Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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2. To ask the Minister for Health if he will elaborate on the third tier medical card and other measures of which he has spoken of in view of the loss of discretionary medical cards by many thousands of citizens in need; and if he will make a statement on the matter. [21352/14]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I ask the Minister to explain his recent reference to a "third tier". Of what is it a third tier? I also ask him to refer to other measures he has spoken of in the context of the loss of discretionary medical cards.

Alex White (Dublin South, Labour)
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While there has been a reduction in the number of discretionary medical cards, I wish to assure the Deputy that there is no policy to reduce the number of medical cards issued where discretion is involved in the assessment process. The fact is that many people who used to hold discretionary cards have been granted medical cards on income grounds because they now fall within the means thresholds. Only a very small proportion of people with discretionary medical cards who have been reviewed recently have been found to be ineligible for a medical card. Of the discretionary cards in circulation in 2011, less than one tenth have been found to be ineligible on review. On the other hand, even where medical expenses have been taken into account, some people have been found to be ineligible because their net income is in excess of the means thresholds, sometimes by hundreds of euro per week.

In accordance with the legislation, medical cards are awarded to persons who suffer undue financial hardship in the arranging of GP services including where this arises as a result of a disease or an illness. The HSE established panel of community medical officers to assist in the processing of applications for medical cards where the income guidelines are exceeded but where there are difficult personal circumstances, such as an illness or physical disability. The medical officer reviews evidence of necessary medical expenses provided by the applicant. As appropriate, he or she liaises with general practitioners, hospital consultants and other health professionals so that costs relating to the health circumstances of the applicant can be taken fully into account.

The Minister for Health and I are conscious of the difficulties faced by the relatively small number of people who have been found to be ineligible. At his request, the HSE is currently examining how individuals who are not entitled to a medical card could still receive services that meet their needs. This examination relates to all of the services and supports provided by the HSE and with regard to as much flexibility as is available at a local level. Additional information will be provided and local information points will be established at major health centres around the country where members of the public can obtain comprehensive information and support in accessing the full range of supports from the health services. The objective is to maximise the supports available for patients and families.

Appropriate notice is also being considered as part of the review for existing medical card holders who may no longer be eligible on renewal, but where serious medical conditions or profound disability continues to exist in the household. The clear intention is to maximise the supports that can be provided in each case to the fullest extent possible. The HSE is seeking to find the best way to achieve this in order to ensure families will receive the support they need.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister up until very recently has refused to recognise the problem. I believe he was prompted into doing so by a recent meeting of his parliamentary party. He floated what I can only describe as a vague notion of some kind of "third tier" of services. The Minister of State made no reference to that in his reply, yet that is the core of the question I have posed. I asked that he would elaborate on the third tier concept. Initially, it was thought it was a third tier medical card but that was discounted in an interview in last week's The Sunday Times.

What is this third tier that was referred to by the Minister? Has he any notion of the distress the loss of, or fear of losing, their medical card is causing people? That fear is absolutely huge, as I am sure will be confirmed by canvassing Deputies across the board. Will the Minister of State reverse the cuts that have taken place and restore the essential discretionary medical practice that has applied heretofore as a central feature of the scheme, in recognition of the hardship now being imposed?

Alex White (Dublin South, Labour)
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Nobody on this side of the House has ever refused to recognise there is an issue in regard to discretionary medical card provision. As I indicated in my reply, we accept that some people have been found to be ineligible following a review of the medical card granted to them under the discretionary process. We are not denying there is an issue, but we have sought to show that the extent of the problem is nothing like as widespread as has been suggested in some quarters. Something in the order of 6% of persons who held a discretionary medical card in 2011 have lost it as of 2014. It certainly is a problem for the people who are impacted, as I acknowledged last night during the Private Members' debate. Where people who had access to a card for a lengthy period lose it, there is a real dilemma for them, particularly in circumstances where there is a disability or illness.

The Minister has asked the Health Service Executive to explore ways of introducing packages of integrated care to ensure people who have lost access to a medical card can still access the services they need. That is what is happening. As to reports in the media of third tiers, second tiers or any other tiers, I cannot speculate about that.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Of course, the only real tears, as opposed to tiers, are those of the families who have been left in distress. The notion that there is no such thing as a discretionary medical card is belied by the Minister of State's own figures, given in parliamentary replies, which show that in March 2011, 97,120 people were in possession of full medical cards or GP visit cards on a discretionary basis. By March of this year, however, that number had fallen to 78,310, a drop of nearly 19,000 or almost one in five. In percentage terms, that is closer to 20% than 6%. These are the figures the Minister of State has given us and they show that the situation is much more serious than he suggested last night and again this morning.

Surely we can be of one voice on this issue? We are asking that the HSE treat with due respect and compassion all applicants for medical cards or renewal of medical cards, taking fully into account not only incomes but the other clear burdens imposed by medical conditions, illnesses and disabilities. That real cost must be factored in.

Alex White (Dublin South, Labour)
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I am sure the Deputy does not intend it, but the figures he has given are inaccurate. Of the 77,925 or so people who were in possession of a discretionary medical card in March 2011, one third still have a medical card on a discretionary basis and approximately one half still have a medical card but not through the discretionary route. This is what Deputies opposite continue to ignore - perhaps deliberately in some cases, although not in the case of Deputy Ó Caoláin. Of the March 20011 cohort, 19% no longer have a medical card. However, this is made up of 3% who are deceased, 7% who did not respond to correspondence from the HSE and 2% who did not complete the review process. That leaves approximately 6% or 7%, not 19%, who were found to be ineligible for a medical card. Somewhere between 5,500 and 6,000 persons, not 19,000, have been deemed ineligible.

I am not for one moment seeking to diminish the effect that loss has on people. That is why the Minister has asked the HSE to take steps to address the issue. However, I appeal to Deputies opposite that we get the numbers right. I realise we are in electioneering mode, but we must have the numbers right so that we can all work off the same pitch.

Billy Kelleher (Cork North Central, Fianna Fail)
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It is the Government that is concerned about the elections.

James Reilly (Dublin North, Fine Gael)
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Senator Marc MacSharry is in very good electioneering mode.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is not about elections.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Ó Caoláin is out of time. We have already had two supplementary questions.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is about facts. I am citing the Minister of State's own figures.

Alex White (Dublin South, Labour)
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The Deputy is misrepresenting them.