John Kelly (Labour) | Oireachtas source

Before I was elected to the Seanad, apart from being a county councillor, I was a community welfare officer for 28 years, during which time I dealt with medical card assessments. I predicted that problems would arise with the centralisation of the medical card system to the primary care reimbursement service, PCRS, in Finglas. I cannot blame the Government for the centralisation decision because it was made by its predecessor.

The medical card guidelines are often interpreted differently by the PCRS than under the old, locally based system. For example, car loans were allowed to be considered under the previous medical card guidelines where a certificate could be produced to show a medical need to have a car. The guidelines state the HSE must have regard to a person's overall financial position. They do not refer to car loans, but the practice was to take them into account in cases of medical hardship. They permit home improvement loans to be considered, but there could be a situation where a woman decides to upgrade to a modern kitchen that she may not need because it looks nicer. Such a loan would be allowed to be considered, but people need their cars to get to work. A car is not a luxury in such circumstances. Many double income families own two cars and most of them have car loans. Furthermore, where a family relies on two cars to travel to work in different directions, an allowance of ¤50 per car should be taken into account. In most cases, however, the PCRS is only allowing for one car.

The PCRS is also interpreting child care costs differently. The guidelines state outgoings on child care are allowable, provided they are necessarily incurred in taking up or continuing in employment or education and training, or in providing family supports. Appropriate documentary evidence is required to ensure the costs claimed are reasonable and being incurred. The medical card application form asks for the name and address of the child's creche or childminder. Previously, if a neighbour or friend looked after the children, it was acceptable for him or her to state in a letter how much he or she was being paid. However, the PCRS will only accept such letters from registered childminders, even though the guidelines are silent on this issue.

As a Senator, I am doing as much work on medical cards as I did during my 28 years as a community welfare officer because of all the problems that have arisen. An individual who was refused a medical card was recently referred to me for advice. He brought his income calculation sheet to our meeting, but he had only studied the first page, which stated he was not entitled to a medical card because he was over the limit. I asked him to show me his P60 which indicated that he had earned ¤19,500. His wife was in receipt of maternity benefit and they had a mortgage, which meant they were under the limit for the receipt of a medical card. He was told that he was over the limit. Understandably, the PCRS has since reversed its decision.

I ask the Minister to address the issues of child care costs and car loans, which are necessary and were allowed to be considered in the past. Somebody needs to tell the PCRS that while it may want to do business its own way, it is dealing with people for whom these costs were previously allowed to be considered when deciding on medical card applications.