Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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I am grateful to the Ceann Comhairle for selecting for discussion the issue of discretionary medical cards. This important issue has surfaced during Leaders' Questions and in the Topical Issue Debate, most recently in May when Deputy Michael McNamara raised it with the Minister of State, Deputy Alex White. While I welcome the presence of the Minister of State at the Department of Education and Skills, Deputy Ciarán Cannon, I would be much more appreciative if the Minister for Health, Deputy James Reilly, or the Minister of State with responsibility for medical cards, Deputy Alex White, were before the House.

I contacted the office of the Minister of State, Deputy White, today to discuss a specific case which illustrates the difficulty experienced by people applying for discretionary medical cards. While I am not sure if the Minister of State is aware of the circumstances, the case involves a young married man who is in employment, as is his wife, and has two progressive and incurable conditions, namely, multiple sclerosis and kidney failure. He was diagnosed with the conditions in 2008 and 2009, respectively, and thereafter granted, as was appropriate, a discretionary medical card by the Health Service Executive. His medical card was renewed in each of the subsequent years until 2012 when, under the administration of this Government, the HSE cancelled his card.

Having pursued this matter through parliamentary questions and direct correspondence with the HSE and Minister, I am informed the criteria for granting discretionary medical cards have not changed. While I am loth to raise on the floor of the House the details of an individual case, in this instance it demonstrates the problem many people are experiencing. The household income of the couple in question has declined because the sufferer of chronic illness and his wife have both had their wages cut. As both of the conditions from which he suffers are incurable and progressive, his condition has not improved. Despite this, the Government, through the Health Service Executive, has withdrawn his discretionary medical card. This is wrong and inhumane and I doubt very much the Minister would stand over the decision. I ask that the Minister review the individual case and ensure a proper and effective review is done of discretionary medical cards as they apply nationwide.

Earlier in the week, Deputy Gerry Adams referred to a case of a man of 102 years who had his medical card withdrawn. We also heard about the plight of cancer sufferers who consider themselves entitled to a discretionary medical card but have not been granted one. I have direct experience of small children, many of them under the care of the Jack and Jill Foundation, who have had medical cards withdrawn or experienced inordinate difficulties in having them awarded in the first instance.

We are all aware of the pressures and difficulties faced by the Department of Health. Something is wrong, however, if, on the one hand, the regulations governing discretionary medical cards have not changed and, on the other, discretionary medical are being withdrawn and applications from people who meet the criteria are being refused.

Ciarán Cannon (Galway East, Fine Gael)
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I thank Deputy Ó Fearghaíl for raising this matter, which I am taking on behalf of the Minister for Health, Deputy Reilly.

I advise the Deputy that, overall, nearly 44% of the national population has free access to general practitioner services under the general medical services, GMS, scheme. The HSE continues to issue medical and GP visit cards, with 2 million people currently having access to free GP care. This reflects an incremental annual increase and is 15% higher than the number at the end of end 2010. Far from cutting medical cards, the Government has provided funding to ensure an additional 250,000 people have been covered by the GMS scheme since it entered office.

As the Deputy will be aware, 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. While people with specific illnesses such as cancer, multiple sclerosis or the other condition to which the Deputy referred are not automatically entitled to medical cards, 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 into account a person's social and medical issues when determining whether there is undue hardship 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 as opposed to a particular illness.

The discretionary system is an exception to the general rule.

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 a discretionary assessment on the basis of illness or undue financial hardship. If the applicant's means are in excess of the medical card income guidelines, the deciding officer will consider whether to refuse would cause undue hardship. If the applicant fails to qualify for a medical card, the deciding officer will consider the applicant for a GP visit card. If the applicant's means are in excess of the GP visit card guidelines, the deciding officer will consider whether it would be unduly burdensome for the applicant to provide for GP services for himself or herself from his or her own resources.

The HSE, in exercising discretion, takes account of all the circumstances of an individual case - the nature and extent of personal, medical or social circumstances of the applicant and-or dependants. If granted, the card may also cover dependants. The HSE ensures that the system responds to the variety of circumstances and complexities faced by individuals in these difficult circumstances.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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The Minister of State said the system responds, but the problem is that the system does not respond. The particular instance I have outlined is one in which the system accepted that undue hardship existed in 2009, 2010 and again in 2011. The person was subject to the same assessment in 2012 but under this Administration the medical card was withdrawn. The Minister for Health has told me that the criteria have not changed. If the criteria have not changed, then the person should have their medical card restored and I appeal to the Minister to do that.

At a broader level, I also appeal to the Minister to read the reports coming from across the country, raised here last by Deputy McNamara in May. He made it clear he was experiencing difficulties in County Clare. We are certainly experiencing difficulties in County Kildare. I believe it is not too much to expect that the Government should make the system work. If it worked in 2009, 2010 and 2011, it can work in 2012, 2013 and into the future. I ask the Minister to please make it work and ensure that those who are entitled to discretion get it and that some sort of humanity is demonstrated by the HSE and Government in these cases.

Ciarán Cannon (Galway East, Fine Gael)
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It is certainly not the intention of the Government to restrict access to the medical card system for people who are genuinely in need of it. On that basis, as I confirmed earlier, some 250,000 more people now have access to that sort of support than had such access when we came into government. In my personal experience, in my constituency office in Galway East we have actively engaged in the process of trying to assist people in securing discretionary medical cards. We have found that in most instances when strong medical evidence is provided of a person's unique circumstances, more often than not these discretionary cards are granted by the HSE. I suggest to the Deputy that he should re-engage with the Minister of State, Deputy White, on the case he mentioned to see if it can be progressed. In my experience we have had considerable success in this area and I hope the same might apply to the case the Deputy referred to.