Dáil debates

Thursday, 28 January 2010

2:00 pm

Photo of Joe CostelloJoe Costello (Dublin Central, Labour)
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I am delighted to have the opportunity to raise this very important issue. I am asking the Minister for Health and Children to establish an all-party Oireachtas committee to review the background to the decision to centralise medical card applications and renewals. I do not call for that lightly; I do so because the system is simply not working. That is the experience I have had with my constituents and I hear anecdotally that most of my colleagues have the same experience.

We need to review carefully how and why the decision was made, how the system is operating and what we can do to resolve the matter. Since the system has been centralised there seems to have been a sharp increase in the length of time it is taking for people applying for medical cards to have their applications processed. The centralisation has also caused confusion and unnecessary hardship to many who are applying. Nearly a year ago a unilateral decision was made to centralise all medical card applications and renewals. All medical card applications and renewals are now being processed by the primary care reimbursement service, PCRS. The PCRS was not designed for this purpose and has been forced to try to cope with the extra and unfamiliar workload. The medical card system was previously based around the local health care providers who made decisions on a case-by-case basis. This system was effective because those who were making decisions had a personal knowledge of the applicants and their needs. The new centralised system does not have this advantage and this could mean that people who are in need of medical cards may not receive them or may receive them only after a long waiting period.

Centralisation has caused chaos to the medical cards applications and renewals process. The PCRS was not set up to deal with medical cards and has struggled to cope with the influx of applications. Some 10,000 people have had to reapply for medical cards since centralisation. The PCRS was not consulted on the plan to centralise the medical system and place it under its control. Now the Minister for Health and Children has had to provide it with extra resources and personnel. Even with these extra resources the PCRS is struggling to cope. The public is finding it extremely difficult to contact the medical card section and when they do finally manage to talk to someone that person is often not the one in charge of that particular case. This situation is made worse by the fact that there is no way to meet a representative of PCRS in person. There is no public office, no reception and anyone who calls to PCRS is turned away by security personnel. It is like the Dark Ages.

My office has been inundated with calls inquiring about medical card applications and renewals. One constituent who contacted me applied for a medical card in February 2009 in her local HSE office. When she subsequently changed her address and contacted the PCRS, it did not have her file so could not amend her address. Neither was the file in local office, so it had disappeared into thin air. On 22 January 2010 I contacted the PCRS about her situation. She still has not received a medical card.

A second constituent who applied to renew her medical card in August 2009 by registered post is still waiting a response. I tabled a parliamentary question to the Minister for Health and Children on 8 December and it was passed on to the HSE. I am still awaiting a reply, almost two months later. These are just two of many cases that have been brought to my attention and they seem to be commonplace, as may be gleaned, anecdotally from the experience of colleagues in the House. It is the sick, elderly and the vulnerable who are suffering.

There is a need for an all-party Oireachtas committee to investigate the situation. It needs to look at the preparation and planning that went into making the decision to centralise the medical card process, examine the problems the system is now facing and decide how best to deal with them. Also, the committee needs to investigate the affects of the delays and numerous lost or mishandled applications.

The Minister for Health and Children told the House on 24 November 2009 that the turnaround time for applications was 15 working days.

Photo of Seán HaugheySeán Haughey (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Dublin North Central, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

Following the change in medical card eligibility for persons aged 70 and over in the Health Act 2008, the HSE through its service plan for 2009, advised the Department of Health and Children of plans to introduce a centralised national processing centre for medical cards and community drugs schemes as part of its value for money programme. The 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 informed the Department that its decision to centralise the processing of all medical card and GP visit card applications and renewals to the primary care reimbursement service, PCRS, in Dublin was in the context of its requirement to make efficiencies in business practices that could realise savings in a very challenging economic environment and provide a modern service to the public within sustainable levels of expenditure. 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. In 2009 the PCRS processed over 72,000 medical card applications which included nearly 42,000 reviews. With regard to these reviews, 85% of cases where the required information was supplied were completed within 20 working days and 95% within 30 days.

The HSE has recently put in place a national online system to allow local health offices track the current status of applications in the PCRS. The HSE has also advised that it has recently launched a facility, where a person who has applied through the PCRS can view the status of their medical card application or review online, using a unique reference number that is provided on the acknowledgement sent to him or her. In addition if a mobile telephone number is supplied with an application, updates by text message will be delivered to the applicant's phone. The PCRS is also finalising the development of a facility which will allow people to apply online if they wish.

The Minister for Health and Children in her letter to all members of the Oireachtas on the 19 January 2010 stated that she fully supports the decision by the HSE 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 times for processing of applications - under the new arrangements the HSE will be aiming for a turnaround time of 15 working days or less, with provision for emergency applications to be dealt with immediately; consistent and equitable application of eligibility and service provision; clearer governance and accountability, as well as improved management information; and a reduction in the overall number of staff required to process medical or GP visit card applications, thus freeing up staff for other service needs.

The decision to centralise the medical card application and review process will, when fully implemented, enhance the delivery of services provided to the public and realise overall savings through the greater usage of shared services. This decision is in line with the Government's Transforming Public Services' Programme announced by the Taoiseach in November 2008. Therefore, it is not envisaged that the establishment of an all-party Oireachtas committee is required to review this initiative.