Paul Connaughton (Galway East, Fine Gael) | Oireachtas source

I am grateful to have an opportunity to speak on Private Members' business. Many people are affected by this issue. We all have our own stories in this regard. It is important to acknowledge the motion we are discussing. No attempt has been made to remove mass amounts of medical cards. The problem lies with the changes that have been made in the process. I will talk about the small number of people who have been affected by these changes, which have had a significant effect on their lives. That is where the problem is coming from.

Like many other Deputies, on a daily or weekly basis I meet constituents who are affected by the reduction in the number of discretionary medical cards. I have identified three problems with the manner in which this reduction has been implemented. I refer to the timing of the decrease, the manner in which it was communicated or not communicated to people and the dire position many acutely ill people are now in. We are all aware of the pressure the HSE is under as it tries to find savings and help enable this country to balance its books. I appreciate the major part the health budget plays in the context of overall expenditure. Therefore, it is clear that when Government budgets are cut, there must be commensurate reductions in the health budget.

When savings are made, it is important that the manner of the cuts does not add to the difficulty being experienced by people. We believe this was the case recently when the number of discretionary medical cards was reduced. I am aware that people who were granted discretionary medical cards in the spring had them removed just three months later, necessitating their re-entry into the application and appeals process. Surely this is a gross waste of resources within the medical cards office and the HSE appeals office. I suggest that the reduction in the number of medical cards should be effected gradually as they fall due, rather than in one fell swoop as appears to have been the case.

The lack of communication in relation to what has been happening has caused great confusion for the public. People deserve to know what is happening. The HSE communications office is well able to publicise good news, so it is only right that the withdrawal of medical cards from the population should be explained in a similarly forthright fashion. The staff in that office should have been obliged to share this information with the general public. Instead, very ill people had their lives thrown into turmoil when a letter arrived stating that their medical cards had been cancelled but failing to provide a reason or context for that decision.

Communication continues to be a problem, especially when it comes to the allocation of medical cards to the chronically ill. Three examples come easily to mind. A lady who was paralysed in an accident last year was granted a medical card in early 2013 following a mammoth battle. She had been rendered tetraplegic after the accident and required extensive rehabilitation in the National Rehabilitation Hospital. She was informed in July of this year that the medical card was cancelled. An application to have the card reinstated was turned down. The matter is now under appeal. In the meantime, she has been left without a card.

The second case I would like to mention is quite similar. It relates to a man who suffered an accident over 30 years ago which left him paralysed and in a wheelchair. He has always held a medical card. He was informed in July without warning that his card was cancelled. He faces the prospect of cutting back on the number of colostomy tubes and bags he uses because the cost of those items is prohibitive in the absence of a medical card. There is no doubt that this will increase the likelihood of infection. This man may well have to present himself to his local accident and emergency department before the winter is out. To add to his difficulties, he has developed high blood pressure since his card was withdrawn. His family believes this is due in no small part to his worries about the medical bills that may accrue if he is hospitalised. To add insult to injury, the last time he was granted a medical card - on discretionary grounds due to his disability - his wife received a GP visit card. They took the time to ring the medical card office to say she did not need the GP visit card, and had not sought it, but they were told it had been granted and they should keep it.

The third case to which I would like to refer is just as surreal. It relates to a man who is on the transplant list as he awaits a kidney transplant and attends dialysis three days a week. Now that he does not have a medical card, the cost burden on his family is proving great. Surely it does not take weeks for a medical assessor to determine that someone on the transplant list has exceptional medical needs. In addition to his health concerns, the man is now worried that if his transplant operation comes through, he will be faced with astronomical medical bills. Why did the HSE once again use a sledgehammer to crack a nut? Is there absolutely no common sense in the allocation of medical cards? Surely someone on the transplant list is defined as having an exceptional medical need. Can a programme not be put in place whereby the medical card office can refer to the current transplant list so that these ill people can be spared the stress of waiting for weeks to see whether their applications are successful? Details of all these cases have been provided to the Minister. I have already been in contact with the medical card office in relation to all three cases.

It is quite obvious to me that there are problems in the assessment of medical evidence. Surely it is not impossible for the primary care reimbursement office to provide guidelines to people on what can be said to constitute "exceptional medical circumstances" which warrant a discretionary medical card. Equally, people should be given guidance on how best to prove their medical evidence. I understand that the HSE service plan for this year included a plan to reduce the number of discretionary medical cards from 63,000 to 55,000 and replace them with the full medical card. I believe the manner in which this has been conducted is nothing short of a disgrace, especially given that the people worst affected are those with the greatest medical needs. I accept that a small number of people in possession of discretionary medical cards might not have merited them. The manner in which the HSE has handled this has ensured the greatest burden and stress has been placed on those most in need.

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