Terence Flanagan (Dublin North East, Independent)
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I thank the Ceann Comhairle for the opportunity of raising this very important issue. I welcome the changes the Government announced recently to improve the medical card system to make it fairer and ensure people with terminal illnesses will not be subject to review of their medical cards, which is very welcome. I seek to raise a number of issues that my constituents are having with the processing of their medical card applications by the primary care reimbursement service, PCRS. Like many Deputies, I deal with many medical card queries on behalf of my constituents. Recently, I wrote to the Minister, Deputy Varadkar, about a case in which a constituent of mine encountered serious problems with her application and the information that PCRS received. While I am aware that the issue does not fall under the Minister's direct responsibility, as it is a matter for the HSE, it is very important that he be kept up to date with what is happening on the ground, and he needs to take an active interest in what is happening in the PCRS.

I am concerned that some constituents have reported submitting the same documents, including application forms and medical forms, up to five times, with the PCRS stating it has no record of receiving any application. I am asking constituents to send the information by registered post to ensure the PCRS can confirm it has received the applications. The fact that information is being mislaid is very frustrating, particularly for ill or elderly constituents. They must go through the bureaucracy of pulling together an application. Having to do it a second, third and fourth time is embarrassing and shows up a very dysfunctional system which does not work. If the PCRS is saying An Post is not delivering the post, what investigation has it been seeking? If the difficulty is within the PCRS, what is it doing about it? There seems to be no issue with information leaving the building, given that constituents are receiving letters with updates on their applications. There is a major privacy and data protection issue. If private and personal information about people's bank accounts and medical histories falls into the wrong hands, it could open the door to abuse and identity fraud.

A constituent who wanted to renew her medical card in March 2014 sent in everything except her bank statements. When she contacted the PCRS in April for an update on the status of her card, she was advised that no documents had been received with the renewal application, although she had stapled them to the application. She had to resend all her documents, including a second copy of her private and confidential medical report, which costs €15 each time she requests it from her doctor. In July, she contacted the HSE and was told that while some of her documents had been received, the bank statements and medical report had still not been received, although she had sent them in the same envelope. Her doctor is, naturally, concerned about her private medical information going astray, as well as her confidential bank statements possibly lying around somewhere, where somebody can read it. Recently, two members of PCRS staff told her that all her documents had been received, including her bank statements. A week later, another staff member told her no bank statements had been received and that her medical card had been revoked. There are major issues, and this is just one example.

Damien English (Meath West, Fine Gael)
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I thank the Deputy for raising the issue. I am taking the debate on behalf of my colleague, the Minister for Health, Deputy Varadkar, who apologises for the fact that he could not be here, although he makes an effort to try to hear all Topical Issue debates. The Government is conscious of the importance of the medical card system in ensuring that people whose needs do not enable them to access GPs and other health services are provided with such supports, in line with the legislative provisions. There is always room for improvement in how public services operate, and the Minister, Deputy Varadkar has made it clear to the HSE that it must continue to improve the level of service provided to applicants for medical cards. The Deputy raised a specific case, on which neither I nor the Minister could comment. Most of us in the House have heard similar stories.

Terence Flanagan (Dublin North East, Independent)
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I have multiple cases.

Damien English (Meath West, Fine Gael)
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People have put such cases on the record, and the Minister has made it very clear that it is unacceptable. It is certainly unacceptable that information gets lost, mislaid or delayed. He has made it clear that this aspect is not good enough and needs to be reformed. There have been many such stories, and it was part of the review of the application process which the Minister has organised. The HSE has a structured protocol in place for the medical card application and review process, and every effort is made to ensure ongoing engagement between the HSE and applicants during this process. However, I will outline some of the steps being taken to improve the quality of the service.

The Deputy will be aware of the publication of the reports of the expert panel on medical need and medical card eligibility and the external review of the medical card process. The external review was commissioned to examine how the HSE currently administers the medical card application process and to recommend ways in which the process could be made more efficient, simple and user-friendly in the future. Efficiency is the one the Deputy is seeking. In the light of the conclusions of the two reports, ten key actions have been identified to improve the operation of the medical card system, particularly for people with significant medical needs, and these are most welcome. To deliver on these, a range of actions are being put into effect or will be pursued in the short-term by the HSE. As an example, the HSE will ensure a more integrated and sensitive processing of applications, involving greater exchange of information between the central assessment office and the local health offices about people's medical circumstances and needs. In addition, the HSE has appointed a senior manager to lead the reform of the systems for handling medical card applications and reviews, with a focus on a high-quality customer service and easy-to-understand information and processes.

Improved communications and information will be developed and provided for the public, health sector staff and health advocacy groups to ensure a better understanding of people's entitlements and the rules of the medical card scheme. Furthermore, a clinical advisory group will be established by the HSE in the new year to develop guidance on assessing applications involving significant medical conditions in order to take account of the burden involved and the needs arising from the condition and to ensure that appropriate services are provided to people who need them.

Other actions the Health Service Executive, HSE, will progress in the short term will be the development of a single, integrated process for people to apply for a medical card, a GP-visit card, the long-term Illness scheme and the drugs payment scheme, as well as the establishment of access points nationwide in health offices to support and assist people to make applications. This will enable the HSE to make every effort to provide applicants with the benefits or services most suited to their needs. The Minister, Deputy Varadkar, also has asked the HSE to examine, with his Department, the best way to meet the needs of people with significant medical conditions who need the support of the public health system. This work includes considering the best way to make available medical aids and appliances to persons who do not hold a medical card, the provision of services to children with severe disabilities and to enable people with particular needs to have these met on an individual basis, rather than awarding a medical card to all family members.

The Minister for Health will continue to oversee the implementation of these actions and, if it emerges that further improvements are deemed necessary, he will consider them. It is important to note that under the relevant legislation, there is no role for the Minister for Health in assessing an individual's medical card eligibility, as the Deputy himself recognised, or give a direction to the HSE relating to a decision concerning the eligibility of an individual. Notwithstanding this, should the Deputy wish to give me details of the case he raised, I certainly will bring it to the Minister's attention and will ask the officials to pursue it further.

Terence Flanagan (Dublin North East, Independent)
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I thank the Minister of State, Deputy English, for replying on behalf of the Minister for Health, Deputy Varadkar and I acknowledge the Minister sent his apologies for his absence this evening. In respect of the Minister of State's response, what I seek is an investigation into the primary care reimbursement service, PCRS, at this point in time. The major problem appears to be with the processing of applications, as applications either are not being received by the PCRS or are being received and basically are being kept in bags of mail or whatever. There is a black hole in the system at present and every single piece of paper sent in to the PCRS should be scanned, computerised and put onto a computer system. The age of manual systems is past, particularly in respect of information so sensitive as people's confidential bank details and medical records. All that information must be scanned and retained and huge efficiencies are required in the system, as it appears to be outdated.

There also is an issue regarding the processing of applications, in that different sections process different parts of the application form within the PCRS. Does the Minister of State agree that the entire system must be streamlined in order that one person will deal with one file from beginning to end? Recently, one of my constituents was informed that she needed to submit a new application to renew her medical card, whereas when I made a representation directly to the PCRS on her behalf, I was informed that her medical card was valid until the summer of 2015 and that she would not be obliged to renew it until then. Consequently, I obviously have major concerns about the integrity of the system when different messages are sent by different staff within the service. There also is a difficulty about delays in sending out information to constituents. Recently, a case was brought to my attention in which, although one is meant to have 21 days in which to appeal a medical card application decision, the person concerned had less than seven days in which to make an appeal because once the letter had been printed off, a delay arose in getting that letter signed and sent out. From my perspective and I am sure from those of others - Deputy Ellis may have the same experience - there are multiple problems within the system that must be investigated thoroughly. People's information is too confidential for it be lost. There appears to be a problem with the integrity of the system and I ask the Minister to investigate.

Michael Kitt (Galway East, Fianna Fail)
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Thank you Deputy but I must now call on the Minister of State to conclude.

Damien English (Meath West, Fine Gael)
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I again thank Deputy Terence Flanagan for raising these issues. I certainly will pass on to the Minister the Deputy's desire for an investigation into where information is stored or where it has gone. As for the examples the Deputy is given, as well as others provided by other Members - I believe all Members probably have had negative experiences of the process - this is why, when the Minister took up office, one of the first issues with which he dealt was to have an external review of the entire manner in which the HSE was administering the medical card application process and making decisions. Arising from that are the recommendations and the ten new actions the Minister believes and hopes, as do I, will fix this process and system that has been a cause of concern for the Deputy and many others. It certainly has not been satisfactory for applicants.

Terence Flanagan (Dublin North East, Independent)
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The Minister needs to visit the PCRS to walk through the processes.

Damien English (Meath West, Fine Gael)
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While I understand he has visited, I certainly will tell him again that the Deputy wishes him to do that.

The Minister has made clear that he expects all the changes that will happen in the new year, as well as the new actions, will address the problems with the process. He has stated clearly that if this does not happen, further changes must take place and he will address that as well. Most Members are aware that it is not satisfactory. A key part that probably will help is the establishment of the access points around the country in health offices to support and assist people to make applications because all Members are aware that at present, many people believe they must approach the office of a Deputy or a Minister to try to get help with the process alone, that is, with the forms and so on. They should not be obliged to do this and should not think they must go to that level. Ultimately, I believe the access points will address that issue and should address the handing over and the seeking of information. However, the Deputy is correct that it would not be good enough were any information to get lost or mislaid and the Minister also is clear at that point. The changes arising from the external review and the recommendations regarding the processes across the board should make a difference. It certainly should put right matters and the Minister expects that to happen.