Alex White (Dublin South, Labour) | Oireachtas source

We are changing the law to adjust the eligibility for medical cards. I am genuinely interested in people's views. Is it being proposed by Deputy Kelleher or anyone else in the House that we should change the 1970 Act in that radical way to move it away from an assessment of means to an assessment of medical condition? I will not press Deputy Kelleher to respond but if that is the view he or anyone else has, let us start debating it because it would be a fundamental change in the way we allocate medical cards. Maybe we should look at it. I do not think it would be the right way to proceed. I think we should go for full universal access to GP services as quickly as we can achieve it for the whole population because there is a significant public health reason for doing that as well. Ultimately, it is the only way we can get away from people having to go through mean testing and applications for discretionary medical cards when, in a civilised society, we should have universal access for all people to a basic primary care service. That is the view I have and the view I believe the Government has, which is why we are implementing the measures we have announced.

I will respond, in no particular order, to some of the issues raised. Deputy Terence Flanagan raised the issue of data sharing. I assure him that we have made considerable progress in respect of data sharing between the HSE, the Department of Social Protection and the Revenue Commissioners. The powers to do that were in the parallel legislation from earlier this year arising from last year's budget when we made changes affecting the over 70s. The Deputy may recall that there were provisions in that legislation facilitating the exchange of data between those bodies, and that is moving ahead. It is good that this opportunity exists.

Deputy Calleary was very fair in what he said. He accepted that while there are sometimes difficulties in respect of the administration of the scheme, the HSE and PCRS staff who are administering it are working well, are approachable, are doing the best they can to administer the system and are doing so professionally. I thank him for acknowledging that. He again raised the issue of cards being taken away. He said someone, possibly a constituent, went to the doctor and was told their card was gone. It really troubles me if this is happening. There is no reason somebody should be surprised by an announcement by their doctor that their card has been taken away because people are written to three months in advance of there being any change and again a month in advance. I will not stand here as Minister of State and say this would never happen because I know it is a human situation and things go wrong, but it should not happen as long as the person who receives the letter engages with the HSE, and there seems to be no reason it should happen.

A constituent of mine contacted me in recent weeks with a similar situation but it turned out that it was simply a bureaucratic mistake. The person had been in hospital for a lengthy period, came out, went to see her doctor and was told she had gone off the system. Due to the fact that she had been in hospital, she presumably had not been receiving mail and there had been no engagement. There was no loss in that situation.

It is important that people engage with the system and I think people are doing so. Deputy Calleary said that the PCRS should ensure it contacts the Irish Cancer Society and motor neurone disease advocacy groups, and this is happening. I encourage this to continue happening and I agree with him that it is important. In respect of medical decisions being made without the doctor ever seeing the patient, I repeat the point I made earlier. It is not a medical examination in the way we understand it for the purposes of a diagnosis or medical report. That is not the involvement of the doctor in the system of discretionary medical cards. For the purposes of clarity, the discretionary medical card may be awarded to an individual in circumstances where paying for his or her medical costs may cause undue financial hardship, for example, an ongoing medical condition that requires exceptional and regular medical treatment or visits to the doctor or hospital. If doing so would cause undue financial hardship, because this is still the test, a card may be granted by the HSE on a discretionary basis even though the person is in excess of the income guidelines. The HSE set up a clinical panel at the Minister's request some time back to assist in the processing of applications for discretionary medical cards where there are difficult personal circumstances which ensure the applications by those diagnosed with ailments such as cancer are assessed and addressed in the most expeditious and sensitive way. In respect of what Deputy Calleary said, it is not about a medical decision or diagnosis per se. Input is probably a better word to describe it. It is the medical input of a doctor to endorse the fact that the medical expenses are reasonably associated with a particular medical condition the person has.

Deputy Healy-Rae made many points and I listened carefully to him. He alleged that a secret decision had been taken to take 40,000 cards out of the system. I am not aware of any secret decision. I suppose if it is secret, I probably would not know about it but I certainly was not let in on any such secret. A decision was taken last year which had an impact on 40,000 medical cards. Of these, 20,000 belonged to over 70s - this was last year's change relating to the over 70s - and 20,000 belonged to the under 70s where certain adjustments in respect of the allowable expenditure in the assessment of under 70s were made. Perhaps that is the 40,000 to which the Deputy is referring. If it is, it was no secret and it was certainly no secret in this House because it was debated and we were criticised for it many times.

Deputies Wallace and Lowry referred to the following point. Deputy Wallace thinks that what we are doing is contradictory and confusing. He mentioned the views of certain organisations, including some doctors, that we should not be doing this. I am not sure if this is Deputy Wallace's view because he then agreed with the value of a universal system. Some people have said we should not be giving medical cards to children under six whose parents are wealthy. The majority of people who will benefit from under-sixes getting the medical card are not wealthy people. They are not millionaires. They are people on low and middle incomes. If one looks at the profile of those who qualify for medical cards at the moment and the profile of people above that who do not qualify, one will see that the majority of the people in this State whose children will benefit from the medical card are very far from being millionaires.

We come back to the point about targeting and universality. It is a discussion we need to have in this House about the medical service. Do we want to have universal access? Do we believe a properly functioning primary care service and health system should contain access to one's doctor without having to pay fees with all that can entail for improving one's own health, preventative health strategies and the management of chronic illnesses - all the things we have been talking about in this House for more than ten years or perhaps 20 years? They include the necessity of promoting primary care. We need to take away the barrier of fees. We will never solve the problems in the health service if we do not reallocate resources and adjust our perspectives towards primary care. Everybody in the House agrees with that. If we agree with that in principle, we must start the process of achieving it. I sometimes pause when people say this is not the right time to do it. Deputy Kelleher might not have said it but others have. They say we should do it in the future. I disagree passionately with that because I think that even though we are facing financial constraints and must make these decisions in this legislation and other things that nobody likes, we should make a start on this big project of universal access to primary care.

I see the decision on the under six year olds as part of that. I do not see it as a political stunt, a once-off or a sop, as it has been described by some, because it is not. It only makes sense as part of a project to extend universal access to primary care services to the entire population, and I passionately believe that is what we must do as a Government and Oireachtas. We must start to deliver on this policy imperative and principle that we all say we share, so it is not contradictory. It is true we are obliged to plug many leaks in the existing system and that there are many pressures and difficulties in that system, but we must start looking to the future as well and try to do the two at the same time. I believe we should make a modest start on this, then look to see where we go next and find the best way to deliver the laudable objective of universal access to primary care. There is no other way to solve the problems in the health service. No country in the world would be able to solve the problems in the health service and the challenges of an aging population, chronic illnesses and the other problems that already exist, with more coming down the tracks, without doing this. The very welcome decision by the Government on the under six year olds is a key step towards delivering that.

Deputies Shortall, McConalogue and Keaveney referred to the arrangements for the over 70 year olds not taking account of medical expenses on the basis that it is a gross income assessment. A person over 70 years of age who faces large medical expenses can also apply to be assessed under the standard means assessment for medical cards for the general population. That assessment takes account of housing, travel to work, child care and medical expenses.

I dealt with the point raised by Deputy Clare Daly. Deputy Browne said it is very difficult or impossible to obtain an end-of-life medical card within one to two weeks. The HSE has special arrangements in place to issue an emergency medical card for a person in palliative care with a terminal illness. It will be issued within 24 hours. It would trouble me if there were cases where that is not occurring. I cannot swear, hand on heart, this always works as well as we would like on every occasion, but I know from the many cases of which I am aware that it is working. I hope that is so generally and that it remains to be case.

I will conclude with the remarks made by Deputy Cowen. His critique of the Government in the broader sense, and Deputy Healy-Rae and others made similar points, was largely about what was said before the election and what is happening now. It was in that category of contributions. It is difficult for Deputy Cowen to criticise the Government in one sense because, in the next breath, he or his colleagues say we are implementing the agreement made by the last Government before the election. It is difficult for people to criticise us for doing something they say they would have done anyway.

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