Ciarán Lynch (Cork South Central, Labour)
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I thank the Ceann Comhairle and his office for providing me with the opportunity to debate this issue and I thank the Minister of State, Deputy Shortall, for coming to the Chamber to respond to the debate.

I very much welcome the recent announcement by the Department and the Minister that under new procedures, a medical card will remain valid, irrespective of the expiry date on the card, once the medical card holder is genuinely engaging with the HSE review process. Given the long delays in processing medical card applications, this should bring some relief to applicants, especially renewal applicants who have been turned down and feel they have strong grounds for appeal.

Under the new procedure, as Members may be aware, while an appeal is being processed the claimant should be able to present the existing card to a doctor or pharmacist who can check the validity of it on the website www.medicalcard.ie. If a person's card is under review, the person presents it to a pharmacist or GP who goes online and sees the card is under review, and the person remains in the system. However, therein lies the problem.

I will take the example of one of my constituents who had been engaged in the review process. This person had been granted a full medical card for more than a decade but on review was issued a GP visit card. When this decision was being appealed, it was discovered, during a visit to a pharmacist, that the person had been locked out of the system. The difficulty then arose of having to meet medication costs while locked out of the system.

The appeal process cannot be seen online. When the medical card was checked online, it should have shown the card was under review, but it showed a GP visit card had been granted. A technological system which is supposed to be more efficient is causing a problem. For the new procedure to work the medical card database must be up to date and must be cognisant of the appeals process. My office has tested this. I do not claim the examination was scientific but we entered a selection of valid GP visit and full medical cards and drug payment scheme cards, none of which was recognised by the system. There is a technical difficulty. In bringing the matter before the House I ask the Minister of State to examine it and explore how the difficulty can be surmounted.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputy Lynch for raising this issue. I am very conscious of the fact there have been serious difficulties and delays in processing applications, renewals and appeals of medical cards. I have been in ongoing discussions with the HSE in recent months to ensure the level of service provided to the public is brought up to an acceptable level because what is happening at present is not acceptable.

I wish to clarify a number of developments that have taken place in recent weeks and months which should improve the situation. Any medical card holder undergoing a review for a renewed card who genuinely engages with the HSE in this review will retain entitlement to a medical card until such time as the HSE decides on the outcome of the review. This new procedure applies to individuals regardless of the expiry date shown on their medical card.

The eligibility of all standard medical cards for people under 66 years of age has been extended to three years, and to four years for people aged 66 years and over. A self-assessment review process is now in place for all standard renewals for all clients, regardless of age. Discretionary cards, emergency cards and cards held by people in a small number of other categories will continue to be reviewed in the normal way. A fast-track decision process and the associated technical changes have been put in place to deal with urgent review cases. In addition to these changes to the processes for medical card applications, 20 additional staff were redeployed to the central office in January to bring its complement to 150 people. I hope this will help improve the level of service.

I know Deputy Lynch is particularly concerned about medical card appeals. It is HSE policy that a person's eligibility is maintained while the outcome of an appeal is awaited. I will ask the HSE to ensure immediately that this policy is applied in respect of the case the Deputy highlighted and to ensure adequate procedures are in place to prevent mistakes such as this occurring in future. I will engage further with the HSE on the points raised by the Deputy in respect of the website www.medicalcard.ie. I have taken note of the points he has made and I heard a similar complaint recently.

On the broader issue of appeals, I have had very constructive engagement with the HSE in recent weeks on addressing the backlog in medical card appeals. Extra staffing resources have been deployed in this area in recent weeks. The backlog in appeals is being reduced. In recent weeks more than 500 files have been cleared. I expect progress will continue to be made. Senior staff in the Department have assured me they are targeting the end of April as the date by which most of the backlog should be addressed. I have asked for regular updates on progress in this regard. I am very hopeful we will see significant improvement in the coming weeks. I accept fully what Members have been saying about this. The current level of service has not been acceptable. I thank the Deputy for raising the matter.

Ciarán Lynch (Cork South Central, Labour)
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I thank the Minister of State for coming to the Chamber to respond to this issue. I acknowledge the categorical statement made that people whose cards are under review are entitled to be provided with treatment under their previous qualification. We have a systems rather than a policy difficulty here. The policy is correct but the systems difficulty must be sorted. I appreciate the Minister of State's response in dealing with this matter in a speedy fashion today.

I have a supplementary question. One of the initial stages in the proposed roll-out of a universal health care programme as laid out in the programme for Government is the provision of doctor-only medical cards for patients with long-term illness. This is a similar sort of process in that it broadens the qualification process for the medical cards. Will the Minister of State tell me how that part of the universal health care programme is developing?

Róisín Shortall (Dublin North West, Labour)
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I am happy to do that. As the Deputy noted, the programme for Government commits to introducing free GP care during the lifetime of this Government. The first phase will be introduced shortly, bringing all existing claimants of free drugs under the long-term illness scheme to free GP care under that initiative. That requires primary legislation although the Bill is short and straightforward. Work on it is well under way at this point and we hope to bring a memo to Government within the next few weeks, with the legislation to follow. I will seek to have that legislation taken as quickly as possible through both Houses. There is a backlog of Bills stacked up, including a number of health Bills, but I will seek to get this legislation through as soon as possible. I hope that first cohort of people will be brought into the free GP care initiative in the early summer.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Ceann Comhairle for the opportunity to raise this very important issue and I acknowledge the presence of the Minister of State, Deputy Ciaran Cannon.

Through parliamentary questions and a Fianna Fáil Private Members' motion I had the opportunity to outline our concerns about the adverse effects the proposed changes to staffing schedules for small schools will cause to many communities throughout the country. This issue is not confined to rural Ireland but is also a concern for some communities in urban areas.

I welcome that the Minister has included an appeals mechanism in respect of staffing schedules for small schools with effect from next September, and that the element of retrospection is removed. However, I understand from the circular that although this part of the retrospection element has been removed actual enrolment numbers for September 2012 have been increased. My understanding is that a school that formerly needed 49 pupils for a third teacher appointment will need to have 53 pupils enrolled in September 2012 to retain a teaching complement of three. The required higher number of pupils is a further cause of concern. Is there provision to take into account an individual school's circumstances?

The Minister's predecessor commenced a value-for-money review of the role of small primary schools which was intended to find out the best way of supporting such schools. Small schools should be valued and protected. The extent of the current concern is due to the unusually high number of primary schools we have in proportion to our population. This is the result of many factors, the most important of which is that our national schools have always played a focal point in the local community. Our population patterns and dispersal are very different to those of most European countries.

In terms of education standards the evidence is that pupil outcomes in smaller schools keep pace with those of schools that have much larger enrolment and specialised support services. Happily, in the past ten to 12 years we have had a major investment in our smaller schools in human and physical resources. In the overall context the money involved has been a tiny fraction of the State's spending but the impact has been enormous, positive and progressive.

I pointed out that 47% of the 3,200 primary schools in the State have five teachers or fewer and consequently it is evident what a huge impact the staffing schedule changes would have on small rural schools. We all accept that small schools tend to have a more favourable pupil-teacher ratio than larger schools. It is important that we bear in mind that teachers in small schools have pupils of different ages and different grades in their classrooms and this adds to the complexity of multi-grade teaching.

The proposed cuts will have a disproportionate and severe impact on minority faith schools such as Church of Ireland schools of which there is a sizeable number in my constituency of Cavan-Monaghan, as well as in County Donegal, the general Border region and elsewhere. Those communities are very concerned about the proposed changes and the future viability of their schools. Minority faith schools have experienced a comprehensive rationalisation during recent decades. If some of these schools close, for reasons of distance it will be practically impossible for some children to attend school under the patronage of one of the minority churches. Many of the clergy, teachers and parents involved in minority faith schools are extremely worried about the future of their schools and are extremely disappointed with the changes being introduced by the Minister.

This action flies in the face of the Minister's stated policy. What does this policy do for school patronage and choice? These changes are blunt in nature and force cuts based on numbers alone, without any consideration of a school's ethos, the geography of a particular area or the impact on the community of removing such a key amenity. In most areas such schools have been the beneficiary of good parental and community involvement. In addition to the potential effects on schools under the patronage of minority churches there will be a severe impact on Gaeltacht schools and gaelscoileanna. I outlined this point clearly in our Private Members' motion.

Why are such important decisions being made in advance of the value-for-money review? This should be finalised and in the public domain at an early date. It is simply not good enough for the Minister and his Department to advise small schools to consider their future and assess their options for amalgamation. The clear message is, "Talk among yourselves". This leads to uncertainty and doubt which are not in the interests of any school or any institution.

We all realise there can be a fluctuation in enrolments from year to year depending on the number leaving sixth class and the new intake. It is not easy for schools to prove likely enrolment for future years, particularly when the numbers are small. The enrolment of one or two pupils can be critically important in small schools. I appeal to the Government to recognise the importance of our small schools. That importance must be given due recognition. Unfortunately, the uncertainty has not been removed with the detail of the appeals mechanism.

Ciarán Cannon (Galway East, Fine Gael)
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I am taking this matter on behalf of my colleague, the Minister for Education and Skills, Deputy Ruairí Quinn. I thank the Deputy for giving me the opportunity to outline to the House the expansion to the staffing appeal process to include small schools affected by the recent budget measure.

Budget 2012 provided for phased increases in the pupil thresholds for the allocation of mainstream classroom teachers in small primary schools. This affects schools with enrolment of fewer than 86 pupils. The first of these phased increases in the pupil thresholds takes effect from September 2012. Out of an overall total of almost 1,200 small primary schools it is envisaged that marginally more than 73 schools will lose a mainstream classroom teacher in September 2012 as a direct result of the impact of the budget measure. The final number of such schools will become clearer as the teacher allocation process is progressed.

The existing staffing appeals process is being expanded to be accessible to those small schools which are due to lose a classroom post as a direct result of the budget measure. Such schools will be able to submit an appeal to the independent staffing appeals board on the basis that it is projecting increased enrolment in September 2012 that would be sufficient to allow it to retain its existing classroom posts over the longer term. The detailed arrangements for this are set out in the Department's staffing circular which was published yesterday on the Department's website. The first meeting of the staffing appeals board will be held in April. Small schools that are projecting increased enrolments in September 2012 should submit their appeals to it on or before Friday, 23 March 2012. The outcome of appeals will be notified to schools as soon as possible after the meeting of the staffing appeals board in April.

This Government recognises that small schools are an important part of the social fabric of rural communities. They will continue to be a feature of our education landscape. However, this does not mean that small schools can stand still or never have their staffing levels changed to something that is more affordable and sustainable for these difficult and challenging times.

School communities should have no reason to feel that there will be a forced closure or amalgamation of their local school. A school does not close because it loses a teacher; schools close because of a loss of pupils. Small primary schools that have had to close in recent years are those that are no longer viable due to falling enrolments. The enrolment in such schools had typically fallen below a total of eight pupils for two consecutive school years.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State for his reply but, unfortunately, it does not convey any assurance to schools under the patronage of minority faiths, schools in Gaeltacht areas or gaelscoileanna. I emphasise that this does not affect only rural schools. I met teachers and members of boards of management of schools in Dublin who are fearful for the future.

I welcome the extension of the appeals mechanism to cover small schools. Can individual school circumstances be taken into account? The uncertainty and doubt about the viability of a number of small schools has not been allayed by the Minister's decision and the detail provided regarding the appeals mechanism. I read the circular on the Department's website last night. It was starkly clear that the increased enrolment necessary next September will pose further difficulties for some schools. That is not the understanding I took from replies the Minister gave to parliamentary questions in the House previously. I instanced a school that needed an enrolment of 49 pupils to have a three teacher complement last September, which will need an enrolment of 53 pupils next September to maintain that complement. It is not easy to increase enrolment by that number in a small area, given that enrolments fluctuate.

Ciarán Cannon (Galway East, Fine Gael)
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Unfortunately, the budgetary and academic years do not coincide and anomalous cases always arise when a change is made to the pupil-teacher ratio in the middle of the academic year. This is not unusual and it happened in the past when previous Governments implemented changes to the pupil-teacher ratio. The number of pupils required for retention of a teacher was increased and the Department used the numbers enrolled the previous September to work out the posts that would be retained or lost the following September.

The appeals process sets out deliberately to resolve the anomaly that has arisen from the recent budgetary change. Such concession has not been available to schools in the past and I am glad it will be from now on. Minority faith schools, gaelscoileanna and schools in Gaeltacht areas will also have access to the new appeals process. It sets out to address the potential anomaly whereby we might have removed a teaching post from a school only to find that the pupil numbers dictated that the post would have to be reinstated the following year. The process will take that into account and if a school is experiencing an upward trend in enrolment, it should have no fears about losing posts. It is, however, important to realise that if schools are showing a static or downward trend in enrolment, it will be difficult to make the case to sustain teaching posts in that instance.