Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

I welcome the opportunity to speak on this legislation and agree with its principle. The Minister of State, Deputy Alex White, probably has the most important job in the State at present in trying to develop the primary care sector. If he can achieve this, he will have done a service, probably for two generations to come, but it is a daunting task. The Bill is one small step in that direction.

Like previous speakers, I must ask who is paying for this. It is sad that every second person coming through my door or contacting my constituency office is doing so about a medical card. This morning at 8.15 a.m. a general practitioner in my constituency rang me to apologise for the number of patients he had been referring to my office about medical cards.

He explained to me the level of desperation he has in trying to deal with the volume of people coming in to him in situations where their medical card has been withdrawn and where he is trying to put the paperwork in place to justify the reinstatement of that medical card for people who are critically ill or have chronic diseases, and do not have the means to pay for their medication.

The whole idea behind discretionary medical cards is that they are there to address undue hardship. As the Acting Chairman will know, down through the years we have done that, particularly in the area covered by the Western Health Board, which was one of the most of the difficult health boards to get a medical card from. However, if one actually presented a clear case to the appeals officer at that time, a discretionary medical card was issued. That no longer applies. The hardship is now being caused when applying for or trying to renew a medical card, or trying to appeal a decision which was wrong in the first place. What I have found in recent months since the whole issue of probity came to the fore is that we are now denying medical cards to people who are legitimately entitled to them, black and white, and not just with the discretionary medical cards. I had a belief this practice was happening in the PCRS but it was only when I came across a recent case that I could actually prove it. I have e-mailed the details to Mr. Paddy Burke and I am still awaiting a response from him.

In this case, a 79 year old woman was informed at the end of April, on the renewal of her medical card by the PCRS, that she had lost her card because she was over the income threshold. Luckily, a relative who lives close by picked up the telephone and got through to the medical card section in Finglas. In fairness, the young woman at the other end of the telephone very politely went through the figures with her and it was realised that the Finglas section had made a mistake. The PCRS had calculated the woman's HSE widow's pension, which comes on a fortnightly basis as it does for every single HSE pensioner in the country, on a weekly basis. The PCRS staff member was very apologetic and said the PCRS had made a mistake and that the woman should not have had her medical card withdrawn. However, she then asked if the woman could submit an appeal and get her payslip from the Department of Social Protection along with the payslip from the HSE, and the PCRS would then rectify the matter. Of course, it takes three weeks for the data to go up on the computer systems in Finglas and it takes 15 working days to process the application that goes to Finglas. When nothing came back, I contacted Mr. Burke's office and pointed out that this woman would probably have to wait six weeks to get back a medical card to which she was entitled, in a situation where his staff made a mistake in regard to the calculation of her entitlement.

Her relative contacted me yesterday, irate, to tell me she had received another letter from Finglas informing her that the payslip did not state that the pension was paid fortnightly by the HSE, and that the PCRS wanted a letter from the HSE stating this. When that went in, the PCRS would reinstate her medical card. Therefore, she will have to wait another three weeks before the case is looked at again. It is just not good enough that a 79 year old woman who is legitimately entitled to a medical card has to go through these loops to get a card. If there was such concern that she had all of this money under the mattress, could someone in the PCRS not pick up the telephone and call the paymasters in the HSE to ask whether its pensions are paid weekly, fortnightly or monthly, and issue the card to the poor woman?

This is a renewal card. My understanding was that when it was a renewal, until a final decision was made on it, the person held onto that card. Of course, the decision to refuse was made on flawed maths and this woman has been denied her entitlement in the interim.

In another case I am currently dealing with, a man who is undergoing cancer treatment returned his renewal application and the PCRS wrote back to him looking for additional documentation. He sent back that documentation but when he went to his GP earlier this week, the GP said, "Tom, I am afraid your medical card is no longer valid". Again, it was my understanding that, pending any decision on the cards, people would retain their entitlement until a decision was made.

In another case I am dealing with, a young man with epilepsy has appealed a decision to the Ballyshannon office. Again, we are told that once an appeal is submitted, the medical card is reinstated temporarily until a decision is made. He had to go to one of the Dublin hospitals last week, and he was told he did not have a medical card and that he had no cover. He has to go back next week and he telephoned me yesterday in fear of what they are going to say to him when he goes back.

In another case, a young man who is just over 16 years of age has been informed that if he does not respond within 21 days of the date of the letter regarding his application, the case will be closed. The real sting in the tail is that the letter to him states that a new medical card-GP visit card application form will have to be submitted with up-to-date documentation. If anything puts the fear of God in people, particularly sick people, it is having to fill out the form, gather up all the documentation and get it resubmitted to Finglas again, when it should be there on file in the first place.

The reason this young man cannot send back the documentation is that he needs to have his parents' medical card reference number in order to have the application processed. The difficulty is that the PCRS has his parents' medical card suspended and they must wait for another six weeks before they will get a decision on that before he can respond. In the meantime, he will be told that, because it is outside the 21 days, he will have to go through the whole rigmarole again.

We deal with the Department of Social Protection on a regular basis, and the target is that documentation has to be sent back within 21 days. It could be 22, 25, or 30 days, depending on the time it takes to get the documentation from the different agencies involved. However, I have yet to have a case where the Department of Social Protection came back to me to say it was rejecting an application because it was outside the 21 days, although if it an application is six or 12 months late it might legitimately dismiss it. The idea with the medical cards is to break people down and to create as much hardship as possible so they will abandon their application. The policy is to try to force people to throw in the towel, to surrender, to put up the white flag. That is what probity is about within the PCRS at the moment.

I have another example in regard to documentation that was sent by e-mail from my office on 8 April last. On 14 May, the PCRS wrote back to the family looking for the same information. The family came to me wondering had I sent on the information, and I had the record that I had sent it. Nonetheless, I sent it on again to the PCRS, enclosing the original documentation, and still no decision has yet been made.

We are told with great fanfare that the troika has left the country and we are back to our own devices. Yet, we find that the processing of these applications has been sent to Germany. Naturally, someone in another jurisdiction will look at the black and white situation regarding the rules of the medical cards, and say that a person is not entitled to a medical card based on the rules.

Of course, as the Minister of State knows, based on the rules, nobody is entitled to a medical card in this country. The income limit for a single person is €184, and the social welfare rate is higher than that, so nobody is entitled to a medical card, if one looks at the rules that are set down there in black and white, because the rules have not been updated. The Minister of State should not look confused about that, because it would really scare me if he did not know the income limit for a medical card.

I spoke to a postman at the weekend who told me that he dreads going out with the medical card review letters. The fact that older people are living in fear of getting that letter from Finglas telling them that their medical card is under review, even if they have only had it for a couple of months, is one of the reasons the Government got such a bashing during the recent elections. It is the threat of the withdrawal of that card that causes the fear. People who have lost their medical cards and cannot afford their medication are visiting GPs such as the one with whom I spoke this morning to ask them what tablets they really need to take and what medication they can put on the long finger, because they cannot afford to buy all of it.

Another issue with which the Minister of State can deal very quickly is the lack of understanding of what is and is not covered by the medical card. People are coming to me who are afraid of having to pay for an outpatient appointment - which, of course, does not have to be paid for regardless of whether the person has a medical card. These are people who, based on the comments of Ministers, are legitimately and legally entitled to a medical card but who are denied that at the moment. Each of those cases involves a person who is entitled to a medical card pending a final decision or who is entitled to a medical card based on the figures he or she has submitted but who has not got it. I am not talking about discretionary medical cards. These are people who are entitled to medical cards, but they are being denied them.

The other issue on which I wish to focus is that of children over the age of six who have a profound disability or illness. As the Minister of State knows, we have spoken about children with life-limiting conditions. I put a proposal to him that we create a national fund of about €8 million that could support home care for those children. These are children in palliative care situations who will never have the opportunity to vote for the Minister of State or for me because they will never see their 18th birthday. Some of those children are stuck in very expensive paediatric beds in hospitals in this city, costing approximately €150,000 per year. We cannot find the €24,000 or €25,000 that the Jack and Jill Foundation needs to keep them in their own homes or that the LauraLynn children's hospice needs to care for them in the hospice service, yet we have a fund of about €8 million that is spread across the country in respect of the various primary care units. If we could pool that nationally, it would be an effective budget. We are not talking about new or additional money to provide very valuable care for these children. We are talking about using the existing money more efficiently to deliver a service for some of the most vulnerable children in this country. I hope that in his response, the Minister of State can update me on the progress he has made on this issue, which has been on his desk for more than 12 months.

My next point relates to the Our Children's Health campaign. I met the people involved in that campaign earlier this week. The Minister of State knows their objective is to try to ensure there is an automatic entitlement to a medical card for children diagnosed with a serious illness or a congenital condition. We are giving automatic entitlement to every child under the age of six, yet we are told that we cannot legally grant automatic entitlement to people with particular conditions, which is, of course, wrong. This tripe is being given out to these parents who have seen what has gone on. There is a lack of understanding of the hurt caused to a parent when they get a letter asking them to prove that someone with a genetic disability such as Down's syndrome still has the condition. It is really hurtful to get a letter like that and it really drags any family down.

If we are talking about giving every fit and able child and every child with a disability under the age of six a medical card, we should review matters regarding sick children over the age of six. There is nothing worse than having a child with a long-term illness that requires parents to go in and out of hospital. They have enough on their plate in trying to meet hospital appointments without having to go through the rigmarole about which I spoke earlier. It hurts me when these parents come to me and I have to help them jump through the hoops to try to prove their entitlement to a medical card. Two of those parents met me this morning to speak about genetic illnesses. It is just not right that they have to go through the yard manure about which I spoke earlier. We wrote into law through the Health (Amendment) Act 1996 a provision giving women who had contracted hepatitis C from contaminated blood, due to a monumental mistake by agents of the State, a legal entitlement to a medical card based on a medical condition and regardless of means, so it is possible to do it. We are talking about a small handful of children and I will tell the Minister of State why it is just a small handful. There are about 56,000 discretionary medical cards in this country, are we are talking about the withdrawal of roughly 2,000 of those per year due to probity measures. The sort of money we are talking about is around €2 million, based on the average cost of a medical card. Of those who have discretionary medical cards, perhaps about 50% - probably fewer - are in respect of children, so we are talking about a very small cohort of children who would not automatically be entitled to a medical card or who would be entitled to a discretionary medical card once they have gone through all the hoops. Enshrining this entitlement in law would mean they would not have go through these hoops any more and would get a medical card by right. The Minister of State can set down in a statutory instrument exactly what those conditions are. He knows the implications of it, including financial implications.

If we are considering introducing an entitlement for under-sixes, surely we should be looking at this for what is a saving to the Exchequer of about €2 million per annum. That is the sort of money we are talking about. It makes such a difference to those families. I will press this on Committee and Report Stages and I hope the Minister of State will examine it. I know he is one of the exceptions in the Government. When I met the families this week, I told them he is a Minister who thinks and listens to what goes on in this House. I know he will take this away and consider it. I hope that by the time this legislation is passed, he will still be dealing with it - or, possibly, he will be in a more senior position to deal with it.

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