Tom Hayes (Tipperary South, Fine Gael)
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I thank the Ceann Comhairle for selecting this important topic for debate.

Medical cards have dominated much of the debate in recent months in this House, but today I want to talk about a specific group of applicants. In recent weeks, my office has seen an increasing number of cancer patients who have been waiting for extended periods for their medical card applications to be processed. None of us wants those diagnosed with cancer to be put under any undue stress waiting for a medical card. The reason I brought this to the attention of the Minister of State today is that I want to ask her to consider fast-tracking medical card applications for cancer patients and issuing medical cards automatically to those who are terminally ill. Both of these suggestions should be implemented through a dedicated unit within the medical card section of the Department. As the Minister of State is well aware, this call has been made by many on the front line in recent years. I have been in touch with people such as social workers who deal with patients on a daily basis, and some of the stories I have heard are genuinely upsetting, such as patients who received their medical cards after passing away or had to go without wigs following their chemotherapy treatment because they simply could not afford to purchase them on their own. No Member of the House, including the Minister of State, wishes to hear stories such as this, but that is the reality.

Prior to the centralisation of the application process, emphasis was put on fast-tracking applications from cancer patients. Staff at local level did this well and effectively, and it took many people out of difficulty. However, that is no longer the case. To make the problem worse, neither patients nor their social workers can speak personally to anybody, thus increasing the uncertainty. Although some staff in the HSE try to help over the telephone, people are very dissatisfied with the current service.

I urge the Minister of State to give serious consideration to these two categories of patients. When a person is diagnosed with cancer, it is a point in their lives when they are under more stress and pressure than ever. I have spoken to the Minister of State personally about this issue and know she understands the difficulties people are experiencing. It would be a huge step forward if she could do something for them.

Róisín Shortall (Dublin North West, Labour)
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I thank the Deputy for raising this matter. I, too, am very dissatisfied at the level of service being provided for the public by the HSE in respect of medical cards, especially renewals. I am engaging on an almost daily basis with the HSE to get to grips with the problem. The indications are that as a result of changes made in recent weeks, there is an improvement, but there is still some way to go. What has been happening in recent months is unacceptable and I hope it will come to an end shortly.

As the Deputy is aware, medical cards are provided for persons who, under the provisions of the Health Act 1970, are in the opinion of the HSE unable without undue hardship to arrange general practitioner, GP, services and other health services for themselves and their dependants. The assessment for a medical card is, therefore, determined primarily by reference to the means, including income and expenditure, of the applicant and his or her partner and dependants. Under the legislation, there is no automatic entitlement to a medical card for persons with a specific illness such as cancer. There is, however, a provision for discretion for the HSE to grant a medical card in cases of "undue hardship" in which the income guidelines are exceeded. The HSE recently set up a clinical panel to assist in the processing of applications for discretionary medical cards where there are difficult personal circumstances.

With regard to the fast-tracking of medical card applications for certain categories, it is important to point out that the HSE already has a system in place for the provision of emergency medical cards for patients who are terminally ill or seriously ill and in urgent need of medical care that they cannot afford. Emergency medical cards are issued within 24 hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. This can be initiated through the local health office by the office manager who has access to a dedicated fax and e-mail contact within the primary care reimbursement service, PCRS. As a result, there are no plans to establish a new unit.

While stressing that these arrangements are for cases of emergency only, it is necessary to better publicise these arrangements and I have asked the HSE to put together an information pack on these and other procedures for the public, health care professionals and Members of the Oireachtas in order that emergency cases can be dealt with properly and in good time. I am not sure why social workers in the local offices would not be aware of this facility. They certainly should be.

With the exception of terminally ill patients, the HSE issues all emergency medical cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual, with a limited eligibility period of six months. The arrangement is slightly different for persons with a terminal illness. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure the person receives the medical card as quickly as possible.

If there are specific details in the case of patients with a terminal illness, it is important that they be brought to our attention. As I said, there is a facility in place to deal with this issue, although it is not sufficiently well known. I am insistent on there being a very fast turnaround in such circumstances.

Tom Hayes (Tipperary South, Fine Gael)
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I thank the Minister of State who is committed to trying to help people who are in difficulty and to reforming the medical card system. However, it must be brought home to officials in the Department that whatever system they have in place, it is still not working. That is the issue I am raising. When an oncologist says a person has cancer, there should be a facility whereby the person receives a medical card immediately - that does mean in days or weeks but within 24 hours. As the Minister of State's heart is in the right place on the matter, I will not press her on it. I genuinely believe she will solve the problem, but I hope it is solved sooner rather than later. I urge her to continue her good work on the issue.

Róisín Shortall (Dublin North West, Labour)
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There is a facility in place for cases in which a person has a terminal illness. When such applications are brought to the attention of the local health office, there will be a very fast turnaround. If there is an issue with someone not being aware of this service, we will deal with it by publicising it in a more effective way. There is a system in place and I want to be informed if it is not working properly.