Gerald Nash (Louth, Labour) | Oireachtas source

The awarding of medical cards on discretionary grounds is a fraught issue and is probably one of the most familiar to Members of all political persuasions. We have all been asked at one stage or another by our constituents to make representations on their behalf. In an ideal world, I would like to see a system of universal health care where all citizens have free and ready access to primary health care provision, a system which would be self-sustaining in the long run by avoiding later more serious or prolonged medical intervention for conditions which could have been treated simply and cheaply with early action. We are making some inroads in that regard. Unfortunately, we do not live in such an ideal world currently and we must try to make do with the limited resources we have available to us in a fair and equitable manner. Even under such constrained circumstances, it is important to remember that almost half our population has access to a medical card.

In general, the system of issuing cards based on an individual's financial circumstances is very clear and quite well understood. The problems arise where people do not meet the income criteria but may have large medical bills due to long-term illnesses or disabilities. There are groups of people with conditions who may rarely need to see a doctor but who would need the security of ready access should it be needed. One group is children with congenital heart defects, some of whom may not need regular visits to a GP but obviously would need ready access should it be needed. It is my belief and that of most Members that parents of such children should not have to worry about finding the money to visit the doctor nor should the parents of children with Down's syndrome have to share that burden.

Other groups which should not be refused medical cards include patients undergoing oncology treatment. Surely the non-renewal of cards for such people can only add to stress and lessen their chances of a full recovery. We are all aware of certain examples where the system does not necessarily work to their benefit.

Having said all of that, I know the Minister of State is aware of these problems and I commend him and the Minister, Deputy Reilly, for directing the HSE to set up a clinical process to assist in the processing of such applications. However, it is important when dealing with such cases that not only is the system fair but that it is seen to be fair. In cases where a refusal to grant a discretionary medical card on medical grounds is being reviewed or appealed, the HSE issues a simple "Yes" or "No" decision at the end of its deliberations. This is fine where a review or an appeal has been successful but it is, as the Minister of State knows, deeply frustrating in unsuccessful cases where people are sometimes left in the dark, to a degree, about the basis for that decision. As I have mentioned previously to the Minister of State, it is not unreasonable for the HSE to provide even a basic summary of its findings and the rationale behind why certain decisions are not in somebody's favour. The HSE will only provide these reasons on foot of a freedom of information request which can be very time-consuming and frustrating.

As I said, I raised this with the Minister of State last week and in fairness to him, he has agreed to take a look at that particular process. I take the opportunity to urge him to continue in that vein and to ensure we have an even fairer and more transparent system.

As I said previously, I cannot see how any costs would be incurred by such a change. If anything, savings could well result from it. Such transparency would also bring more consistency to decisions made in relation to medical cards issued on a discretionary basis. The perceived and sometimes real lack of consistency can sometimes be a bit of a bugbear for people.

It was mentioned earlier that 1.8 million citizens have full access to medical cards. That is not an insignificant number. There is clear evidence that approximately half of the population benefits from medical cards. Given that so many demands are being placed on the system, there is no doubt that there can be problems in getting decisions right all of the time. As public representatives, we often hear about some of the challenges people encounter in their dealings with the medical card system. While I acknowledge that there can be problems with the administration of the system, I think it is improving and changing. We should not be blind to the improvements that are being made to a system that was not renowned for the transparency of its decision-making process. Some of the interventions made by this Government, the Minister for Health and the Ministers of State in the Department of Health to ensure there is greater openness and transparency in this area are to be commended. Much more can be done to make sure we are all satisfied that the situation is much clearer and much more transparent for all citizens.

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