Mattie McGrath (Tipperary South, Independent)
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I thank the Ceann Comhairle for giving me the opportunity to raise this matter of huge importance. It is a problem in the HSE primary care reimbursement service system that is preventing medical card patients from accessing their care and medication. It must be rectified as a matter of urgency.

I was shocked recently when a medical card holder informed me that she was charged by her doctor for visiting him as she was told her medical card was invalid. She was then told by her chemist that she would have to pay for her medication. Luckily, she had enough medication to last a few days until this problem was dealt it. This patient was a medical card holder whose card was due for renewal. A number of months ago she submitted all her documentation but due to the large backlogs in the local medical card office her review had not yet been dealt with.

The medical card office has a policy that if a number of medical card reviews remain unprocessed on the last working day of each month, the unprocessed applications are rolled over into the next month. This extends the medical card expiry date for another month to allow the review be finalised. However, due to a glitch, it takes approximately four days for the primary care reimbursement service system to be updated and during these four days, the patient's medical card will be shown as "card expired" in the system. That is a worrying and most unsatisfactory situation, particularly for the elderly.

Unfortunately, my constituent was obliged to attend her doctor within these four days. If she had not, she would not have been aware of this situation. Her medical card was rolled over on the last day of October and when she attended her doctor four days later, she was told her card was expired. This was just one of the 2,300 reviews rolled over in south Tipperary last month. There were thousands more throughout the country. I have great respect for the local health board officials who do their best but there is a glitch in the system which must be rectified.

Having checked with the primary care reimbursement service I was informed that it was not its problem. I then spoke with staff in the local office who informed me that they had updated their system on the last day of the month, four days previously, and that the primary care reimbursement service had not yet updated its system. I was also informed that this was a very common problem. I ask the Minister to examine this issue immediately and to try to rectify it.

Joe Costello (Dublin Central, Labour)
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The medical card is a matter of life and death for many people. Not having a medical card can have a very serious effect on a person's health. The changes the Minister introduced recently with regard to the medical card, the general practitioner, GP, card, the centralised system for processing renewals and fresh applications and the new prescription levy for medical card holders have added to the confusion and delays in the system. Why is it the case that the health system, above all else, has constant delays, queues, confusion, bureaucracy and waiting lists? It is almost as though it is a purgatory which sick people have to endure before they are able to access medical care and their rights. I find that many more people have come to my clinics in recent months regarding medical cards than I ever experienced before. Much of that is a result of the new changes the Minister introduced.

The situation is very depressing and worrying for people who have difficulties with applications and renewals. The current system is such that it can take months to process them. There are regular requests for additional information. The official average time for appeals is now two months. Documents go missing on a regular basis. The elderly and the chronically ill suffer most and they have immediate needs which should be addressed. A centralised system now operates on the north side of Dublin in a compound that is worthy of Fort Knox because it is impossible to get in and out of the place. It created a bureaucracy that results in everybody being put on the same conveyor belt when a local system with local information and local knowledge would produce instant results.

In addition, the system does not do what is supposed to do, namely, provide a level playing field. Rather, it discriminates against the elderly and chronically ill as they are most likely to have difficulty with filling out the application, renewal and appeal forms. The Minister must realise that she is dealing with the most vulnerable of citizens. An application processing system should reflect that rather than creating a centralised bureaucracy and pretending that all is well.

Seán Connick (Wexford, Fianna Fail)
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I thank Deputies McGrath and Costello for raising this Adjournment matter, which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

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 and their dependants. 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 the executive's value for money programme. The 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 the executive's requirements 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 has allowed the situation to be continuously monitored and, if required, modified to address any issues arising. Under the centralisation plan, the HSE's local offices will continue to provide the public with assistance and information locally on medical card eligibility and making an application. They will also provide information on the current status of their application or review.

In June 2010 the HSE introduced a new website, www.medicalcard.ie, which enables people anywhere in the country to apply for a medical card through a simple and efficient application process. Phased implementation of the centralisation project will allow the situation to be continuously monitored and, if required, modified to address any issues arising. To date, the central PCRS office processed over 232,461 medical card applications and reviews of which 7,023 were unsuccessful, 186,512 medical cards were issued and further information is awaited in respect of 14,141 applications. Some 7,534 applications are currently being assessed.

The Minister for Health and Children in her letter to all members of the Oireachtas on the 19 January 2010 stated she 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 deliver a number of improvements for medical card applicants. Under the new arrangements, the HSE will improve turnaround times for the processing of applications. The aim will be a turnaround time of 15 working days or less, with provision for emergency applications to be dealt with immediately.

Joe Costello (Dublin Central, Labour)
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That is what the Minister said six months ago.

Seán Connick (Wexford, Fianna Fail)
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The centralisation of applications will deliver consistent and equitable application of eligibility and service provision. This measure will provide clearer governance and accountability, as well as improved management information. Finally, the process will lead to a reduction in the overall number of staff required to process medical and GP visit card applications, thus freeing up staff for other service needs.

The decision to centralise the medical card application and review process to a central office will, when fully implemented, enhance the delivery of services provided to the public. It will also realise overall savings through the greater usage of shared services. This decision is in line with the Government policy Transforming Public Services programmeannounced by the Taoiseach in November 2008. The HSE has indicated that procedures are in place to ensure that gaps in eligibility, as described by Deputy McGrath, do not occur. Each month the HSE PCRS updates the central national database on the day that the data is provided to them by local health offices.

In cases where the local health office considers that a review of eligibility will require additional time to complete, then eligibility should be extended prior to the last month which prevents any gap in eligibility for the medical card holder. The HSE is not aware of any such problems and if the specific details of the issue in question are passed to it, it will investigate the matter. If the Deputy has information that a gap in eligibility has occurred in an individual case, the details should be forwarded to the HSE who will investigate it. These individual cases suggest that the procedure to prevent eligibility gaps has not been uniformly implemented. This problem does not arise in regard to the 39% of the medical card population that are being managed directly by the central office at PCRS. This error will be eliminated altogether when the centralisation process is completed early next year.