Michael Ring (Mayo, Fine Gael)
Link to this: Individually | In context

I thank the Ceann Comhairle for selecting the matter I raise for discussion on the Adjournment. The position of Chair suits Deputy Wall, the Acting Chairman, well.

The reason I raise this issue is that a major concern has arisen in my constituency as a result of plans to centralise the processing of medical cards in Dublin. At present, applicants submit applications for medical cards to a community welfare officer and an appeal mechanism is in place at county level. Medical and other circumstances may be taken into consideration in the appeals process. This will no longer be the case if the processing of medical cards is centralised in Dublin.

People find it difficult to make contact with social welfare offices, Land Registry offices and various other Departments and bodies in Dublin. The planned centralisation of the processing of medical cards will not work. I call on the Minister not to permit the plan to proceed. As the current arrangement works well, I fail to understand the reason for the proposed change. One cannot remove services of this nature to Dublin. Until this week, Government policy was to pursue decentralisation and provide goods and services at local level. It is now moving in the opposite direction by removing services from local areas and transferring them to Dublin.

The most popular man and woman in this country are Mr. and Mrs. voicemail. People are frustrated because they cannot communicate with Departments. If applications for medical cards must be submitted to Dublin, it will create a major problem. I call on the Government to reconsider the current proposals because people are angry as they believe they will lose contact with community welfare officers and will be unable to make their cases properly. They are also worried that an appeals mechanism may not be provided.

The new arrangement will not work, as is clear from the operation of another scheme. Politicians tabled questions in the House regarding the nursing home repayment scheme. The outfit charged with processing applications under the scheme was supposed to have completed the process within a year. We are now in the second year of the scheme and it has still not done so. Removing services from local areas to Dublin does not always work and in this case it is wrong and dangerous. I call on the Government and Minister for Health and Children to stop it immediately.

Jimmy Deenihan (Kerry North, Fine Gael)
Link to this: Individually | In context

As Deputy Ring noted, plans are at an advanced stage to have the medical cards, drug payments, ophthalmic, dental, domiciliary care allowance and immunisation schemes centralised in Dublin or other locations. In January, the administration of the medical card scheme for those aged over 70 years was centralised to Dublin. This is the start of a process. I understand it is envisaged that the other schemes will be transferred to locations outside County Kerry by next June. The net effect is that up to 20 people will have to be relocated and some may lose their jobs.

The quality of service provided by local offices and community welfare officers is generally excellent. Community welfare officers in County Kerry understand local people well and do their best to help them out. The Minister of State should imagine the scenario which will arise if members of the public must telephone Dublin. Clearly they will not receive the instant service they receive in counties Kerry, Mayo and other areas.

I understand the centralisation of these services is intended as a cost-saving exercise and could result in a reduction of 300 jobs. While a commitment has been given at local level that staff will be redeployed, temporary staff will lose their jobs. In addition, end users will lose out because, as Deputy Ring stated, they will not receive the same personal service they currently receive. For example, a person who experiences a problem on a Friday evening currently receives emergency medical treatment. This will no longer be available because communications will not be possible and they will not be able to wait.

The proposed centralisation is a retrograde step. I understood current policy was one of promoting decentralisation. The Government appears to be rowing back on its commitment in this regard. The proposals will affect all parts of the country, including County Galway. Before entering the Chamber, I met Senator Healy Eames who informed me that people in County Galway face precisely the same problem and ten staff could lose their jobs as a result. People will no longer receive a personal service. I appeal to the Minister of State, Deputy Barry Andrews, to use his good offices to ensure the HSE scraps this plan, which will not provide the service vulnerable people need. The new arrangements will be highly disruptive for people who are sick or hold medical cards.

Barry Andrews (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context

I will take this Adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The assessment of eligibility for medical cards and general practitioner visit cards is statutorily a matter for the Health Service Executive and is determined following an examination of the means of the applicant and his or her dependants. Under section 45 of the Health Act 1970, medical cards are provided to persons who, in the opinion of the HSE, are unable without undue hardship to arrange general practitioner medical and surgical services for themselves or their dependants.

Section 58 of the Health Act 1970, as amended, provides for GP visit cards for adult persons with limited eligibility for whom, in the opinion of the HSE, and notwithstanding that they do not qualify for a medical card, it would be unduly burdensome to arrange GP medical and surgical services for themselves or their dependants. Under the Health Act 2008, the income thresholds for entitlement to a medical card for those aged 70 years or over is €700 gross per week for a single person and €1,400 gross per week for a couple.

Until the start of this year, medical card and GP visit card applications were processed in the 32 local health areas. However, under the HSE's 2009 service plan, the processing of medical card and GP visit card applications will be centralised and will transfer to the executive's primary care reimbursement service. The change is being implemented on a phased basis.

The decision by the HSE to centralise the processing of all medical card and GP visit card applications has been made in the context of the requirement to make efficiencies in business practices that can realise savings in this very challenging economic environment. The change will provide an enhanced standardised service to the client population with the ability to deliver services for the public within sustainable levels of expenditure and with the aim of delivering efficiencies by the greater usage of shared services for both internal administration and direct service delivery.

There will be no adverse impact on patient care or the quality of service provided and there will be no adverse effect on the assessment of people whose income exceeds the income guidelines but have a case to be considered on medical or hardship grounds.

Michael D Higgins (Galway West, Labour)
Link to this: Individually | In context

There will be an impact.

Barry Andrews (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context

Under the new arrangements, the HSE will aim for a turnaround time of 15 days or fewer for all medical card and GP visit card applications. Emergency applications will be dealt with immediately with a card issuing within 24 hours.

While there are no plans to close any of the local health offices that currently process medical card and GP visit card applications, the process will involve a reassignment of existing staff within the HSE. In this regard, discussions have commenced with IMPACT and SIPTU under agreed arrangements and these discussions are ongoing.

Local health offices will continue to provide advice and necessary supports to people applying for medical cards and GP visit cards. They will also deal with queries of a general nature about the medical card scheme and, along with the HSE national helpline, will handle inquiries from clients in respect of their medical card and GP visit card entitlements.

This is a good example of the type of innovation signalled in the transforming public services programme announced by the Taoiseach last November. It demonstrates how the HSE can deliver improved services within the more limited resources available in a way which meets the needs of citizens in a modern society.

The number of persons with a medical card has increased by more than 200,000 since the start of 2005. More than 1.35 million people are now covered by the card and more than 85,000 people have a GP visit card. In excess of 32% of the national population are covered by the GMS scheme.

The HSE service plan for 2009 highlights the impact of the continued growth in numbers on the live register and uptake of demand-led schemes as an ongoing challenge for 2009. Consequently, it has provided for an additional net increase of 81,000 medical cards and 46,000 GP visit cards in 2009. I am satisfied the centralisation of the medical card application process will ensure a more efficient service for the public during these challenging times.

Michael Ring (Mayo, Fine Gael)
Link to this: Individually | In context

It is another attack on the poor.

Paul Connaughton Snr (Galway East, Fine Gael)
Link to this: Individually | In context

The issue raised by Deputies Ring and Deenihan is connected with the issue I propose to raise, namely, the awarding of medical cards to those aged more than 70 years. As the Minister of State will be aware, every pensioner aged over 70 years received a letter in February from the primary care reimbursement service in Finglas, County Dublin, the office which will carry out all assessments for medical cards. The letter stated that those who believed their income was less than €700 per week in the case of an individual or €1,400 per week in the case of a couple had no reason to return their medical cards. In other words, people would be taken at their word. As we know, 10,000 or 12,000 answered it and said their income was over the guidelines. A commitment was given at that time by the Minister for Health and Children and Professor Drumm that this was the end of it. They gave people a guarantee that this was the only assessment that would be made.

This week, five or six elderly people ranging in age from 75 to 90 called to my clinic. They had another letter in their hands. At this stage they had two letters. They received a new letter last week with a new application form which they had to fill out to apply for a medical card. The application required them to go to their doctor to have it signed, to the bank to prove the amount they had in savings and to the Department of Social Welfare to prove the size of the pension they received.

I know the Minister of State, Deputy Andrews has an interest in this matter. Can he imagine, having been told a month before that this was the end of the assessment, that people received another confusing letter? They were running around as if they were 50 years younger to go to all the various places required and send the application to Finglas in Dublin.

There is great deception going on. This is out of all order. All this has happened within the past month without the Minister for Health and Children or Professor Drumm stating publicly that all persons over 70 with a medical card will be assessed as the due date is reached on their medical cards. This is an outrageous attack on the elderly. The Government could have been honourable and said every person over 70 will be assessed. However, it is beginning to forget the thousands outside on the streets last October. Its memory is getting short.

This is beginning to frighten people. Once this becomes well known this type of deception will not be accepted by the elderly. Can one imagine a 90 year old having to go to the bank, the Department of Social Welfare and the doctor to complete the application and send it to Finglas? There was a telephone number for Finglas one could ring. I tried seven times yesterday and today to get through to it and I only got through this evening. Can one imagine an elderly person in Mountbellow in Galway trying to get through to that number to have a normal, reasonable query answered? If ever we were in for one of the greatest debacles of all time, it will be the medical cards.

Barry Andrews (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context

I will take this adjournment matter on behalf of the Minister for Health and Children, Deputy Mary Harney.

Under the Health Act 2008, automatic entitlement to a medical card for persons aged 70 or over ceased on 31 December 2008 and with effect from 1 January 2009 the income thresholds for entitlement to a medical card for those aged 70 or over is €700 gross per week for a single person and €1,400 gross per week for a couple. Where a person aged 70 or over does not qualify for a medical card by virtue of his or her gross income being over the specified thresholds, he or she may apply to the HSE for a medical card or GP visit card under the existing net income thresholds, which allow for medical, nursing and other relevant expenses to be taken into account.

Notwithstanding that, the HSE may issue a medical card on a discretionary basis, if the applicant would otherwise be caused undue hardship in providing general medical and surgical services for himself or herself. Following enactment of the Health Act 2008, the HSE wrote to all medical card holders aged 70 years and over in January 2009. Persons who were in receipt of a medical card without a means test, where they were granted a card on age grounds when they reached the age of 70, were requested, if they were over the income limits set out in the Act, to make a declaration to the HSE on or before 2 March 2009.

Where persons received a medical card after undergoing a means assessment, the HSE wrote to them to advise them that they would retain their card as long as their circumstances did not change. They were not required to take any further action. It must be emphasised that in the normal course of events when the medical card of a person in any age category reaches its expiry date and comes up for review, the HSE will carry out a review to confirm their ongoing eligibility status. The review for persons aged 70 and over will not take the form of a full application but will be a simple review of gross income to ensure continued eligibility and accuracy of information.

To date, 19,954 medical cards for persons aged 70 and over have been returned or removed from the medical card register and 10,690 of these cards were returned to the HSE by persons aged 70 or over whose weekly income was in excess of the specified thresholds. It is important to note that the vast majority of people in the age group, in excess of 343,000, retained their medical card. In addition to the returned medical cards, a further 9,264 cards were removed from the medical card register as part of a data quality exercise, where for example, the HSE had been advised that the card holder is deceased or the card holder was not known at the address. I am satisfied that reviewing of medical card eligibility on expiry or change of circumstances is a necessary process to allow the HSE to maintain accurate database information and the best use of public resources.