Ann Phelan (Carlow-Kilkenny, Labour) | Oireachtas source

This issue is extremely important to me and my constituency. Sometimes we pay lip service to debates. Tonight we should endeavour, with the Sinn Féin Members who are left in the House, to conduct a mature debate on medical cards. The system is not perfect but I do not want to terrify the public. It is a particularly Irish trait to terrify the wits out of people, no matter what we try to introduce, and spend the rest of the time trying to claw back the ground we lost.

I want to work with the Minister of State and I know he is committed to trying to solve some of the extremely difficult problems surrounding medical cards. We can do it only if we step back and see the difficulties. When people are afraid they cannot see a way forward. People have come to my constituency office who are terrified of the medical card review and of the bureaucracy they must deal with. If we try to work with them and make a good sound argument, 93% of people have their cards renewed. We should not lose sight of that fact.

This is the second time I have spoken about medical cards in the House. To reiterate what I said previously, the medical card system was centralised to make the system fair and depoliticise how they were granted. In the past people did not get medical cards because they were entitled to them, or on the basis of medical evidence, or because of their low income. In some cases people got them because of the political party they supported. Centralising the system to depoliticise the process is the right thing to do. I accept there are difficulties but we will work through them.

Many people have called to my office saying their medical cards were removed because they slightly exceeded the financial threshold. Their medical need, however, outweighed their income but this was not taken into consideration. While in general the issuing of medical cards based on financial circumstances is very clear and definite, there are problems where people do not meet the criteria but have large medical expenses due to on­going long-term illnesses or disabilities. This is not taken into consideration. Why should someone's financial means override their medical and personal hardship when assessing for a discretionary card? This is the second time I have expressed this view in this House.

There are also people who may not regularly need to attend a GP but when required, may need the security of a card should something happen. Sometimes it is most important to have the psychological security of having the medical card. The same people may be in receipt of medication on a long-term basis. They may also require the additional services associated with the medical card, such as those provided by the public health nurse. This is one of the difficulties we must face.

There are other groups of people such as cancer patients who are in remission. They should retain a full medical card for at least three years, irrespective of financial means. The provision of services in addition to free access to their GP, is of pivotal importance to many cancer patients and their families. We need to maximise this. Ultimately, this system not only has to be fair, but has to be seen to be fair.

Many recipients are unnerved when they receive a letter of request for renewal because it is so formal and no real guidelines are provided. I commend the Minister of State who is committed to tackling the issue. Fairness must be the core of the medical card system.

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