Enda Kenny (Mayo, Fine Gael) | Oireachtas source

I thank Deputy Martin for his question. There has not been any change in the policy that is adopted here. The number of people with free access to GP care is now the highest in the history of the State. Some 43% of people now have access to free GP care, while 40.7% have medical cards and 2.72% have GP visit cards. In the past two and a half years, there have been an extra 250,000 people with access to and eligibility for free GP care. As of 1 August 2013, some 1.866 million people have a full medical card and a further 131,000 have a GP visit card, which is a total of 1.991 million.

When the Government was elected to office, discretionary medical card applications were not routinely assessed by medical personnel. The Minister for Health, Deputy Reilly, instructed the HSE to establish a clinical panel to assist in the processing of applications for discretionary medical cards. This process allows for medical professionals to have an input into granting a medical card to people who exceed the income guidelines but who face difficult personal circumstances, such as a particular illness. We all know people who are in that category. Discretionary medical cards are awarded to people who are unable, without undue hardship, to arrange GP services for themselves and their families.

The number of discretionary medical cards has fallen because more than 22,000 such card holders now qualify for an ordinary medical card as they now meet the income eligibility. Since 2011, 22,584 individuals who were previously recorded on the medical card register as having eligibility for discretionary medical cards are now registered as ordinary medical card holders because they meet the income eligibility.

The HSE is entitled to award medical cards only in accordance with the Health Act 1970, so applicants must be assessed. The Act states that persons who are "unable without undue hardship to arrange [GP] ... services for themselves and for their [families]" qualify for a medical card. Therefore there is not, and never has been, an automatic entitlement to a medical card for persons with a specific illness. That is the position as outlined in the Health Act 1970, to which I have referred. There is no legal basis for what people might call a cancer medical card or a motor neurone disease card. Of course, that does not mean that in applying the assessment, those people do not qualify under particular circumstances for a medical card.

There is also the question of discretionary medical cards in emergency situations. A system has been put in place for the provision of emergency medical cards for patients who are seriously ill and who are in urgent need of medical care that they cannot afford. Emergency medical cards are issued by the HSE within 24 hours of receipt of the required patient details and a letter of confirmation of the patient's condition from a doctor or medical consultant.

With the exception of terminally ill patients, the HSE issues all emergency 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 that emergency card. As a result, medical cards are issued to a named individual with a limited eligibility for a period of six months. This is always applied with the flexibility that community welfare officers used to have.

There is a slightly different interpretation of discretionary medical cards for persons who are terminally ill. Once the terminal illness is, unfortunately, verified, patients are given an emergency medical card for a period of six months. Given the nature, urgency and sensitivity of that issue, the HSE has put in place an expeditious process to ensure such people receive those cards as quickly as possible, and rightly so. Therefore, the HSE ensures the system responds as quickly as possible to the variety of circumstances and complexities that such individuals face in what are traumatic personal situations.

See this speech in context