James Reilly (Dublin North, Fine Gael) | Oireachtas source

To pick up where the Minister of State left off, it is worth repeating that the number of people with access to free general practitioner, GP, care is the highest in the history of the State. Some 43% of the population has access to free GP care. Compared with when the Government took office, more than 250,000 additional people are eligible for free GP care. At the end of August, almost 2 million people held medical cards or GP visit cards. The number of discretionary medical cards has fallen. As the Minister of State demonstrated clearly, this is because almost 23,000 people who would have had discretionary medical cards now hold full medical cards. In this light, the Opposition motion has a hollow ring to it.

The Minister of State has clearly outlined to the House the legislative basis for awarding medical cards, particularly those medical cards that are awarded on a discretionary basis. His thorough description demonstrates how every effort is made to support applicants in applying for medical cards and, in particular, the efforts made to accommodate those who may be in excess of the income limits but who have difficult personal circumstances. These processes, in themselves, demonstrate how the Government is concerned with looking after people and with making every effort to ensure that those most in need can qualify for the service. This point is critical. The Deputies across the way would be the first to jump up and down at the Committee of Public Accounts and in this Chamber if they discovered that people who were not entitled to medical cards had them. It is important that our limited resources are focused on those who are entitled to and need services the most.

The number of people who hold medical cards on discretionary grounds has fallen in recent years, as more people who previously were marginally over the normal qualifying limit became eligible for medical cards under the normal qualifying scales. There has been no change to the qualifying criteria for discretionary medical cards in the past year and the scheme continues to operate in such a way that those who suffer genuine financial hardship as a result of a medical condition receive the benefit of a medical card. Indeed, I asked that a group of professionals be put in place to consider the issue of hardship because of particular medical needs as well as the normal other issues that can result in hardship for people.

The processing of medical cards at a national level, rather than at a local level as before mid-2011, ensures that all people are assessed in a similar and fair manner when applying for a medical card. The HSE set up a clinical panel to assist in the processing of applications for discretionary medical cards where income guidelines had been exceeded but difficult personal circumstances, such as an illness, existed. The HSE put in place a process whereby a medical doctor would consider the assessment for discretionary medical cards. In previous years, there was a decentralised process, which meant that there could be inequities throughout the country. This means that people may have been awarded discretionary medical cards in some parts of the country and not in others because of the lack of a centralised, standardised approach. This led to inequities and pockets in which there were high numbers of medical cards above what one might have expected.

A team of medical doctors unrelated to the patient assesses the situation and grants or declines a discretionary medical card on a medical basis. Previously, different approaches may have been used in different parts of the country. Now, the process is standardised and there is fair and equitable treatment for all.

The HSE takes a person's social and medical issues into account when determining whether there is undue hardship for a person in providing a health service for himself or herself or his or her dependants. The same supports are offered to new applicants and those under review. Discretionary emergency medical cards may also be awarded. The HSE has a system in place for the provision of emergency medical cards for patients who are seriously ill and 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 the letter of confirmation of the condition from a doctor or a medical consultant.

The HSE issues all emergency cards on the basis that the patient is eligible for a medical card as a result of his or her 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 terminal illnesses. Once the terminal illness is verified, a patient is given an emergency medical card for six months. There is no means test and the nature of the terminal illness is not a factor.

I am satisfied that, given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible. Furthermore, the HSE ensures that the system responds to the variety of circumstances and complexities faced by individuals in these circumstances.

Deputies will be aware that, under the provisions of the Health Act 1970, as amended, persons who are unable, without undue hardship, to arrange a GP service for themselves or their families qualify for medical cards. In accordance with this legislation, the assessment for a medical card is required to be determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. Furthermore, it is clear that every effort is made by the HSE within the framework of the legislation to support applicants in applying for medical cards. In particular, efforts are made to ensure that those who may be in excess of the income limits but who have difficult personal circumstances are catered for.

I am aware of how the diagnosis of a serious illness can invoke fear and insecurity for the person affected and his or her family and friends. Through the systems operating, every effort is made to provide the support needed to avoid further distress. I am also acutely aware of how, regrettably, certain misinformation or misconceptions reported in latter months on awarding discretionary cards have caused such concern.

The scheme provides GP and public health nurse services. I wish to commend those working in our primary care services on their sterling work. It is one of the most trusted parts of our health service. Satisfaction with the GP service in this country is second to none. Being able to see a GP within 24 hours must improve outcomes for our citizens. However, I would dearly love to see reliable outcome measures so that we might focus on the work that improves outcomes and focus less on some other areas of activity.

It is worth repeating that, since this Government took office, there has been no change to the qualifying criteria for discretionary medical cards in the past year. Furthermore, there was never a medical card for a specific condition, which is what seems to be implied here.

See this speech in context