Gerald Nash (Louth, Labour) | Oireachtas source

I am glad to have this opportunity to raise an issue which will be familiar to all Members. All of us have at some stage been asked for advice or help with regard to medical card applications. Of course, we are usually only ever asked to help in cases where a card has been refused on grounds of income and a review or appeal is sought on grounds of hardship, in most cases caused by the expense of dealing with an ongoing illness or disability.

It is important when dealing with such cases that the system is fair and is seen to be fair. In cases where a refusal to grant a medical card is being reviewed or appealed, the Health Service Executive, HSE, issues a simple “Yes” or “No” decision at the end of its deliberations. This is fine where a review or appeal has been successful but it is deeply frustrating in the unsuccessful cases where people are left in the dark as to the reasons behind the decision.

It is not unreasonable for the HSE to provide a basic summary of the reasons behind such decisions. Such reasons may include insufficient medical evidence, a relatively low level of cost or a myriad of other explanations. This information could prove crucial in deciding whether or not to proceed to a further appeal.

The HSE, however, does not seem to share the belief this is a reasonable proposition. Incredibly, it actively blocks any attempts to disclose the reasons behind its decisions and will only provide them on foot of a freedom of information request. Surely, such a stance cannot be justified. One promise we made when we got into government was to bring more transparency to our decision-making process across all State bodies. Much progress has been made and more will come. In light of such changes, the attitude taken by the HSE is looking increasing archaic and obstructive.

I believe there is a culture in the HSE that has to be changed. There are elements of management within the organisation that do not understand the principle that they are there to serve the public, not to make life difficult for them. Such a culture was referred to recently by the outgoing Ombudsman who pointed out the contrasting difference in policy between the Department of Social Protection and the HSE whose default position seems to be closed and defensive, often to the great cost of the State and the distress of our citizens.

On this particular issue, I see no reason for the HSE to continue with its policy of requiring freedom of information requests before releasing information regarding medical card decisions. If anything, it would streamline the process and help reduce the small number of spurious appeals. More importantly, it would of course remove much of the frustration and distress for medical applicants. Also there is the additional difficulty for some families that they may be handling the application for a person who is unable to do so themselves, either through illness, age or disability. Freedom of information requests in such cases can be difficult if those assisting are not legally the guardians or wards of the person requesting the card.

Will the Minister give strong consideration to changing these procedures? I cannot see how any cost would be incurred by such a change. If anything there could well be savings. More importantly, we would make our system a little bit more human and easier to navigate.

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