Alex White (Dublin South, Labour) | Oireachtas source

I thank Senator Higgins and Senator Moloney for their contribution on this issue. As Senators will be aware, under the provisions of the Health Act 1970, assessment for a medical card is determined primarily by reference to the means, including the income and expenditure of the applicant and his or her partner or dependants. People with specific illnesses such as cancer are not automatically entitled to medical cards. This has been the legal position since 1970. It is not possible for the Minister for Health or any Minister to issue a directive to change that position. There would have to be new legislation passed by the Oireachtas because this is the law passed by the Oireachtas in 1970. The basis for obtaining a medical card is on foot of an assessment of a person's means. That is what the law provides. I understand the point Senator Moloney made but it is not something that is amenable to being changed by ministerial directive. It could not be done by ministerial directive because the Act of 1970 would have to be amended.

Having said that, the HSE has discretion to grant a medical card where a person's income exceeds the income guidelines. The discretion must be exercised by the HSE but the fundamental provision in the 1970 Act is that a person is assessed on the basis of his means. The question asked is whether the person can provide for his own health care and treatment without undue hardship. The opportunity for the exercise of discretion is in place to deal with the types of cases raised by Senators Moloney and Higgins, that is, people who are above the income limits but who still face genuine hardship in terms of providing for themselves. It still cannot be done on the basis of someone having an illness.

I am always mindful of how harsh it sounds for a Minister to say that we do not give medical cards to people simply on the basis of an illness. It is a hard and crude way of answering the question. However, I am simply setting out for the benefit of the House what the law provides. There is no basis for extending a medical card to a citizen on the basis of his having a particular illness. That is not the current state of the law and if we were to change it, it would have to be done by legislation.

The Government has a commitment set out in the programme for Government for universal access to a free general practitioner service. I accept this is not the full General Medical Services, GMS, scheme but it is a free GP service for the entire population. This is for the entire population; whether they are well or ill we want everyone to have access to a free GP service. The aim is to develop primary care and do all the things in primary care that we need to do in this country in terms of identifying the area of health care which is closest to where a person lives and where they are. They should be treated there and should have available to them treatment in the community. We should have available all the preventative strategies that we need to have in the health service that have not been sufficiently well-developed. The idea is to involve and assist people and encourage people across the board not only when they are ill, although obviously that is the most sensitive and difficult time.

I do not take from anything that the Senators have said and what Senator Moloney said may be true in terms of the guidelines being so low. However, fully 43% of the population satisfy the guidelines. Medical cards have been extended to 43% of the entire population. That is a statement of how incomes have been affected generally as a result of the recession because so many among the population can satisfy what Senator Moloney has described as low figures. It reflects the situation in which the country finds itself.