Camillus Glynn (Fianna Fail)

History is an important subject because if we learn from mistakes we will not repeat them. Senator Ryan is a member of a party with a moving policy — it makes it up as it goes along. However, those of us who live in the real world must deal with the facts as they are.

It is open to all persons to apply through the chief executive of a health board for a medical card if they are unable to provide these services for themselves or their dependants without hardship. In line with the health strategy, Quality and Fairness — A Health System for You, the possibility of extending the medical card by statute to various groups is undergoing ongoing review in the Department in the context of the strategy's second goal. This should be viewed in the broader context of the strategy's emphasis on fairness and its stated objective of reducing health inequalities in our society. It is a fact that there are and have been inequalities and while much work has been done in this regard, more needs to be done.

I agree with Senator Ryan that the time is past when people trailed into the surgeries despite everybody knowing the situation. The medical card scheme, the GMS and the choice of doctor scheme were innovative policies which should be welcomed by all right-thinking people. Health board chief executive officers have discretion in regard to the issuing of medical cards and a range of income sources are excluded by the health boards when assessing medical card eligibility.

Reference was made to the number of medical cards which have been discontinued. As it is an income-related facility, it is to the credit of this Government and the incoming Minister for Health and Children, who brought many more people into the workforce, that people are now in the workforce playing their part in society and are therefore falling outside the eligibility terms for medical cards.

Although a person's income exceeds the guidelines, a medical card may still be awarded by a health board chief executive officer. The health strategy includes a series of initiatives to clarify and expand the existing arrangements for eligibility for health services, including recommendations arising from a review of the medical card scheme carried out by the health board CEOs under the PPF which include streamlining applications and improving the standardisation of the medical card application process to ensure more fairness and transparency. There were many difficulties in dealing with applications that I as a public representative dealt with over many years by providing clearer information to people about how and where to apply for medical cards.

As somebody with a background in the area of health I am aware that there are people who can afford to go to a doctor, or people who have medical cards, who will not go to a doctor for reasons best known to themselves. One reason that has been put forward is that they might not like what the doctor might have to say. I do not know whether that is true.

The Department of Health and Children is committed to the preparation of new legislation to update and codify the whole legal framework for eligibility and entitlement in regard to health services. There are 768,895 medical cards at the moment, covering 1,151,106 people. That is just under 30% of the population. However, it must be recognised that many of the people who had medical cards have entered the workforce and are now ineligible for a medical card.