Róisín Shortall (Dublin North West, Labour)

I thank Senator Kelly for raising this important issue, one with which I am familiar. I can provide information on the background to the initiative taken by the HSE to standardise the processing of medical cards throughout the country. Medical cards are provided to persons who, in the opinion of the HSE, are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants. While income guidelines are the principal benchmark used for deciding medical card eligibility, the HSE looks beyond the applicant's financial situation and has regard to other matters it considers appropriate in assessing a person for a medical card.

If a person's income and outgoings fall outside the HSE guidelines and there are personal and financial burdens arising from medical or social circumstances, the HSE may issue a discretionary medical card. The essential principle applied to such cases is that, if by bearing the cost of services covered by a medical card, an individual's or family's ability to meet essential costs is compromised, then a medical card will be issued. Taking into account the circumstances of each case, it is a matter for the experience and judgment of the decision-maker to determine if hardship exists within the context of the legislation and guidelines.

The HSE decision to centralise the processing of all medical card and GP visit card applications and renewals to the PCRS is part of the HSE value for money programme. There is a requirement on the HSE to make efficiencies in business practices in order to realise savings in a very challenging economic environment and provide a modern service to the public within sustainable levels of expenditure. The centralisation project is well under way and almost 40% of medical card applications are now processed centrally by the PCRS. Phased implementation of the centralisation project allows the situation to be continuously monitored and, if required, modified to address any issues arising. Local offices will also provide appropriate local services to the central office to ensure that when local input and information is needed it will be available and there is a resource to gather and provide it.

Under the centralisation plan, the HSE's local offices will continue to provide the public with assistance and information locally on medical card criteria and making an application, and the current status of the application or review. From a customer perspective, this means that at all times a person will be able to seek advice from his or her local health office. Local health offices can also deal with queries of a general nature about the medical card scheme and will continue to provide necessary supports to any person making an application. Local offices can also handle all inquiries from clients in respect of the medical card scheme, including assisting them in the completion of their application and advising them of their entitlements.

At the new national processing centre, medical card processing is characterised by standardised decision making aligned with the medical card guidelines. The process is transparent from application receipt through to completion, with customer service provided through multiple channels including phone, correspondence, online facilities and SMS messages. Applicants for medical cards, discretionary or otherwise, will benefit, under the centralised application process, from a quicker, more streamlined and more consistent approach to the appraisal of their applications than was available under the old decentralised system. That is the theory. The challenge is to ensure that happens in practice. We must learn from the experience of the early days in terms of the pilot project over the past 18 months. There are lessons to be learned. I wish to ensure that the HSE has taken those lessons on board and has adjusted and improved the service accordingly, and I undertake to ensure that happens.