Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

Under the Health Act 1970, as amended, eligibility for health services is based primarily on residency and means. The Deputy will be aware of the publication of the report of the expert panel on medical need for medical card eligibility and the medical card process review in November 2014. A key recommendation of the expert panel was that a person’s means should remain the main qualifier for a medical card. Discretion continues to be an integral part of the medical card assessment process. All applications are assessed under the relevant legislation and the HSE’s national assessment guidelines. However, to build on the conclusions of the two reports, a suite of actions have been identified to improve the operation of the medical card system, particularly for people with significant medical needs. A detailed programme of reform has been drawn up by the HSE with short, medium and long-term actions to be addressed in the period 2015 to 2016. The HSE has appointed a senior manager, at assistant national director level, with specific responsibility for primary care schemes and eligibility, to lead the reform.

I can advise the Deputy that the temporary reinstatement of discretionary medical cards that were previously removed, pending full implementation of actions to improve the operation of the system, remains in place. Holders of discretionary medical cards are no longer included in random reviews and a discretionary medical card issued on the basis of a terminal illness will not be reviewed and end dates are no longer included in the medical card.

The HSE has ensured a more integrated and sensitive processing of applications, involving a greater exchange of information between the central assessment office and the local health offices on people’s medical circumstances and needs. The HSE is taking steps to establish a clinical advisory group to develop a methodology and guidance for the assessment of applications involving significant medical conditions so as to take account of the burden involved and the needs arising from the condition and to ensure appropriate services are provided for tose who need them.

The number of medical cards held on the basis of discretion having been exercised by the HSE has increased from approximately 50,300 on 1 January 2014 to approximately 76,700 on 1 January 2015. The Deputy can see, therefore, that the process is working.

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