Michael McNamara (Clare, Labour)
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I thank the Minister of State, Deputy Alex White, for taking this Topical Issue. It is always good when someone with direct responsibility for an issue comes into the House to face the music.

When the centralisation of medical card applications was announced, the HSE and the Government promised that it would result in a more streamlined, efficient and, ultimately, compassionate system, in which people's needs would be responded to quickly, directly and compassionately. It is clear, however, from what I am hearing from my constituents in County Clare that this is simply not happening, unfortunately. I have heard numerous stories of medical cards being withdrawn from children with disabilities who are among the most vulnerable in our society. The parents of these children did not find out about the withdrawal of the medical cards until they went to pharmacies, as they do on a regular basis, to obtain the drugs or pharmaceuticals needed by their children. When they learned that the medical cards were no longer valid, they contacted the centralised unit and were told the matter would be dealt with if they filled in an application form. The people concerned have been treated with very little compassion or understanding of the very difficult situation in which they find themselves. That is certainly not what the Government promised. As someone who regularly goes through the voting lobbies in support of the Government, it is certainly not what I would have expected.

I do not intend to take up a very long period. There are some specific questions I would like to have answered. How many medical cards have been withdrawn this year from children with special needs, particularly with autism and cancer? Has any of these medical cards been cancelled without a statutory review being conducted? In other words, have they simply been cancelled on a whim, with people being asked to reapply if they believe they really deserve them? Is there a deliberate policy of cancelling medical cards to save money, before making people reapply and prove they should have had them in the first place? How many medical cards have subsequently been restored on appeal? I appreciate that the Minister of State might not have an answer to that final question.

I commend the Minister of State again for coming into the Chamber to deal with this important issue. It is very difficult for families to deal with the severe stress caused by lifelong conditions such as autism spectrum disorder and attention deficit hyperactivity disorder. The removal of medical cards from such families adds very much to and compounds the pressures they are facing at a difficult time for everyone in the country.

Alex White (Dublin South, Labour)
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I thank the Deputy for raising this matter. Budget 2013 introduced some amendments to the guidelines governing the provision of medical cards and GP visit cards for those under the age of 70 years and those over that age. None of the changes that has been made to the schemes would affect this specific group of children in the manner suggested by the Deputy. No change has been made that would have such an impact. The Deputy has referred to instances of people who have been advised while attending a pharmacy that the medical cards awarded for children with certain conditions have expired and that reapplication is required. That is essentially the issue he has raised. I am surprised and concerned that this situation, as outlined by the Deputy, could arise. I will outline briefly to him and the House the standard and uniform processes required to be applied when medical cards are being renewed.

The medical card scheme is operated by the primary care reimbursement service, PCRS, to which the Deputy referred. Since the medical card scheme was centralised under the PCRS, every medical card shows an expiry date, before which the eligibility of the holder is reassessed by the PCRS. A letter is issued to the medical card holder three months before the expiry date and again one month before that date. The medical card is renewed after the case has been reviewed and eligibility has been confirmed. A medical card will remain valid, regardless of the expiry date shown on it, as long as the medical card holder is genuinely engaging with the PCRS review process. The medical card holder does not need to take any action other than to co-operate in a genuine way with the review process and communicate with the PCRS on an ongoing basis throughout any review that may take place. Eligibility can be confirmed by any doctor or pharmacist through the GP practice or pharmacy IT systems, or by medical card holders at www.medicalcard.ie. While I appreciate that not everybody is online, this facility is available to those who are. A person can continue to receive drugs and GP services while he or she awaits a decision on his or her medical card renewal application simply by using the medical card number.

While people with specific illnesses are not automatically entitled to medical cards under the provisions of the relevant legislation, the legislation provides 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 when determining whether there is "undue hardship" - the phrase used in the Act - for a person in providing a health service for himself or herself or his or her dependants. It is important to stress that the medical card system is founded on the "undue hardship" test. The basic infrastructure of the medical card system provides that medical cards are allocated to persons on the basis of their material circumstances rather than on the basis of a particular illness. The discretionary system is an exception to the general rule.

However, the general rule is that we allocate medical cards on the basis of material means, which relates to the phrase "undue hardship" in the 1970 Act.

I understand the cards referred to by the Deputy are discretionary medical cards. On average, discretionary cards are valid for two to three years and the renewal processes that I outlined earlier also apply for discretionary cards. People should not receive, out of the blue, statements from pharmacists or anybody else to the effect that their medical card is gone. I am most concerned to hear this is occurring in the manner that has been suggested, and I have no doubt the Deputy is raising the matter on the basis of information he has received. Even for the shorter-term discretionary cards of six months or one year, they will receive a renewal notice three months in advance of the stated expiry date. In setting review dates and to avoid causing anxiety, the HSE must be and is, so far as I can see, sensitive to the needs and conditions of the individual. The target turnaround time for discretionary medical cards is 20 working days.

Having said all of that, if the Deputy has specific cases which he would like to have examined, the PCRS would be happy to do so. If the Deputy needs any assistance in this regard, I will be happy to afford it to him.

Michael McNamara (Clare, Labour)
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I thank the Minister of State for that comprehensive reply, which comes as a relief to me and, more importantly, to my constituents. As I said, I am a Teachta Dála, and I am bringing the message to the Dáil that this issue has arisen in my constituency. It may well be a localised failure due to a systems failure. I am satisfied with the Minister of State's reply and, if the problem persists, I will take up the matter with the PCRS, as the Minister of State has advised. If that fails, I will bring it back to the Minister of State.

Alex White (Dublin South, Labour)
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I cannot put it any plainer than I have. If any further issues arise for the Deputy, I will attend to them.