John O'Mahony (Mayo, Fine Gael)
Link to this: Individually | In context

I thank the Ceann Comhairle for permitting me to raise this matter. There has been a great deal of talk in recent weeks, both in this House and outside it, regarding changes in social welfare provision and how they affect older and vulnerable people. The issue I wish to raise is related to that debate but not directly relevant to the budgetary provisions, namely, the delays being experienced by applicants throughout the State regarding the granting and renewal of medical cards.

The Minister referred in the Chamber last week to the huge increase in the number of medical cards issued in recent years as a consequence of the changed economic climate. I do not mean it as a criticism of anybody working in the medical card processing system in observing that the service seems to be overwhelmed. This is causing additional trauma for applicants, particularly elderly people and those with ongoing medical issues. The application and processing system was centralised during the summer, which we were told would offer enhanced efficiency and quicker processing times. That does not seem to be happening. Instead we seem to be facing a situation similar to that which arose at the Passport Office.

I ask the Minister to address this issue as quickly as possible. Members on all sides of the House are being contacted by constituents experiencing delays in the granting and renewal of medical cards. People come to us because they find it difficult to get information directly in regard to their applications. We are often the first port of call for distressed constituents. We would all like to see a system that works well and would not require our intervention. I have spoken to people who, having sent in information that was requested following an application, are told when they contact the central processing centre some weeks later that there is no record of the information being received. Other constituents who have appealed a decision to the appeals office in Donegal are told by staff there that the relevant file is in Dublin, only then to be told by staff in Dublin that it has been sent to Donegal.

I was prompted to raise this issue by a case of which I became aware five or six weeks ago which serves as an example of how the system is failing to respond in a timely manner. The person who contacted me had a family member who had been diagnosed with cancer and was deteriorating rapidly. Under the previous system, local knowledge would have ensured that a medical card was granted quickly. Under the new system, however, that did not happen, and the card was only finally issued a week after the person was buried. In another case I spoke to a couple who had been granted a medical card at the beginning of 2011. However, when they tried to fill a prescription some weeks ago, the pharmacist told them the card was invalid, a development of which they were not informed. I hope the Minister of State, Deputy Kathleen Lynch, will address these issues in her response.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

I am responding to this matter on behalf of my colleague, the Minister for Health, Deputy James Reilly. I thank the Deputy for raising it as it provides me with an opportunity to set out the progress made by the Health Service Executive's initiative to standardise the processing of medical cards throughout the country. 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. While income guidelines are the principal benchmark used for deciding medical card eligibility, the HSE also has regard to other matters considered appropriate in assessing a person for a medical card.

The HSE implemented its decision to centralise the processing of all new applications and renewals of medical cards at the primary care reimbursement service, PCRS, in Finglas, Dublin, on 1 July 2011. Following the centralisation of the service, the PCRS reported that it was receiving approximately 20,000 applications per week. The PCRS estimates that in excess of 80% of complete applications are processed within 15 working days. Delays can occur where applications are submitted without the correct supporting documentation necessary to complete the processing of the application.

All applications are given a unique application number by the PCRS, which is immediately notified to applicants. Applicants are advised of the importance of quoting this unique application number on all correspondence with the PCRS because it is used to track all correspondence as well as the current status of the application. In cases where an application is not complete, the PCRS writes to the applicant requesting the missing documentation.

In cases where a decision is made not to grant a medical card, the applicant is informed of the decision, notified of his or her right to appeal this decision and contact details for the appeals office are provided. Where appellants submit an appeal within 21 days of a decision, they retain their medical card or GP visit card until the appeal is decided. The appeals officer notifies the appellant of the final decision in the case.

In 2010, as part of the centralisation project, the HSE introduced a new website, www.medicalcard.ie, which enables people anywhere in the country to apply for or renew a medical card through a simple and efficient application process. Thousands of applications are now submitted online every month. Applying online also gives applicants access to up-to-date information on the progress of their medical card renewal or application.

Following centralisation, staff in local health offices continue to provide information and assistance to individuals in regard to their applications for medical cards. They also provide information on the current status of a person's application or review by tracking the application on the PCRS system. The centralisation project is part of the HSE's effort to deliver efficiencies and reduce overhead costs in a manner that minimises the impact on front line services. The administration costs of the PCRS represent less than 1% of the value of the payments processed by it.

The progress of the centralisation project is being continuously monitored and, if required, modifications will be made to address any issues arising. Centralisation delivers consistent and equitable application of eligibility and service provision. It also facilitates clearer governance and accountability, as well as improved management information. Nevertheless, I very much take on board the Deputy's point that for people who are not computer literate, particularly elderly people, it can be a daunting process.

John O'Mahony (Mayo, Fine Gael)
Link to this: Individually | In context

I thank the Minister of State for her reply. However, what she described is how the process should work; my contention is that it is not working as it should. The Minister of State mentioned the extra thousands of applications being submitted. Have additional staff been allocated to the centralised processing service to meet this demand? Some applicants are giving up in despair when they cannot get through to the call centre. Others are told to contact their local office only to find the latter knows nothing about the matter and must then contact the central office on the applicant's behalf. Has that part of the service been outsourced? As the Minister of State observed, the online facility is of little use to older people who may not be computer literate.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

The problem is often that people do not apply for a medical card as soon as they experience a reduction in income. Instead, they wait until they must attend a doctor before applying, at which stage a delay is inevitable because the process must take its course. The positive aspect of the scheme is its equitability. On the other hand, it was great for us, under the old process, to be able to contact the local health manager and explain a constituent's case in detail. The downside of the process is that we and the individual applicant can no longer do so. The GP card or the medical card may be retained until the appeal process is completed and this gives wriggle-room or time to collect additional information as sometimes this may be the difficulty. I acknowledge there are kinks in the system which need to be ironed out and one of the significant kinks in the system is that the local offices do not have sufficient staff to process the files at local level. This will need to be dealt with.

The medical card system works well in the case of the over-70s and this is because it has been in place for longer, but the kinks in the system remain in terms of the overall country-wide application.