Tom Hayes (Tipperary South, Fine Gael)
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I thank the Ceann Comhairle for giving me the opportunity to raise the very important issue of medical cards for persons with cancer. Medical cards have dominated much of the debate in recent months in that there was a proposal to cut their number and so on. I find it one of the hardest things in public life to get an answer stating a person suffering from cancer cannot be given a medical card. I raised this issue in the House only a number of months ago with the former Minister of State, Deputy Róisín Shortall. At the time she was in the middle of making a change, which I understood and accepted. However, I raise the issue again because I remain concerned that we have not arrived at a situation where people diagnosed with cancer, in particular the self-employed, can qualify for a medical card. Financial information is looked for, but the matter is very simple. When the oncologist sends a letter notifying that a person has cancer, he or she should be entitled to a medical card, at least for a short period until the financial and other issues have been cleared. My question is very specific. I raise the matter again today to ask that in a situation when a person is diagnosed with cancer, he or she immediately receive a medical card. The position is unfair. It is traumatic both for the person involved and his or her family. Cancer affects many people and their families. I implore the Minister of State, Deputy Alex White, to act. Other countries also have dire financial problems and other issues that must be dealt with, but the reality is that we must look after sick and vulnerable people with cancer who are going through a very stressful period.

Alex White (Dublin South, Labour)
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I thank the Deputy for raising this matter.

More than 1.8 million medical cards have been issued to individuals, the highest number in the history of the State. It represents an increase of approximately 500,000 since the end of 2008. It is expected that the provision of GP services and prescription drugs under the general medical services scheme will cost almost €2 billion in 2012.

As the Deputy is aware, medical cards are provided for persons who, under the provisions of the Health Act 1970, in the opinion of the Health Service Executive are unable, without undue hardship, to arrange GP services for themselves and their dependants. Under the legislation, determination of eligibility for a medical card is the responsibility of the HSE. The assessment for a medical card is 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 by the HSE to grant a medical card in cases of undue hardship where the income guidelines are exceeded. The HSE set up a clinical panel to assist in the processing of applications for discretionary medical cards where there are difficult personal circumstances.

On the fast-tracking of medical card applications for certain categories, it is important to point out that the HSE already has an effective system in place for the provision of emergency medical cards for patients who are terminally ill, or who are 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 letter of confirmation of the condition from a doctor or 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 PCRS. As a result, there are no plans to establish a new unit given that this regime is in place.

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 medical 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. No means test applies to an application by a terminally ill patient. 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 an individual is unhappy with a decision made by the HSE on a medical card application, he or she has a right of appeal to the HSE appeals officer. The contact details of the appeals officer are provided by the HSE at the time of informing a person of a decision on his or her application. The appeal should be lodged within 21 days from the date of the decision.

Tom Hayes (Tipperary South, Fine Gael)
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I accept that matters have improved. I should have taken the opportunity earlier to thank the staff of the primary care reimbursement service unit who have adapted to the changes to their work practices and made the process much more efficient. The Minister of State referred to a new unit. I am not seeking that such a unit be established. I accept that the Minister of State is new to his position but I ask him to take matters in charge. The position has improved considerably in recent months. As outlined earlier, however, on Friday last I was visited at my constituency office by a person who was supposed to get a medical card but who did not receive it. The facts are not exactly as the Minister of State indicated. I am concerned about those who are experiencing undue hardship. In that context, the lines of communication must remain open. I again thank the Minister of State and ask him to continue to monitor the position.

Alex White (Dublin South, Labour)
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I take the Deputy's point. It would never be the intention or wish of the HSE or any of us to discommode individual applicants, particularly those in the kind of circumstances outlined by the Deputy. I reiterate that there are more than 1.8 million medical cards and in excess of 130,000 GP-visit cards in circulation. This means that almost 43% the population is covered by either medical cards or GP-visit cards. As stated earlier, the number of people in possession of these cards has increased enormously since 2009. The centralisation of the applications process has improved matters. Notwithstanding that difficulties may have been experienced or observed along the way, as Deputy Tom Hayes has acknowledged there have been manifest improvements. I cannot state that we have achieved perfection but the system has definitely improved. I observed that the latter was the case even before I took up my new position. We want these improvements to continue.

As Deputy Tom Hayes has also acknowledged, the primary care reimbursement service unit in Finglas is processing in the region of 30,000 to 40,000 applications on average each month. We have taken a range of steps to improve the system. The Deputy referred to an individual case. In that context, the HSE is reporting - I have no reason to question its information in this regard - that in excess of 95% of completed applications and renewals are processed within 15 working days. This is well ahead of the performance target and is not a bad achievement.