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

I welcome the opportunity to speak on this Bill and I thank the Minister for Health for being present for the debate. I want to declare an interest because I have two children under the age of six who may potentially avail of the medical card. I spoke about one last year, as he was coming up to five years of age in September and I asked would he get the card. It is coming close to the wire.

When the Minister is responding I would like him to clarify what will happen in rural areas, of which there are many in the west, where there is a single GP practice that decides not to go into this scheme? It is even very hard to get GPs when one retires in these areas. The suggestion has been made that the patient can move to another GP but if that GP is 40 or 50 miles away that is not much good to the family or the community. How do we address that problem in isolated rural communities? In my new constituency of Roscommon-Galway, just over 8,000 children will be able to avail of these medical cards, which is welcome for those families. What happens to the six year old who has a chronic ongoing condition, which imposes a significant financial burden on the family? Initially we were told this would be phased in for children, that it would start with those under the age of six and progress to include those in primary school and on up to the age of 18. In the revised programme for Government, however, it is being provided to those over the age of 70, who have in excess of €36,400 per annum, plus potentially another €36,000 in the bank. Is this a good use of limited funds, to spend an additional €12 million in providing a free GP card for some of the most affluent individuals in this State, ahead of children aged between six and eight who have chronic ongoing illnesses which place a huge financial burden on their families? That is wrong. Compare that with a family with two children, one of whom is sick, who earn half of the €700 a week threshold applied to the people aged over 70. If it earns over €350 a week it is over the income limit for a medical card. That family will sweat blood and tears to try to get a medical card to have free access to a GP.

A woman came into my clinic on Monday morning who has recently been diagnosed with cancer. I sympathised with her, not because of her diagnosis, which is a huge burden that she and her family must deal with but because of the horrendous experience she will have with the Primary Care Reimbursement Service, PCRS, based in Finglas, to be granted a medical card. Sadly, her family is over the income threshold for a medical card. She will get a medical card at the end of this protracted process, three to five months down the road, but she has started chemotherapy and will be quite sick in the next couple of weeks. The last thing she needs is letter after letter coming from Finglas asking her to justify her request for a medical card because she happens to be on chemotherapy and receiving treatment. That is wrong. Most individuals in that situation would throw in the towel. They are too sick to have to deal with this on an ongoing basis, having to send back information, then be told there is something else missing, that their payslips are outside the three month limit and that they have not provided clarity that they are sick and no longer in work and may have a reduced income.

They have an additional cost not only of having to deal with the loss in income, but also of having to travel. That is because we have developed centres of excellence, particularly for cancer, but for all other services as well. If a person does not drive and is unfortunate enough to live in County Roscommon, it will cost €150 to get to see a consultant in Galway. Such a person cannot use public transport, so they must pay a minimum of €150 for a taxi from any part of County Roscommon to Galway city to see a consultant and receive medical treatment.

In theory, the medical card section is supposed to take that into account. I have been reassured on numerous occasions that the cost of transport to medical appointments is taken into account, but I have yet to see any evidence of it. I will cite an example of a recent case I dealt with. It concerned a young woman who attends her GP 20 times per annum. She is also attending an endocrinologist in Galway monthly, and a gastroenterologist annually in Ballinasloe. She also attends for audiology appointments six times a year in Galway, and the gynaecology department in Ballinasloe three times a month. In addition, she is attending a fertility clinic in Galway every eight weeks and is forking out €285 a time for that. She is also attending a migraine clinic in Ballinasloe quarterly and is receiving monthly bereavement counselling. She is also attending the breast clinic in Galway ten times a year, as well as awaiting a neurology appointment and one other appointment.

That woman cannot access public transport and does not drive. Her husband has to take time off work so that she can attend those appointments. Based on that, she has been given an allowance for health expenses of the princely sum of €11.54 a week. The allowance for prescribed medicines and appliances is €33.23 a week, which is the drug payment cap of €144 per month. She is also getting an allowance for hospital charges of €14.42 a week, which is the hospital cap of €750 a year.

In that case, absolutely no recognition is being given to the cost of attending those appointments or the cost of her husband having to take time off work so she can attend them. Even though we have sent detailed information to the HSE's medical card section in Finglas, it says that the original decision stands. We have also gone to the appeals office, yet it is giving the woman no hearing whatsoever because the rules, as set out, give no recognition for additional costs associated with transport.

Apart from that particular case I can give the Minister numerous other examples. I know of an individual living in Galway city who is being treated in St. Vincent's Hospital, Dublin. They get an allowance of €11.54 per week for health expenses and €33.23 per week for prescribed medicines and appliances. I also know of another patient in Galway city who is being treated in Galway University Hospital with exactly the same allowances. Can the Minister justify how that woman living in my constituency, who has to travel to the four ends of the country to attend appointments, should receive the same allowance as someone in Galway city who is receiving care there? What about someone in Galway city who has to travel across the country to get treatment at St. Vincent's Hospital in Dublin? Where is the equality in that?

Time and time again, I have been told by the HSE's medical card section that it recognises geographical considerations when people must travel to appointments. That is not happening, however, and people are being discriminated against geographically as regards medical cards. That is based on the fact that they happen to live in a rural area and can no longer access social welfare support to pay for the cost of a taxi to Galway city. Social welfare will not entertain that cost whatsoever. Consultants are not prepared to leave Galway city and carry out appointments in local hospitals, which would save such costs. The hospitals say it is not their problem how people get to appointments. They have no funds for that, so it is up to people to get there.

Is it any wonder that people are missing hospital appointments or struggling to cope with the costs of diagnosing chronic conditions, including cancer, when all these additional costs are not being recognised? One person might live in Galway city and can therefore access cancer treatment nearby via public transport, while another person might live in Arigna and has to pay over €200 for a taxi to Galway city, but it makes no difference as far as the HSE's medical card section is concerned. That is wrong and it should not happen. We were told that it was not happening, but I have the documentary evidence that it is occurring daily. That system needs to be changed without delay because people are being wrongly discriminated against based on where they live.

I want to ask the Minister about figures for the over-70s. Speaking in the Seanad last November, the Minister said that about 10,000 people over the age of 70 would get GP cards. In the briefing we got on this Bill, however, a figure of 36,000 was mentioned. Can the Minister explain the change that has taken place since his speech in the Seanad last November when he said an additional 10,000 GP cards would be issued? Now he says that 36,000 such cards will be issued. Does the Minister have any idea of exactly how many cards will be issued?

There is a welcome provision in the Bill for a new cohort of people who move in with a grandmother. If someone is a qualifying dependant who is not married to the person over 70, but is living with them, they can apply for a medical card based on having an income of less than €700 per week. This seems to be a new provision that has been included, and it is probably welcome because it will encourage young people who are not eligible under the existing medical card scheme to move in with a grandmother. They will thus become a dependant of their grandmother and on foot of that will be eligible for a medical card based on the higher threshold of €700. It will encourage people to move in with their grandparents, but what sort of a handle has the Minister put on the figures involved?

I would like the Minister to clarify the income threshold for a medical card. There is provision in this legislation for the over-70s medical card whereby the income threshold can be increased in line with inflation. Yet for the standard medical card the income threshold for a single person is €184 per week, which is less than the basic social welfare rate of €188. Anyone earning the social welfare rate who is trying to go out to work will be denied a medical card, but if they sign on for the jobseeker's allowance they will get a medical card, even though they have the same income. If a person is slightly over the social welfare income, they will not get a card at all. That is because the income thresholds have not kept in line with inflation or even with social welfare increases over the years.

Surely it is an anomaly within the system whereby we are discriminating against those who want to work but cannot hold onto their medical card. They cannot keep the medical card because when they go over the income threshold the card is withdrawn. It is a barrier for people who try to get off the live register and work. That issue needs to be examined urgently.

12 o’clock

One other issue I want to raise concerns the same section in the Bill. There is a provision in it where compensation payments under the hepatitis C tribunal and the Residential Institutions Redress Board are disregarded for the means assessment. That is very welcome but there is another small cohort of people of whom the HSE and child care services have been grossly negligent as regards protecting children under the age of 18. After their 18th birthdays the HSE has paid out significant amounts of money in compensation because of the gross neglect, yet they are being penalised in the means assessment as regards both the medical card and social welfare. There is no recognition of that in the legislation.

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