Dáil debates

Wednesday, 18 January 2023

Saincheisteanna Tráthúla - Topical Issue Debate

Medical Cards

8:50 pm

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I thank the Minister of State for being available in the House, as usual. I am a bit concerned about this because it is a question of emergency medical cards. These occur in situations where a particular life-threatening or life-changing illness has affected a family and the concerns of the family are and continue to be such that they feel they are entitled to an emergency medical card. In the case of a terminal or life-threatening illness, the families in question have enough worries and problems on their agenda without worrying as well about the possibility of running out of money.

Some might say there are enough provisions to ensure that cannot happen, but that is not so. Years ago, I dealt with a situation where a pivotal officer in the health services was eventually in a situation where the resources had run out. Along with the threat of an illness so serious that it could lead to the termination of a life, the family concerned was also going to face the problem of the loss of the family home. Those are not isolated cases.

This is the second time I have brought the same cases to the attention of the Minister of State. I know she is a very hard worker and that she genuinely and sincerely hopes that the system works as it is supposed to work. However, it is not working as it is supposed to work. The reason I know it is not working is that a person intoned to me that they had reviewed the situation and decided that the person concerned is not entitled to an emergency medical card. On what basis was that decision made? It was made on a financial basis. The decision was made on financial grounds. The whole purpose of emergency medical cards is to get around those considerations to help the people concerned. Those people were receiving emergency treatment six months ago. They expect some little help. I know this matter is safe in the Minister of State's hands. However, some other body is using something to slow the whole thing down and to make it impossible to qualify. There are financial qualification limits when the urgency of the medical situation should be and is sufficient to warrant favourable consideration. I was told in both the cases I have referred to that the situation was being reviewed but a new application would have to be made. I need to ask about that part of the matter. If the existing application is insufficient and income guidelines are the barrier to the grant of the medical card in the first instance, how will that change by making a new application? It is a theory that does not work.

This is not a criticism of the Minister or the Ministers of State. It is simply a question of challenging the concept that exists within the system whereby somebody has the neck, gall and effrontery to say to a public representative that they have reviewed the application and the applicant does not qualify. The people I am speaking of are seriously challenged by their health issues. They have enough other issues to deal with, including increases in the cost of living and the ordinary, run-of-the-mill situations of a household. On top of that, someone has arbitrarily made a decision above their heads that they cannot be helped.

9:00 pm

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this matter, which I am taking on behalf of the Minister, Deputy Donnelly. I will stick to the script I have been given but perhaps the Deputy and I can have a conversation thereafter.

The Deputy may be aware that under the Health Act 1970, eligibility for a medical card is provided on a statutory basis 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. Persons with full eligibility, that is, medical card holders, can generally access a wide range of health services without charge. As of 1 December last year, there are over 1.56 million medical cardholders and over 535,000 GP visit cardholders. Where individuals might be in excess of the medical card income guidelines, every effort is made by the HSE to support applicants 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. I have yet to see that discretion exercised. It is also important that every effort is made to support people with difficult illnesses including, where appropriate, through the provision of a medical card. I can inform the Deputy that the HSE has systems in place to provide emergency cards to support people who are terminally ill or seriously ill and in urgent need of medical care that they cannot afford. For example, circumstances 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 same privately. The HSE has advised me that emergency medical cards are issued within 24 hours of receipt of the required patient details and letter of confirmation of condition from a doctor or consultant. With the exception of terminally ill patients, all emergency medical cards granted are issued for a period of six months. This is based on the patient being eligible for a medical card on the basis of means or undue hardship and following up with a full application within a number of weeks of receiving the medical card eligibility. l assure the Deputy that the Department of Health endeavours to ensure the medical card system is responsive and sensitive to people's needs. The 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.

The most striking piece of what I have read out to the Deputy related to the grant of emergency medical cards for six months with the exception of cases of terminal illnesses. Where a person has a life-altering condition or diagnosis, there is a period of time when filling out forms is not their priority. They are instead ensuring they are in the right space to receive the right care that gives them the time to adjust and understand the life-altering news they have received and its impact on their family. It is not only the individual who is affected. The wider family is also impacted. The HSE and the Department should be looking at that temporary emergency card. We do not want to create a hierarchy of conditions or anything like that. We are talking about life-altering conditions where people are undergoing treatment or need to recover or rehabilitate for six months, at which stage the process would be reviewed.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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The Minister of State has a clear understanding, as I have, of the regulations as they apply. They should be applied in a humane manner to take account of situations that may arise out of the ordinary run-of-the-mill circumstances. The HSE has to take account of a situation that may affect a family who are traumatised enough by virtue of the challenges facing them. If a person is seriously ill, the last thing he or she wants to be told is that this is the end. Who wants to tell somebody that, for God's sake? The therapy to be engaged at that stage is the kind of therapy the Minister of State has talked about and that we all know about from years of dealing with the situation.

I know the way the system is supposed to work. The Minister of State is absolutely right. I will leave the matter in her capable hands and we will talk about it at a later stage. The Minister of State knows what the story is. There is a problem in that particular section and I do not know what it is. I spent three days last summer trying to track down an individual responsible for a payment that was absolutely necessary and vital. I could not understand how it could take three days. It was not because I did not know where the various lines of communication were because I did. It took all of those three days, and that was in the summer when the days were long. It would be beneficial to the good name of the HSE, and bearing in mind the goodwill it has shown in many other cases, to look at these cases in the particular way to which the Minister of State has just referred.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I again thank the Deputy for giving me the opportunity to engage with him on my behalf and that of the Minister, Deputy Donnelly. The cases the Deputy has talked about are very emotive. We know that means could be a barrier but all we are looking for is temporary consideration for six months while the person concerned can adjust to the news of the diagnosis. We are not saying what the term or condition would be. Where a GP submits the MC1 form from the surgery in circumstances where the consultant has written to the GP, I take umbrage with a clerical official saying that a person does not warrant support.

The HSE needs to look at that. In fact, when it comes with medical advice for support that temporary period should not be based on a person receiving a terminal diagnosis. It is in its response that it looks at emergency cases. Emergency cases mean people with a life-altering condition or a diagnosis that has a life-altering effect on them.