Pádraic McCormack (Galway West, Fine Gael)
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I wish to be associated with the matter raised by my colleague Deputy Burke, which he has dealt with adequately.

I am glad to have the opportunity to raise the matter of the proposal by the Government, through the HSE, to transfer medical card and GP visit card services to the primary care reimbursement service and to centralise these services in Dublin. How could this possibly make sense? The transfer is being put forward as a saving or an improvement of the service when it will actually cause a reduction in the level of service available. There are 87,000 medical card holders in Galway who will be left without a local service. Centralisation to Dublin is contrary to Government policy. Why not decentralise it all to Galway? Medical card-related dealings with the over 70s have already been transferred to Dublin. This is creating a major problem for older people, who are now unable to contact the service and are left waiting for long periods on the freefone line. I have had occasion to telephone the service several times on behalf of people who came to my office, and was left waiting for a considerable length of time. How can we expect people over 70 to contact the service in Dublin when they could have had a walk-in service in Galway?

The over 70s are being treated shamefully. They are being terrorised by the new system, which is causing them unnecessary stress and anxiety. It looks as though this may be deliberate, because some of them are now so confused that they will not proceed with their applications for medical cards even though they are eligible. For example, one person who contacted me received a letter in early January of this year stating:

Based on the information available to us in the HSE, you are not affected by this decision [to remove the automatic entitlement to medical cards for the over 70s].

You keep your Medical Card and all associated entitlements.

You do not need to respond to this letter or do anything else.

Please continue to use your Medical Card as normal.

Then, on 24 March, the person received a letter stating:

If you consider that you are still eligible for a Medical Card and wish to continue to avail of the General Medical Service you should complete and return a form MC1a(R) (attached) to the address below before 1 June 2009.

This is completely contradictory information for medical card holders. It was unnecessary to set them up in such a way, first telling them they did not have to do anything and then telling them they must fill in a form. This is complicated and stressful for people over 70, who have already been assessed and means-tested for the card.

The HSE has spent more than €1 million of taxpayers' money on two reports on health reform and then ignored the key recommendations. A recommendation in the McKinsey report was that health care be delivered in six to ten regions with a catchment population of between 500,000 and 700,000. Yet the HSE is proceeding to transfer the medical card service to Dublin, which makes no sense. It will save the HSE nothing because, naturally, staff who have families in Galway - with children in school and houses with large mortgages on houses which are worth much less than they were a few years ago - will not be able to transfer and will have to be redeployed somewhere else.

The centralisation of the medical card service is of no benefit either to the public or to the HSE. It has been the policy of the HSE to have service based locally - for example, primary care teams - yet one section, which is the basis for entitlement to all those services, is now being transferred to Dublin. The front-line staff of the medical card service provide a valuable service locally to people who are ill, vulnerable and elderly. These people will now be left without a core walk-in service or a local number they can telephone. This displays a total lack of understanding of the work being carried out in local offices by the dedicated staff and shows a cruel and complete disregard for medical card holders. The staff in Galway have been working flat-out and providing an excellent service, and the transfer of the service does not make any sense. This is a Government decision, as stated recently by an official at a HSE briefing. For the Government to make such a decision in this day and age is baffling.

John Moloney (Laois-Offaly, Fianna Fail)
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I thank Deputy McCormack for raising this matter on the Adjournment and apologise that the Minister, Deputy Harney, cannot be here this evening.

The assessment of eligibility for medical cards and GP visit cards is statutorily a matter for the HSE. Eligibility is determined following an examination of the means of the applicant and his or her dependents. Up to 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 in the primary care reimbursement service in Dublin. The change is being implemented on a phased basis.

The decision by the HSE to centralise the processing of applications has been made in the context of the requirement to realise savings in the challenging economic environment. The change will provide an enhanced standardised service to the client population. It will deliver services for the public within sustainable levels of expenditure and with the aim of achieving efficiencies through greater use of shared services. The processing of applications centrally will result in the application of a more consistent and transparent approach. There will be no adverse impact on patient care or the quality of service provided, and there will be no adverse affect on the assessment of people whose incomes exceed the income guidelines but who have a case to be considered on medical or hardship grounds.

Under the new arrangements, the HSE will be aiming for a turnaround time of 15 days or less for all applications. Emergency applications will be dealt with immediately, with a card issuing within 24 hours.

Pádraic McCormack (Galway West, Fine Gael)
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That is impossible.

John Moloney (Laois-Offaly, Fianna Fail)
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That is the commitment we have made.

There are no plans to close any of the local health offices that currently process medical card and GP visit card applications. However, the process will involve a reassignment of existing staff within the Health Service Executive. Local health offices will continue to provide advice and necessary supports to persons applying for medical cards and GP visit cards. They will also deal with queries of a general nature about the medical card scheme. Together with the Health Service Executive's national helpline, they 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 Health Service Executive 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 240,000 since the start of 2005, with more than 1.38 million now covered. In addition, more than 88,000 have a GP visit card. In other words, in excess of 33% of the national population is covered by the General Medical Services scheme.