight. I took the view that this was an unfortunate decision. The mistake was to do it overnight rather than to phase it in and build capacity. We have spent a good deal of time since dealing with the fall-out of that decision and trying to resolve the issues that have arisen.

For the first time in the State's history, a single, uniform system of application processing has been put in place. This system replaces the various systems previously operated through more than 100 local offices throughout the country. Among the changes introduced are the online service on the www.medicalcard.ie website and the standardisation of medical card assessments. Ultimately, the new arrangement should provide for a more accountable and better managed medical card processing system. I am aware, however, that there have been many serious difficulties with the centralisation project which have given rise to a large backlog and long delays for both new applicants and medical card renewal applicants. Several factors have given rise to these problems, including the processing of medical card applications being centralised before the necessary resources were in place. That was the key mistake made. The system was not geared up to deal with the significant increase in volume. There was already a significant backlog prior to centralisation. There has been poor communication with medical card applicants and the public. There has been limited support from local health offices and poor communication between local offices and the centralised system. Poor practices and procedures in the handling, filing and processing of medical card documentation have been a feature of the system. There have been problems across the board.

These issues were a source of serious concern for me and I held several meetings with the HSE during the past six months to express my concerns. As a result, the HSE has introduced several changes to the administration of the medical card application system in recent months. These changes include increased staffing levels in the centralised processing service to the full complement; improvements to the way medical card renewals are assessed and the frequency with which they are assessed; increased flexibility for GPs to add certain categories of patients to their GMS list; and the fast-tracking of backlogged cases and cases in which documentation has been misfiled.

I emphasise that in no circumstances should a medical card holder who genuinely engages with the review of his or her medical card have his or her entitlement withdrawn before the review is complete and a decision made. Some such cases were brought to my attention and these occurrences are unacceptable. The HSE is taking steps to ensure this rule is properly implemented.

While several customer service and communication issues remain to be addressed, the HSE has made significant progress in eliminating the backlog and preventing further backlogs from occurring. I am pleased to note that a backlog of 58,000 applications from last year has been completely cleared. Typically, the HSE receives up to 50,000 applications for medical cards each month. More than 90% of complete applications are processed within 15 working days. A review of medical card application processing has been undertaken by PricewaterhouseCoopers. It contains several recommendations which the HSE is addressing. I continue to monitor the situation and meet representatives from the HSE on a regular basis to discuss the quality of service provided for the public and address issues which may arise. I will be happy to take up the specific issues raised by the Deputy to ensure they are addressed.

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