Dáil debates

Thursday, 21 October 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Primary Medical Certificates

7:55 pm

Photo of Donnchadh Ó LaoghaireDonnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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This matter has been raised a few times, although I am not sure if it was raised very recently in the Oireachtas. The primary medical certificate is primarily about adapted vehicles. That is the most common reason people require it. It is relevant where people have a disability or suffered a long-term or permanent injury that means they required a specially adapted vehicle. It is crucial to people's independence, dignity and quality of life.

The Minister of State knows there have been developments in this area. A Supreme Court decision in June 2020 caused the Department of Finance to suspend planned assessments and appeals until further notice, pending legal advice. That pause lasted until January this year, if I recall correctly. Covid-19 also had an impact. The combination of these two events meant both the initial hearing and appeals processes saw very significant delays. I know there have been efforts to clear the backlog but I have heard from people on the ground and those working in the system that there is a backlog of initial applications but the backlog for appeals is very lengthy. I know one case from the west of Ireland was told in recent months that a cancelled appeal would not be rescheduled until some time in 2022. The waiting list for applications is several months in Cork and appeals are between seven and eight months.

People with disabilities should not have to wait a year or two to know whether they can afford to have their card adapted or to purchase an already adapted car. That is not right and this has a major impact on their quality of life. It can hold back their independence. In many cases the disability could emerge quickly, such as in the case of injury or rapidly progressing illness. All of a sudden, a previously completely independent person has to wait for this process and there is nothing to be done to speed it up. All the actions such people can take they would have discharged and the process has been taken from their hands.

What is the latest information? I have an anecdotal sense of it from on the ground in Cork and cases I have heard about in other parts of the country. I have also heard from people working in the service. Will the Minister give a picture of where we are nationally and the progress in clearing the backlog not only in applications but also in appeals? What is the plan to ensure that big backlog of appeals in particular can be cleared so these people can get their primary medical certificate, get on the road and get to shops or visit relatives? That is what this is about. We are talking about their independence, dignity and ability to get on with their lives.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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It is a very important matter.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for raising this very important matter today. I am glad to take the opportunity to set out the position regarding the assessment process for primary medical certificates.

A primary medical certificate is a requirement for the disabled drivers and disabled passengers (tax concessions) scheme. This scheme is underpinned by statute and comes under the remit of the Department of Finance and the Revenue Commissioners. The extent of the involvement of HSE community medical doctors in the scheme relates to making a clinical determination as to whether an individual applicant meets the specified criteria.

Following a Supreme Court decision of June 2020, the assessment process for primary medical certificates was suspended at the request of the Minister for Finance. On the enactment of the Finance Act 2020, which provided for the medical criteria in primary legislation, the Health Service Executive, HSE, was informed that assessments could recommence from 1 January 2021. This has proceeded in the context of restoring services in a Covid-19 environment.

The Health Service Executive community services has developed a prioritisation framework, which enables staff to be deployed where necessary. The ability to hold assessments for primary medical certificates has been affected by, among other factors, the key role played by community medical doctors in the national Covid-19 response.

The Health Service Executive has confirmed that community medical doctors and their teams were predominantly deployed to the Covid vaccination roll-out in residential care facilities and other healthcare settings. Community doctors were also required to undertake school immunisations, which were identified as a priority for the HSE.

If an applicant's case clearly meets the strict criteria that govern the primary medical certificate, a community medical doctor may be in a position to grant it, with supporting documentation from a consultant, without an in-person assessment. However, the majority of applications are not clear cut and need an in-person medical examination to make an adjudication. The HSE has informed me that progress on assessments has been made, with more than 1,270 assessments undertaken up to the end of June this year. I am glad to outline the background and current position on this important matter to the House today. I acknowledge what the Deputy said in that these people want to get on with their lives, get into their cars, do their shopping, meet their relations and travel again. I hope this may be of some assistance.

8:05 pm

Photo of Donnchadh Ó LaoghaireDonnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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I suppose there is good in that response, but it does not deal with all the issues. This process does not seem to be running at full steam. While there has been some progress made in the backlog, the community medical doctors are also doing many other jobs which puts demands on the resources. The other issue which has not been addressed is the delay in the appeals, which is a key part of the process. People are waiting lengthy periods of time for their appeals to be heard, which is also holding them back, and many of these appeals can be successful.

We have come across cases in my constituency office where the criteria might be too severe. I have come across cases involving people with fibromyalgia, and as a result have mobility difficulties, but who do not currently qualify. There are parents of children with profound learning difficulties and related conditions, who do not qualify even though the children, in some instances, are at risk of rapid movements or require a large amount of space to get out of a car. I wish to flag that they do not always qualify either.

I ask that the Minister of State to take my primary concern back to his Department. While I understand there are significant delays with the initial applications, there is also an issue in regard to the appeals, which needs to be addressed. I ask that the Minister of State take that point back to his Department so we can get this issue addressed. I acknowledge the objectives are not wrong. However, the issue is about the urgency at which it is being addressed. It does not involve the most enormous category of people, but the impact it has on their lives is enormous and it holds them back.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I accept the impact it has on people's lives and I hope the appeals will be dealt with more urgently than they have been. As I said, some 1,270 assessments were undertaken up to the end of June this year. I assure the House that if an applicant's case clearly meets the strict criteria that govern the primary medical certificate, a community medical doctor may be in a position to grant it, on the basis of supporting documentation from a consultant and without an in-patient assessment. This may go some way in providing clarity and help. However, the majority of applications are not clear cut and need an in-person medical assessment to make an adjudication. In the context of providing health services within a Covid environment, and the related public health restrictions, the HSE is continuing to make progress with the assessment process for primary medical certificates. As the Deputy said, perhaps it is not going at full steam. Now that many people have been taken off Covid duty, perhaps we will be in a better position to get the process up to full steam.