Dáil debates

Thursday, 24 November 2022

Saincheisteanna Tráthúla - Topical Issue Debate

Medical Cards

5:35 pm

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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This relates to emergency medical cards and emergency relief where patients are suffering from a particular life-threatening situation and the need to issue a medical card quickly. It is true to say that a patient who has a life-threatening illness has enough worries but some are forced to wait again and again and are told they must apply again. The last thing that should be on the mind of the patient should be the delay in applying again. They do not want very much. All they want is a bit of consideration, compassion and a little bit of movement, particularly where the hospitals have issued the request for the medical card.

They know what the condition is and the circumstances, but there is a dragging out of the whole situation to the extent that the deciding officer is making a suggestion on the seeking of further conclusive evidence. For heaven's sake, the hospital has already indicated what is required.

I am referring to two particular cards but I am not using the people's names. There was a call to my office this evening from the Department to suggest one card has been granted. One card has not been granted. A card was granted to a person with the same name. It was not the same person at all. The issue was such that I decided all the cases should be dealt with globally and finished with. Is it possible to indicate to the HSE the urgent need to respond and alleviate the stress on the patients? They are under enough stress already. It should not be necessary for them to repeat the nature of their condition time and again. They have life-threatening conditions. I call for an immediate response in all the cases concerned and all cases that are pending. What I am calling for will not bring the nation to a halt. It involves a simple expression of compassion and concern to alleviate the stress of patients and make life a little easier for them.

5:45 pm

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for raising this issue. He talked about issuing medical cards quickly and people having to supply information again. He has a unique view on the hospital making a decision. A time of illness is difficult and a cancer patient experiencing trauma, for example, needs compassion and needs the State to act as quickly as possible.

Person-centred care is a core value of the health service, whereby everyone living in Ireland and considered by the HSE to be ordinarily resident here is entitled to either full eligibility or limited eligibility for health services. Persons with full eligibility, namely medical card holders, can generally access a wide range of health services without charge. As of 1 November, there are over 1.56 million medical card holders and more than 533,000 GP visit card holders.

Eligibility for a medical card is provided on a statutory basis under the Health Act 1970 and is based primarily on means. The Act obliges the HSE to assess whether a person is able, without undue hardship, to arrange general practitioner services, having regard to his or her overall financial position and reasonable expenditure. Where individuals might be in excess of the medical card income threshold in the guidelines, every effort is made by the HSE to support them by taking full account of the difficult circumstances, such as extra costs arising from an illness. In such circumstances, the HSE may exercise discretion and grant a medical card. That said, it is vital that we do as much as possible to support people with difficult illnesses, including, where appropriate, through the provision of a medical card.

Regarding the particular matter raised by the Deputy, the HSE has guidelines in place on the provision of emergency medical cards to patients who are terminally or seriously ill and in urgent need of medical care they cannot afford. Instances where it would be appropriate to apply for emergency consideration include acute medical crises whereby access to services covered by medical card eligibility is required urgently and the client has no means to pay for them privately. Emergency medical cards are issued within 24 hours of the receipt of the required patient details and letter of confirmation of condition from a doctor or consultant. Medical card eligibility awarded in emergency circumstances is for a period of six months, following which time the client will need to complete a full means assessment, with the exception of terminally ill patients.

With the exception of patients who are terminally ill, all emergency medical cards granted are issued on the grounds that the patient is eligible for a medical card on the basis of means or undue hardship and will follow up with a full application within a number of weeks of becoming eligible. I am advised by the HSE that such medical cards are active on the system within 24 hours of the HSE national medical card unit receiving a medical report and completed application form from a healthcare professional.

I endeavour to ensure that the medical card system is responsive and sensitive to people's needs. My Department keeps medical card issues under review, and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary Estimates process and legislative requirements arising. However, I do hear the Deputy. For every Deputy and Senator, medical cards can be a very difficult issue. It can be harrowing for those with a terminal or serious illness if they find it hard to get a medical card. We do need to do a little better.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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In fact, it is not happening as it should. The people involved know that full well. Where there is a terminal illness or life-threatening illness that may become terminal, what does the section want? Does it want somebody to say the patient is going to die? That is essentially what it is coming down to. That is not something I or anybody else should decide. In order to deal with the situation that presents itself, in which the patient is under stress owing to illness and thoughts of how things might pan out, there is a need for some small gesture of reassurance, such as an emergency medical card. This would be of some small assistance to an affected family. The cost would not tear the nation apart. It is just a simple gesture to alleviate some of the burden on an family affected. It may be the head of the family or a junior member. I ask the Minister of State to relay this to the relevant section of the Department straight away. Could it have a little humanity and compassion and apply them? In all cases, the people in question said they want the medical card only for the time involved, whatever that may be, and not forever. It is to relieve the stress. They have enough stress already. We do not need to add to it by dragging patients through an assessment, all based on money. That is not the way the system is supposed to work.

I assure Minister of State that I have dealt with this for many years. Somebody is sitting on a file or files somewhere waiting for confirmation. They are not entitled to do so. What is happening to the patients is appalling. I ask the Minister of State to convey my views to the authorities concerned in the shortest possible time.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I will bring the Deputy's views to the relevant section immediately. As he said, we need to alleviate some of the burden on people with serious and terminal illnesses. We do as much as possible to support people with difficult illnesses, including, where appropriate, through the provision of a medical card. Every effort is made by the HSE within the framework of the legislation to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances of applicants whose income may be in excess of that stipulated in the guidelines. In this context, it is important to acknowledge that the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold, where he or she faces difficult financial circumstances such as extra costs arising from an illness.

The HSE affords applicants the opportunity to furnish supporting information and documentation to take account fully of all the relevant circumstances that may benefit them in the assessment, including medical evidence of costs and necessary expenses. We will endeavour to ensure the medical card system is responsive and sensitive to people's needs by keeping all medical card issues under review.