Billy Kelleher (Cork North Central, Fianna Fail)
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To ask the Minister for Health if he will help cancer patients in severe distress to acquire medical cards; and if he will make a statement on the matter. [57232/12]

Alex White (Dublin South, Labour)
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Under the provisions of the Health Act 1970, eligibility for health services in Ireland is based primarily on residency and means. There are two categories of eligibility for all persons ordinarily resident in Ireland, those being, full eligibility, which relates to the medical card, and limited eligibility, which applies to everyone else. Full eligibility is determined mainly by reference to income limits and is granted to persons who, in the opinion of the HSE, are unable to provide general practitioner, GP, medical and surgical services to themselves and their dependants without undue hardship.

There is no automatic entitlement to a medical card for persons who have cancer. There is a provision for discretion to grant a card in cases of "undue hardship" where the income guidelines are exceeded. Recently, the HSE set up a clinical panel to assist in the processing of applications for discretionary medical cards where there are difficult personal circumstances.

There is an emergency process for a person who is terminally ill or in urgent need of medical attention and cannot afford to pay for it that provides a card within 24 hours while the normal application process is being completed. Details of this procedure have been made available to all GPs and social workers. Such applications can be initiated through the local health offices, whose managers have access to a dedicated fax and e-mail contact line to the Primary Care Reimbursement Service, PCRS. Once the medical condition is verified by a GP or a consultant and the required personal details are provided, an emergency card is issued to that person for a six-month period. No means test applies to an application in the case of a terminally ill patient.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister of State. Last year, I raised this issue in respect of an individual who was terminally ill and who subsequently passed away. To be fair, the system responded but the reality differs from what the Minister of State claims is occurring on the ground.

The clinical panel that assesses medical card applicants must be strict, given the rate of refusal for cancer sufferers in particular. I have been around Leinster House for 20 years and have always believed that, if one has cancer, one applies in the normal way and the service uses its discretion to grant a medical card based on medical need. That is no longer the case. For example, a woman who has had a mastectomy cannot access a medical card.

It is bizarre, to say the least, that what the Minister of State and the HSE claim is at variance with what is occurring on the ground. According to the Irish Cancer Society, many cancer patients are applying to it for support in accessing treatment. Hospitals are hunting them down for €75 every time they present for chemotherapy. There is something barbaric about this and I ask the Minister of State to consider the issue in the context of next year's service plan.

Alex White (Dublin South, Labour)
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The issue in regard to the inpatient charge, although related, is essentially a separate matter to the question of the discretionary allocation of medical cards on the basis of an applicant having a specific medical condition. There has never been an automatic entitlement to a medical card, even where a person is diagnosed with a debilitating and deeply stressful ailment, including cancer. The system does not provide for the automatic provision of a medical card in those circumstances. The individual concerned must submit an application. I certainly would expect any such application to be dealt with sensitively and expeditiously. If there was any sense in which that was not happening, it would give cause for concern. I reiterate, however, that there is no automatic entitlement. An application must be made and is assessed on the basis of the medical evidence. As I said, I agree that such applications ought to be expedited.

Billy Kelleher (Cork North Central, Fianna Fail)
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The €75 charge is relevant because patients with a medical card are exempt from paying it. I accept that there has never been an automatic entitlement to a medical card. What is clear, however, is that the clinical review panel has raised the bar so high in terms of assessing entitlement based on medical need that applicants are increasingly failing to qualify. Of all the issues to be dealt with in the health service, this one is surely deserving of immediate attention. What is happening is at variance with what we are being told in the Dáil. I cannot countenance a situation where people in such circumstances are having their applications rejected by the clinical panel. I acknowledge that there never was an entitlement in this regard, but the situation in practice has, for many years, been that any person with cancer was granted a medical card on the basis of an assessment of need. That is no longer happening and such patients are being charged €75 upon admission to hospital for chemotherapy treatment. It is a very unfortunate development.

Alex White (Dublin South, Labour)
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At the risk of irritating the Deputy in regard to this sensitive issue, I am obliged to reiterate that there never was an automatic entitlement to a medical card for cancer patients.

Billy Kelleher (Cork North Central, Fianna Fail)
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I did not claim there was. My point is that cards were, in practice, routinely granted to such patients on medical grounds.

Alex White (Dublin South, Labour)
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That continues to be the case. If the Deputy is aware of particular instances where this has not happened, we will be happy to examine them. We cannot, hand on heart, offer an absolute guarantee that every such application will be dealt with in an expeditious way, but it certainly should be. It is not clear to me that there has been the type of fundamental change in practice or approach the Deputy describes. As I said, if there are specific cases that have fallen through the cracks in terms of the application process, we would be anxious to address them.