Ciara Conway (Waterford, Labour)
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I want to highlight an issue that is putting undue strain on people who are already faced with stressful times, particularly where their health is concerned. Unfortunately, there is not a family or home in the country that has not been touched by cancer. A particular problem has come to my attention but, in order to be helpful, I also have a solution. I hope the simple answer to the difficulty that people are experiencing will be taken on board and, more importantly, will be implemented.

The issue has to do with the turnaround concerning decisions on medical cards, as well as the pain and financial strain that have been caused by the delay involved.

Over recent months I have had a number of very worried and sick people have come to my office in Dungarvan in County Waterford seeking help with their medical cards. Naturally, these people are extremely worried and stressed about their diagnosis and the treatment they are facing. I am sad to report that while they were focusing on getting treatment and trying to get better, our medical card system was adding to their stress. This is simply not good enough.

I will illustrate the point by way of example. Recently, a lady came to me who had received a serious cancer diagnosis in June. Straight away she applied for her medical card. By the time she had contacted me it was September and there was no decision on her card. Only this morning I received from Kieran Healy, head of customer services at the HSE, a response to a parliamentary question on this issue. The reply clearly states that the application processing team works to a 15-day working day turnaround time for complete applications. That is clearly not the case.

More upsetting, I spoke to the lady who had been waiting from June to September, by which time there was no decision on her medical card. In that time she had incurred bills of in excess of €500 in the pharmacy and was also facing a very expensive bill for four chemotherapy treatments. I know of another case where a sick man applied for a card in August and as of today, 7 October, it has not even been sent for initial assessment. That lapse is far more than 15 days. The response I received to a parliamentary question is simply not good enough.

The applications for a medical card need to be screened initially for serious illnesses such as cancer. These applications should be taken from the pile and fast-tracked. There should be a quick initial scan of applications and the relevant applications should be prioritised for means. The HSE should ensure these are done within 15 days. It is as simple as that. I realise the Minister of State knows that people facing serious illnesses have enough to worry about. They should not have to worry about the cost of chemotherapy or drugs as well. They should be focusing on getting well and should not have to go to Deputies or ring helplines to get something to which they are entitled.

Denis Naughten (Roscommon-South Leitrim, Independent)
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A woman came into my clinic in Ballinasloe recently. She had been diagnosed with cancer. I sympathised with her not because she had been diagnosed with cancer or because herself and her family were going to have to go through that challenge over the coming months but because of the horrendous experience she is going to have to go through to be granted a medical card.

I welcome the report by the Irish Cancer Society because it exposes two issues, the first of which is the failure to recognise properly the medical expenses in the assessment of medical card applications for illnesses such as cancer. It is not a means assessment; it is a mean assessment. The average spend per month for a cancer patient is €862 while the average income loss is €1,400. However, the allowances provided under the medical card system for health expenses, prescribed medicines and appliances and hospital charges come to the princely sum of €62.65 per week. This means the figure of €459.49 per week in costs and income lost, as identified by the Irish Cancer Society, is being ignored in the current medical card assessment. Regardless, even to get recognition from the medical card section for the €62.65 per week, patients on chemotherapy will literally have to sweat blood and tears. The majority of these cases will be granted a medical card at the end of the process, but that is months down the road. It seems that the main policy is to try to wear people down in order that they simply throw in the towel and do not pursue it to the bitter end.

I welcome the report and I welcome that the Minister of State with responsibility for rural affairs is replying to the issue in the House today because the report exposes the active discrimination within the medical card section against people who are sick and residing in rural areas. The report highlights that the average cost for travel expenses per week is €66.23. This is not only for cancer but also relates to other medical conditions requiring frequent attendance at regional centres. The provision for transport under the medical card assessment comes under health expenses. I have seldom seen a case where an application gets anything more than €15, that is, one quarter of the real cost identified by the Irish Cancer Society. We have developed centres of excellence, particularly for cancer, and they are all welcome. For someone in my county who has to travel to Galway for a hospital appointment, the cost comes to €150. We do not have public transport to facilitate such people in getting to the appointment and back again on the same day. As a result, these people must pay for a taxi. The HSE will not assist with this cost and the Department of Social Protection will not assist in the matter either. These people have to fork out the money from their own pockets. If a person is unfortunate enough to come from Arigna, for example, it will cost him €200 to get to the hospital appointment in the first place. No recognition is being given to that fact by the medical card section.

Ann Phelan (Carlow-Kilkenny, Labour)
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I thank the Deputies for raising these important matters. At the outset, I am keen to acknowledge the work and effort of health staff that has resulted in Ireland's cancer survival rate improving consistently in recent decades. I have no doubt the national cancer strategy steering group set up to advise on developing a new national cancer strategy for 2016 to 2025 will build on positive developments.

We do not have a universal eligibility system for primary and community health services. I maintain the view that until we have universal health care and everyone is entitled to health care, we will always have anomalies and injustices. There will always be someone who is a little above the means threshold, who does not have the prescribed disease or whose condition is not sufficiently severe. As a result, these individuals will not meet the assessment criteria.

The Deputies 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, known as the Keane report. One key recommendation was that a person's means should remain the main qualifier for a medical card. The panel concluded that it would not be feasible, desirable or ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility. The findings of the expert panel raise questions for us as legislators about the approach of basing eligibility for health services on having a particular disease or special assessment arrangements for one disease or another.

The HSE is ensuring a more integrated and sensitive processing of medical card applications. This involves greater exchange of information between the central assessment office and the local health offices on people's medical circumstances and needs. We can see the results of these improvements. The number of discretionary medical cards in circulation has increased by approximately 76%, from 52,000 in mid-2014 to almost 93,000 at the beginning of September this year. Under the General Medical Services scheme, eligibility is granted from the date a complete application has been assessed and a decision is made by the HSE in accordance with the legislation and the national assessment guidelines. The HSE makes every effort to make timely decisions. The HSE has a target to process 90% of properly completed claims within the 15-day period to which Deputy Conway referred. The current turnaround is over 98%. This ensures a short lead time between applications being submitted and a decision being made on the eligibility of the applicant.

I imagine the Deputies will appreciate in light of the legislation that applications must be supported with a range of documentation, as outlined on the application forms. It has to be acknowledged that the processing time for incomplete applications is dependent on the furnishing of the required supporting documentation. Discretion continues to be an integral part of the medical card assessment process. If an applicant's means are above the financial thresholds, as set out in the national guidelines, the HSE routinely examines for indications of medical or social circumstances that might result in undue financial hardship in arranging medical card services and, exercising discretion, may grant eligibility for a medical card on this basis. I am aware the HSE routinely affords applicants the opportunity to furnish additional supporting information and documentation to take account fully of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.

Ciara Conway (Waterford, Labour)
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I thank the Minister of State. Nobody is disputing that there are issues in terms of what we as legislators decide to do regarding changes to legislation on eligibility criteria other than means, but I referred to cancer patients who are entitled to medical cards because of their means and are still waiting in excess of the 15 day turnaround period. I received a response today from Mr. Kieran Healy, head of customer services in the HSE. It is not happening.

I was able to lift the telephone in my office in September and within two days a card was issued. The woman concerned had built up a large bill in her local pharmacy and had received a large bill from the treating hospital for her chemotherapy. Pharmacists are under the illusion that medical cards are backdated, but they are not. It is something we as a Government need to tackle. The date of the initial application for social welfare payments is the date from which the card is sanctioned. I am not referring to people who do not have an entitlement to a card, but rather those who are entitled to one.

In the two cases I outlined, in a response the HSE referred to 98% turnover and stated that 90% of people have their applications completed within 15 days. I must know of the two unluckiest people in Dungarvan, County Waterford. They are just two cases of the many I could highlight to the Minister of State. We need to consider backdating the initial application date of a medical card. People who are entitled to a card and who are trying to tackle, conquer and overcome cancer should not have their burden added to because of additional financial pressures resulting from bills from hospitals and local pharmacists.

Denis Naughten (Roscommon-South Leitrim, Independent)
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The problem with cancer patients and the 15 day loophole the HSE uses is that the medical card section in Finglas is involved in what is called a three card trick. Even though it has direct access to Revenue and social welfare and can get information at the touch of a button, it deliberately forces sick patients to go to local tax offices to get printouts of their last tax liabilities and to go into social welfare offices to get printouts of their social welfare payments. Such a policy delays processing applications and saves the medical card section money.

The report of the medical card eligibility group recommended that we should not base medical cards on particular medical conditions. However, the subsequent Minister announced that every child in the country diagnosed with cancer would get a medical card. I ask the Minister of State to lift that age barrier. Regardless of age, if someone is diagnosed with cancer they should get a medical card.

I refer to the rural discrimination that is taking place across the board regarding medical cards, and not just for cancer patients and the chronically ill. I want the Minister of State to address this issue. A patient in Galway city is receiving treatment in Dublin and was given medical expenses of €14.45 a week less than a patient living beside him in Galway city who receives treatment in University Hospital Galway. The reality is that even though there is a lack of public transport in rural Ireland, the HSE is deliberately ignoring transport costs when making medical assessments. This practice is taking place across the county and the reality is that the HSE is actively discriminating against those living in rural Ireland who are sick and cannot travel from provincial towns to regional centres.

Ann Phelan (Carlow-Kilkenny, Labour)
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I assure the Deputy that we have already taken the initiative on rural transport and are working with the HSE and the NTA on the parts of rural Ireland where people experience difficulties in trying to travel to hospital appointments. We will be able to develop cost savings through such an initiative.

On foot of the Keane report, the HSE established a clinical advisory group to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system. The group includes patients' representatives and is continuing its work on the development of guidance on assessing medical card applications involving significant medical conditions. In the context of that work, the group made an interim recommendation, as Deputy Naughten stated, to award medical cards to all children under the age of 18 years with a diagnosis of cancer for a period of five years. This decision was accepted by the HSE director general.

The existing assessment system is complex because it tries to ensure that a wide range of personal circumstances can be taken into account. We are still committed to further improving the existing system and the work of the Comptroller and Auditor General will be central to this in the immediate future. In the medium term, I believe that we should focus on the strategic goal of universal health care, which will benefit everybody.

Denis Naughten (Roscommon-South Leitrim, Independent)
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Will the Minister of State deal with the issue of discrimination?

Ann Phelan (Carlow-Kilkenny, Labour)
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We are already working on an initiative with the NTA and the HSE.

Denis Naughten (Roscommon-South Leitrim, Independent)
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I refer to rural discrimination in regard to the issuing of medical cards. Will she look into that specific issue?

Ann Phelan (Carlow-Kilkenny, Labour)
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I ask the Deputy to send me an e-mail on the issue.