Nicky McFadden (Fine Gael)

I raise this matter because it has been brought to my attention that the HSE plans to centralise the processing of all applications for medical cards in Dublin. A pilot project has been established since 1 September 2009 and the new system is called the primary care reimbursement system. I have grave reservations about this change because I believe it will lead to chaos and confusion for medical card applicants.

When the automatic entitlement to a medical card for those over the age of 70 was removed earlier this year, the processing of applications for medical cards was centralised. Applicants have experienced long delays and elderly people have experienced poor access in terms of a response to queries because of this system.

A constituent brought to my attention the case of his father who was born in 1918 and was moving from Dublin to live in a nursing home close to him in Athlone. The man's family only realised that his medical card had been cancelled when his general practitioner requested a €50 fee. The man did not receive any communication from the centralised primary care reimbursement system advising him of that. I do not want this system to be a reflection of our society in terms of the way we treat our people who are vulnerable, sick, or less well off. Our health service must be patient-centred and must always act in the interests of the sick and vulnerable person.

The centralising of the processing of applications for medical cards will make the service slower and less accessible for all our citizens. It will dramatically reduce the system's responses to citizens, GPs and politicians. Neither I nor the Minister of State will have adequate access to it, although the Minister of State who is based in Dublin will probably find it easier than I to do so. It is discriminatory that it is not easy for rural-based politicians to check and monitor progress on the processing of an application for a medical card.

The new system will remove flexibility and safeguards from the process. Staff in the local office were able to proof an address. The local staff in the office in Athlone, from where I come, know every street and area in the town. Matters requiring such knowledge cannot be dealt with in Dublin.

There is also the aspect of the depersonalising of the service. I am speaking on behalf of elderly people. Not everybody has access to e-mail nor can everybody communicate even by telephone. There are people, in particular in lower socioeconomic categories, who do not have access to these technologies. I gave an example already of a man born in 1918 who did not even receive a letter from the Health Service to say that his medical card was being cancelled and who was requested by staff at the local office to bring in a utility bill as proof of address. How does a person with no son, daughter or relative to assist him or her at aged 89 or 90 years do this? I earnestly and fervently request that the service remain as is. I believe the local administrators do an excellent job in terms of medical card applications. I will be fighting this move tooth and nail. There is no question of this service being better for the patient or that replacement of the current medical card applications service will benefit from a depersonalised, nameless, faceless service in Dublin.