Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I thank Senator Murnane O'Connor for her contribution and for raising this important issue.

While we have made significant progress in the treatment of cancer in Ireland, a cancer diagnosis obviously has a major impact on the patient both physically and psychologically. A cancer diagnosis can also have social as well as financial impacts. The diagnosis often has a significant effect on a patient's family and friends.

I have met many cancer patients and their families during my time in the Department of Health. This has given me a profound appreciation of how difficult and varied the effects of a cancer diagnosis can be.

Eligibility for a medical card is determined by reference to the means, including the income and expenditure, of the applicant and the partner or dependants. Therefore, the legislation was neither designed for, nor would it permit, the granting of a medical card solely or primarily on the basis of a person's medical condition. In 2014, following considerable public and political controversy regarding the basis on which people’s eligibility for a medical card was determined, the HSE was asked by the Minister for Health to establish an expert panel to examine the range of conditions that should be considered as a basis for eligibility and seek to prioritise such conditions. The Report of the Expert Panel on Medical Need for Medical Card Eligibility, the Keane report, was accepted by the Government and forms the basis for the current operation of the medical card system. The report explicitly considered the potential for the award of medical cards on the basis of a person's medical condition and recommended that a person's means should remain the main qualifier for a medical card; the panel concluded that it would not be feasible, desirable nor ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility and that a financial assessment remains the most equitable method of allocating scarce resources in the health sector.

Following the expert group report, a clinical advisory group was established by the director general of the HSE to assist in the development of guidance on assessing medical card applications involving significant medical conditions. Now, as a result of this group's deliberations, the HSE, when assessing a person for a medical card, has procedures in place which as well as looking at income have regard to their overall financial position, including medical evidence of cost and necessary expenses.

The HSE also has a system in place for the provision of emergency medical cards for patients who are terminally ill or who are seriously ill and in urgent need of medical care they cannot afford. Emergency medical cards are issued within 24 hours of receipt of the required patient details. Where a patient is terminally ill in palliative care, the nature of the terminal illness is not a deciding factor in the issue of an emergency medical card in these circumstances and no means test applies. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure the person gets the card as quickly as possible.

To sum up, the HSE is ensuring a more integrated and sensitive approach towards the processing of medical card applications, including those from persons with a diagnosis of cancer involving greater exchange of information between the central assessment office and the local health offices in relation to people’s circumstances and need.