Alex White (Dublin South, Labour) | Oireachtas source

It is not the first time it falls to me to put on the record of the House that with regard to medical cards allocated on the basis of discretion, there is no policy to abolish such cards. There is no deliberate so-called targeting to reduce the number of these cards. There is no targeting of any patient group holding these cards, nor would this even be possible, as I have explained before. I accept that some individuals have lost eligibility. We have not denied that although the suggestion has been that we have. However, cards are not being arbitrarily withdrawn or refused. There has been no change in the rules governing the awarding of medical cards where discretion is involved. On the contrary, I can tell Deputies that the medical card scheme continues to operate so that those who suffer undue financial hardship, as assessed under published guidelines, in the arranging of GP services are awarded a medical card in accordance with the legislation passed by this House.

For ease of discussion in our debate, I am going to use the term "discretionary medical card" but it is important to be clear that medical cards are awarded by the HSE, in accordance with the legislation, on the basis of means assessment or where the HSE exercises discretion in circumstances where a person exceeds the income guidelines. I repeat what I have stated in the past in that there is no separate entity of a so-called discretionary medical card, as there is no distinction between any medical cards in terms of eligibility for services and all medical cards are identical in terms of coverage for services. That is irrespective of the route which a person has travelled, in a matter of speaking, to obtain a medical card.

The motion before the House calls on the Government to "reverse the cuts to discretionary medical cards imposed in the Health Service Executive ... 2014 Service Plan". I must respectfully ask where these cuts, or any target for such cuts, is to be found in the national service plan. I searched the plan to find a reference to discretionary cardsand no such reference is to be found therein. Of course, discretion is referred to in the plan, but discretion is not a stand-alone exercise. Rather, the exercise of discretion has been and remains an integral element of the assessment process for a medical card. The Deputies will be aware that medical cards are awarded on a number of grounds which are set out in the HSE national assessment guidelines. However, it is important to be clear that neither the Department nor the HSE has in place differentiated targets for the awarding of medical cards, such as the allocation of so many in this or that category. It would simply not be possible to stipulate or to prescribe in advance the number of medical cards in circulation based on the income guidelines, the number of medical cards based on entitlements under EU legislation or the number awarded on the basis of having income solely from the Department of Social Protection or the HSE. In the nature of a demand-led scheme, the HSE forecasts the overall number of all medical cards it anticipates will be in circulation at the end of the year in order to facilitate its financial planning over the course of the year, but it simply cannot fix in advance the number in any particular category.

I am aware of recent media reports referring to the alleged plan to reduce the number of discretionary medical cards. The HSE's figures clearly indicate that the number of medical cards issued where discretion was involved has fallen in recent years, and I am not disputing that. However, this reduction is not as a result of a change in policy or a deliberate targeting of discretionary cards, which my Opposition colleagues have persistently claimed. Rather, it is attributable, in the main, to the fact that many people who previously were marginally over the qualifying means thresholds have subsequently been granted medical cards because they comply with those means thresholds.

Of the discretionary medical cards in circulation in 2011, approximately 6% have subsequently lost their medical card following review. On any reasonable account, this could not be described as indicative or reflective of a policy to remove discretionary cards over a period of three years. Of course, whereas the numbers who have lost their discretionary medical cards may be relatively small, let me assure the House that I do not for a moment make light of the difficulties that may arise for people who are found to be ineligible, especially where they may have relied on the medical card for a period, as some Deputies have alluded to during the course of this debate. It is important the facts are clear for the record, and in the region of 80%, or four fifths, of those who held a discretionary medical card in 2011 held a medical card in 2014 on the basis of either a means assessment or with HSE discretion. Approximately half of all individuals who held a discretionary card in 2011 went on to retain the card under the basic means assessment, so that they transferred from a card granted on discretion to one granted under the basic means assessment. Approximately one third continued to hold the card following the exercise of discretion by the HSE. The balance, approximately one eighth of the 2011 cohort, is mainly made up of people who did not respond to the HSE renewal notice, did not complete the review process or are deceased, or cases where other family members were awarded a card. I repeat that approximately 6% of those who held a discretionary card in 2011 have lost that card following review. That is between 5,500 and 6,000 who have lost discretionary medical cards in those three years.

I have listened very carefully to what the Deputies said and this discussion will continue over the two days of debate. Far from targeting people who need our support, this Government has provided very substantial funding to meet the increase in the number of medical cards and GP visit cards required by individual citizens. Of the national population, 42% of people currently have access to GP services without any charges under the General Medical Services scheme. Of these, 39.2% of people have medical cards and 2.6% of people have GP visit cards. As the Deputies will be aware, the HSE is responsible for assessing an individual's entitlement to a medical card and a GP visit card. In this regard, the HSE has produced national assessment guidelines to provide a clear framework to assist in making reasonable, consistent and equitable decisions when assessing each applicant. These guidelines are available for review on the HSE website.

The relevant legislation is the Health Act 1970, as amended. Under the provisions of the Act, persons who are unable, without undue hardship, to arrange a general practitioner service for themselves or their family qualify for a medical card. In accordance with the legislation, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure of the applicant and his or her partner and dependants.

It is a fact that under the health legislation, there is not, nor ever has been, an entitlement to a medical card for a person with a particular illness or medical condition. In accordance with the legislation, it is not possible for the HSE, and the HSE has no authority, to award a medical card by virtue of an illness or a medical condition.

I listened carefully to what Deputy O'Brien said. He made a compelling contribution to the debate. If I understood him correctly, however, he referred to circumstances in which persons who had applied for a medical card and were outside the income limits ought to, or should have been considered on the basis of his or her illness or medical condition. It is not possible for the HSE to do that. All the HSE is expected to do, and does, is take into account the medical expenses, or expenses associated with the medical condition or illness of a person who is above the income threshold and therefore does not qualify under the income limits. That is where the doctor is involved in the assessment for a medical card. The doctor does not give a medical report on the severity of the illness. This may sound harsh but I feel it necessary to state the position clearly. The doctor and panel are involved in assessing the expenses that are reasonably associated with that illness or condition. It is not the illness or medical condition that qualifies a person for a medical card. That is not the position. People may believe that we should migrate to that system. There may be a case for allocating medical cards on the basis of an illness or medical condition but that is not how the system has operated since 1970.

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