Michael Ring (Mayo, Fine Gael)
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What is happening is disgraceful. People over 70 fully entitled to a medical card, when they submit their review forms with supporting information, find that they still have not received their cards months later. Several have received letters from their doctors to tell them their medical cards have been cancelled. A number of very upset people have contacted my office. These are people who were due for hospital admission or needed medical procedures but are refusing to leave home because they cannot afford the hospital bills and they cannot get their renewed cards. This is no way to treat the elderly in our society. It is an appalling situation that has been allowed to develop. The elderly are very frightened because the medical cards to which they are entitled are not being sent out to them. The Minister cannot blame the HSE. She has the responsibility for this. I demand that those cards be sent out immediately to alleviate the hardship and remove the fear from these people.

I shall cite three cases. There is a 93 year old woman in the district hospital whose medical card expired at the end of October. She was given a temporary card until the end of November. Her daughter spent more than an hour and a half on the telephone to the HSE one day trying to get this matter resolved. The HSE says it could be some weeks before the medical card issues. Her family had been told that they will have to pay for their mother's stay in the district hospital and they are not in a position to do so.

An 84 year old woman has waited three months for her medical card. She needs hospital treatment, yet is refusing to be admitted until such time as she has her card, as she is afraid she will have to cover the medical expenses. Her daughter telephoned the HSE nine times and on one occasion was left 18 minutes on hold. On another occasion she was left holding for a full ten minutes.

An 85 year old woman, who has spent most of the year in hospital and has several more operations to undergo, has told her family she will not attend for any further surgery until she receives her medical card.

Yesterday, I wrote to the Minister for Health and Children because I knew she would not be here tonight nor any of her Ministers of State, which is a disgrace in itself. I also wrote to Professor Brendan Drumm. I tell Dr. Drumm and the Minister that this is an outrageous situation where people over 70 are worried and frightened, because the HSE removed this service from every county and centralised it in Dublin. It is now on a go-slow and unable to cope with the workload.

I am calling on the Minister tonight to bring the services back into the regions and the counties where there was no problem before, and not have elderly people frightened. I call on the senior citizens to march as they did a year ago, to ensure that elderly people aged 70 and over get the medical card to which they are entitled. It is a disgrace, an attack on the elderly and I am disappointed there is not a Minister or Minister of State present from the Department of Health and Children. How can this be sorted when they are not here to listen to what is going on?

Martin Mansergh (Tipperary South, Fianna Fail)
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I will take the adjournment on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children.

Under the Health Act 2008, the income thresholds for entitlement to a medical card for persons aged 70 or over is €700 gross per week for a single person and €1,400 gross per week for a couple, effective from 1 January 2009. All existing medical card holders aged 70 or over are now required to undergo a means assessment. Under this assessment they are required to complete a simplified review form, and provide up-to-date evidence of their income. To date this year, 26,713 reviews in respect of persons aged 70 years or over and their dependants have been received in the HSE's central office. Some 22,726 - 85% - of these have been completed with eligibility confirmed to the client.

Additional information has been requested from 3,194 persons - 12% - who did not provide the required information or evidence. Some 735 persons -2.8% - are currently going through the assessment process, 58 people - 0.2% - lost eligibility as their current income is above the income thresholds and 85% of the completed reviews, where all the relevant information was supplied, were completed within 20 days, with 95% completed within 30 days.

The HSE has indicated that it has no control over delays where relevant information is not provided but it has confirmed that when the required information is received the review is processed without further delay. The Deputy will also be aware that under its 2009 service plan, the processing of all medical card and GP visit card applications will transfer to the HSE's primary care reimbursement service, PCRS in Dublin. The initial phase of the centralisation process commenced in January 2009 with the PCRS processing all medical card applications for persons aged 70 or over.

The second phase commenced in September 2009 with the transfer of the case load from two local health offices in Dublin city to the PCRS. The phased implementation will allow the situation to be continuously monitored and, if required, modified to address any issues arising. The PCRS has processed more than 63,000 medical card applications since the start of 2009.

Centralising of the medical card application and review process is facilitating a number of enhancements to the level of customer service associated with these applications. The HSE has recently put in place a national on-line system to allow local health offices track the current status of applications in the PCRS.

The HSE has also advised that it is in the final stage of the development of an on-line facility where clients or persons acting on their behalf can apply for a medical card on-line if they wish. It will be able to view the status of their medical card application on-line and if a mobile phone number is supplied with an application, updates by text message will be delivered to the applicant's phone. The Department of Health and Children is in discussion with the HSE about putting in place a dedicated telephone number for Oireachtas members for inquiries about applications being processed by the PCRS.

The Minister fully supports the HSE's decision to centralise the medical card and GP visit card application and review process to one location. The HSE has advised that when fully implemented, this measure will ensure: improved turnaround time for the processing of applications - under the new arrangements, the Executive will aim for a turnaround time of 15 days or less for all medical card applications and emergency applications will be dealt with immediately with a card issuing within 24 hours; equitable application of eligibility across the country; consistency of service provision to customers; clearer lines of governance and accountability; and improved unified data.

The Minister is satisfied that the reviewing of medical card eligibility on expiry or change of circumstances is a necessary process to allow the HSE maintain accurate database information and the best use of public resources. I have been asked to highlight that the number of persons with a medical card has increased by more than 316,000 since the start of 2005. More than 1.46 million people are now covered by the medical card. In addition, more than 95,900 people have a GP visit card.

Michael Ring (Mayo, Fine Gael)
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No disrespect to the Minister of State, but it has been a waste of time for me, coming in tonight. He did not dealt with the query I raised, namely, what was happening as regards the go-slow in the Department and what it was doing about it. I got the answer - nothing. I am calling on the elderly to march on the Minister for Health and Children's office, to try and get this resolved. It is an attack on the elderly, and is outrageous.