Alan Farrell (Dublin North, Fine Gael)
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7. To ask the Minister for Health if he will provide an update on the efficiency of the process by which discretionary medical cards are assessed and granted; if he will provide information on the average waiting time between receipt of an application and a decision being made; and if he will make a statement on the matter. [2340/15]

Alan Farrell (Dublin North, Fine Gael)
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I wish the Minister, Deputy Leo Varadkar, a belated happy birthday. As someone who had the honour of being elected with him in 2004, I have known for a long time, to my great regret, that he is about 13 months younger than me.

My question concerns the efficiency of the discretionary medical card process, with which we have had great difficulty in recent months and years. I am asking the Minister to provide an update on its efficiency and the current position on waiting lists.

Kathleen Lynch (Cork North Central, Labour)
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Under the Health Act 1970, as amended, eligibility for health services is based primarily on residency and means. The Deputy will be aware of the publication of the report of the expert panel on medical need for medical card eligibility and the medical card process review in November 2014. A key recommendation of the expert panel was that a person’s means should remain the main qualifier for a medical card. Discretion continues to be an integral part of the medical card assessment process. All applications are assessed under the relevant legislation and the HSE’s national assessment guidelines. However, to build on the conclusions of the two reports, a suite of actions have been identified to improve the operation of the medical card system, particularly for people with significant medical needs. A detailed programme of reform has been drawn up by the HSE with short, medium and long-term actions to be addressed in the period 2015 to 2016. The HSE has appointed a senior manager, at assistant national director level, with specific responsibility for primary care schemes and eligibility, to lead the reform.

I can advise the Deputy that the temporary reinstatement of discretionary medical cards that were previously removed, pending full implementation of actions to improve the operation of the system, remains in place. Holders of discretionary medical cards are no longer included in random reviews and a discretionary medical card issued on the basis of a terminal illness will not be reviewed and end dates are no longer included in the medical card.

The HSE has ensured a more integrated and sensitive processing of applications, involving a greater exchange of information between the central assessment office and the local health offices on people’s medical circumstances and needs. The HSE is taking steps to establish a clinical advisory group to develop a methodology and guidance for the assessment of applications involving significant medical conditions so as to take account of the burden involved and the needs arising from the condition and to ensure appropriate services are provided for tose who need them.

The number of medical cards held on the basis of discretion having been exercised by the HSE has increased from approximately 50,300 on 1 January 2014 to approximately 76,700 on 1 January 2015. The Deputy can see, therefore, that the process is working.

Alan Farrell (Dublin North, Fine Gael)
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I thank the Minister of State for her response and appreciate, in particular, the last nugget of information which obviously is pertinent. I commend the Minister and the Minister of State, given that, if I am not mistaken, this is the first time in seven years that the Department of Health's budget will actually be increased. It is also welcome that discretionary medical cards will not be reviewed for individuals who are terminally ill. That is a far more humanitarian way of approaching these issues. The last thing a family member wants when coping with potential grief is to have to deal with reams of paperwork from the Department of Health.

Given the difficulties with the medical card system in recent years, culminating in the report published in November 2014, I am pleased that we have seen some movement on the issue. However, a number of such cases have come through my office in recent months. While I am positively disposed to what the Minister of State said, the information with which I have been provided somewhat belies what has happened in individual cases. I appreciate, however, that what has happened in individual cases is not the best way of ascertaining how the whole system operates. Nonetheless, more could be done and I would like to see the Minister of State undertaking a review of the process in the coming months. That would give us an opportunity to debate the matter which I am sure Ppposition health spokespersons would welcome.

Kathleen Lynch (Cork North Central, Labour)
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The review of the system, both within the Department and the HSE, is virtually continuous. Because of the difficulties that arose with medical cards the matter is constantly being reviewed, re-evaluated and tweaked. There are difficulties concerning medical cards because they no longer technically just give access to a GP or medical services in an acute hospital. Their expansion sometimes causes difficulty. We are examining what additional services are provided and whether it should all come within the ambit of the Department of Health. That is all being examined, but the discretion promised in both reviews by the Government has continued. The Deputy can see from the last piece of information I have provided that clearly the process is working. The humanity and compassion that need to come into play when someone receives a diagnosis, which each and every one of us hopes we will never have to get, must be shown within the system. It is difficult to include this in legislation, but it does need to be provided for.

Alan Farrell (Dublin North, Fine Gael)
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I thank the Minister of State for her comments. I will be brief and do not require a further response. The approach being taken to medical cards should, for instance, include continuing medical card cover for those seeking employment. That would give them peace of mind when they re-entered the workforce. These changes are being welcomed by the general public. While it is a separate issue to that of the discretionary medical card, it is worth mentioning.

Michael Kitt (Galway East, Fianna Fail)
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As the Deputy does not need a reply, we will make some progress.