Billy Kelleher (Cork North Central, Fianna Fail)
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To ask the Minister for Health if he intends to revise the criteria for issuing medical cards on the basis of medical need; and if he will make a statement on the matter. [7879/13]

Alex White (Dublin South, Labour)
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The medical card scheme cost in excess of €1.9 billion in 2012 and, by the end of 2012, 1.85 million people were covered by the scheme, an increase of half a million people since 2008. It is expected that the total will reach 1.9 million by the end of this year.

Under the provisions of the Health Act 1970, medical cards are not awarded on the basis of having a specific illness or a specific disease. Rather, they are provided for persons who, in the opinion of the Health Service Executive, are unable without undue hardship to arrange general practitioner, GP, services for themselves and their dependants. The assessment for a medical card is determined primarily by reference to the means, including income and reasonable expenditure, of the applicant and his or her partner and dependants. The assessment guidelines were published by the HSE in 2009 and are publicly available on the HSE's website. Under the current legal framework, there is no automatic legal entitlement to a medical card solely on the basis of a specific illness.

However, under the Health Act, there is provision for discretion by the HSE to grant a medical card where a person's income exceeds the income guidelines. The HSE takes a person's social and medical issues into account in determining whether "undue hardship" exists for a person in providing a health service for themselves or their dependants. The HSE recently set up a clinical panel to assist in the processing of applications for such discretionary medical cards, where there are difficult personal circumstances. This approach recognises the need to have in place a standard process for considering applications in respect of people who, while over the income guidelines, require a discretionary assessment on the basis of illness or undue financial hardship.

There are no proposals to revise the criteria under which medical cards are granted. However, the programme for Government commits to reforming the current public health system by introducing universal health insurance with equal access to care for all. As part of this, the Government is committed to introducing, on a phased basis, GP care without fees within its first term of office. Legislation is currently being drafted by the Office of the Attorney General and the Department to extend access to GP services without fees to persons with prescribed illnesses and it will be published shortly.

Billy Kelleher (Cork North Central, Fianna Fail)
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I have raised this issue of the qualification criteria and the discretionary scheme on a number of occasions. Now, there is a clinical panel in place to assess and adjudicate on discretionary grounds. My concern is, and I believe every Deputy has had the same experience, that people who have been diagnosed with cancer are finding it more difficult to get medical cards on the discretionary ground of health needs. That is a problem. I accept there has been a major increase in the number of medical cards issued to the public. The reason for that is the economic downturn. People are assessed on financial means.

However, there must be greater flexibility with regard to qualification on medical grounds. Heretofore, if a person was diagnosed with cancer, he or she made an application for a medical card and was granted it, not on the basis of financial need but on medical grounds under the discretionary scheme. This clinical panel has raised the bar so high that people simply cannot access discretionary medical cards on health grounds. That is the indication I have been given. I raised this in the Dáil on a number of occasions and I passed the details to the Taoiseach, as he invited me to do one morning after Leaders' Questions. This issue is causing huge hardship for people who have been diagnosed with cancer.

The Irish Cancer Society and others are of the view, which I believe is correct, that there should be a mechanism whereby a person who is diagnosed with cancer can apply for and get a medical card, and that it would be timebound. Major advances have been made in cancer care, cancer treatment and survival rates. They could be granted a card for the duration of the treatment and any secondary aspects to that treatment, and once they have completed the course of treatment and received the all clear, the medical card could be withdrawn.

Alex White (Dublin South, Labour)
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This is an important issue and it has been addressed. I can give the Deputy some further information on this important question. There are currently 62,987 discretionary medical cards in circulation out of a total of 1.85 million medical cards. New processes have been commenced in respect of applications for discretionary medical cards. It is important to recall that sometimes there is confusion between discretionary medical cards and emergency medical cards. They are different cards but occasionally there is confusion about that. We are discussing discretionary medical cards.

Under the process that has been put in place a medical officer from the Dublin/mid-Leinster region region has been appointed as the national lead with responsibility for managing the process. The national lead established temporary arrangements while appropriate medical personnel were being identified across the country. One of the issues is freeing up medical capacity to undertake the assessments and that has been addressed. A total of 12 medical officers are now involved in the assessment of discretionary applications. There are various needs assessments from region to region depending on the specific demands on the community medical service in that region. Training sessions have also been put in place for the medical officers involved in this important process. The current position is that, as with any new system, there have been some challenges during implementation. Each RDO has confirmed that where these difficulties have been identified they have been addressed.

All outstanding applications are being processed as a priority. The number of total outstanding applications has been reduced from 3,602 last December to 1,447 on 31 January.

Terence Flanagan (Dublin North East, Fine Gael)
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The Minister must conclude. We are over time.

Alex White (Dublin South, Labour)
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The current average turnaround time for discretionary medical card applications is now 20 working days. I have further information on the broader application of the scheme which I can make available to the Deputy.

Billy Kelleher (Cork North Central, Fianna Fail)
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There is no confusion on the part of the Minister or myself about the difference between emergency and palliative care medical card applications.

Terence Flanagan (Dublin North East, Fine Gael)
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Deputy, the time for the question has concluded. We must proceed to the next question.