Séamus Kirk (Louth, Fianna Fail)
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I thank the Ceann Comhairle and his office for the opportunity to raise this most important issue. It is based on a case in the Louth constituency where both spouses are undergoing treatment for cancer in the same hospital. It is hardly necessary for me to outline in detail the trauma and stress this brings on a family. A medical card application is in the system and under consideration, but no final or definitive decision has been made because of a concern that the income is marginally above what will allow them to qualify.

The regular process of applying for a medical card and the completion and submission of supporting documentation can be stressful and traumatic for families that are in difficult health situations. While I do not want to be negative, the cancer may be terminal for one or both of the spouses. One can only imagine the stress imposed on the family when, while undergoing chemotherapy, these people must hunt down the financial documents and other information that are necessary to bring a successful conclusion to their applications.

We need to consider the special circumstances that obtain, not only for the family I have in mind, but for other families across the country. We need to streamline contact arrangements so that a designated person in the medical card section in Finglas can deal specifically with inquiries and submissions of information. It is important that families and public representatives have an opportunity to communicate directly via telephone with the official dealing with their cases. E-mail is fine in its own way, but contact via telephone is necessary to ensure that all of the information is available as required.

Some time ago, our spokesman on health, Deputy Kelleher, advocated in the House the possibility of issuing time-bound medical cards to cancer patients upon diagnosis, irrespective of income. It would not be an open-ended medical card, but it could be reviewed after a specific period and renewed, if that is what the circumstances dictate.

Serious financial hardships are imposed on families whose members are in and out of hospital for treatment or must stay in hospital for long periods. They have mortgages, some of their members may be in third or second level education and others may be ill. In many instances, the families' circumstances are dire.

We must examine the system. I appreciate that processing medical cards is demanding work, as people are under severe financial stress and are anxious to have medical card cover. In the circumstances that I have just outlined, however, a special processing arrangement is required. It is fine to claim that a committee or panel will examine the details, but criticising the officials involved is unsatisfactory. The arrangements are also unsatisfactory and need to be addressed urgently.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this matter. Under the provisions of the Health Act 1970, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. There is no automatic entitlement to a medical card for persons with a specific illness, including cancer. The income thresholds apply to all applications and there are no variations on these where an applicant or family member has a specific illness. The net weekly income limits for a married couple for a standard medical card are €266.50 and €298.00 for persons aged up to 65 years and aged 66 years or over, respectively. The net income limits apply after tax, PRSI, rent or mortgage payments, child care costs and travel to work costs are taken into account. A different system operates for persons aged 70 years and older. Assessment for a medical card is based on gross weekly income, which is €1,200 in the case of a married couple, well above the limit for people aged 66 years or under.

Under the legislation, 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 himself or herself or his or her dependants. The HSE 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 discretionary assessments on the basis of illness, such as cancer, or undue financial hardship.

The HSE has an effective system in place for the provision of emergency medical cards for patients who are terminally ill or are seriously ill and in urgent need of medical care that they cannot afford. These are issued within 24 hours of receipt of the required patient details and the letters of confirmation of the condition from their doctors or medical consultants. With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on grounds of means or undue hardship and 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, which is what the Deputy is seeking.

For persons with a terminal illness, no means test applies. 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 that the person gets the card as quickly as possible.

Séamus Kirk (Louth, Fianna Fail)
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The Minister of State's response was predictable, although I do not say that in a disparaging sense. My experience in pursuing cases differs somewhat from the situation set out in her response.

We must examine this problem. We need a special arrangement and a clear understanding for families in traumatic and stressful situations. The patients' priority is chemotherapy and they hope that they will recover over time. They should not need to worry about supplying supporting documentation to the HSE. We need to remove this stressful element from the equation.

I do not suggest that open-ended cards should be granted. Cards should be granted for specific periods to allow for reviews of the circumstances involved. Will the Minister of State ask the section of the HSE that deals with medical cards to examine its arrangements for processing applications?

Kathleen Lynch (Cork North Central, Labour)
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I will be brief. The Minister of State with responsibility for this matter, Deputy White, the Minister for Health and I asked that that be done at a meeting we attended in the past month or two. I take Deputy Kirk's comments on board, but stress is inevitable in the circumstances that he outlined. It is a by-product of being extremely unwell. However, we could never move to a situation in which someone would be issued a medical card just on the basis of a telephone call. Confirmation of the condition by a medical consultant or doctor is required. The application could be made at a later stage. This is as much as one could possibly hope for in such circumstances. It would not be possible to grant a card on the basis of a telephone call alone.

Séamus Kirk (Louth, Fianna Fail)
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I did not suggest that.

Kathleen Lynch (Cork North Central, Labour)
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I understand that. Regarding the Deputy's last request, we have already stated that, when people who are extremely ill and have been given particular diagnoses, their cases must be dealt with as swiftly as possible. However, we will relay that direction again.