Seanad debates

Wednesday, 15 July 2009

3:00 pm

Photo of Pearse DohertyPearse Doherty (Sinn Fein)
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I welcome the Minister. The issue I have tabled, and the last issue to be discussed in the Seanad before the summer recess, is important to communities throughout the island of Ireland. It affects about 300 HSE employees but it will affect hundreds of thousands of medical card holders across the State.

I wish to focus on the office in Ballybofey, County Donegal, where ten employees of the HSE provide a remarkable service to medical card holders. These individuals process applications for medical cards and deal with appeals submitted by members of the public in an efficient and caring manner. They possess a knowledge and understanding of the way of life in Donegal, the geography of the county and the difficulties people experience. Those to whom I refer operate under an extreme amount of pressure and I acknowledge that there is a backlog in respect of the service being provided. At present, 78,000 people in Donegal possess medical cards and a further 5,700 utilise the GP visit card. This means that some 84,000 people, over half the population of Donegal, have access to either card. As a result, a major burden has been placed on the staff who work at the office in Ballybofey.

I am concerned with regard to the immediate threat on the part of the Government and the HSE to remove the service and centralise it to what is primarily a call centre in Dublin. On foot of this action, the knowledge, understanding and compassion which those who work at the Ballybofey office possess will be lost. The HSE has already centralised the service relating to the medical card for those over 70 years of age and it must be acknowledged that this has not worked. The lack of staff in this regard means that there is not an ability to deal with the issues that have arisen in respect of those over 70 years of age, not to mention tackling matters relating to those between the ages of zero and 69. Some 350 calls go unanswered each week at the hub in Dublin because the staff there do not have the capability to cope with them. Such calls are made by those over 70 or people who are applying for medical cards. What will be the position when the 84,000 people in Donegal who possess cards of one type or another and their counterparts in other counties will be obliged to avail of the services at this call centre?

The centralisation of this service runs completely contrary to the Government's commitment in respect of decentralisation in the early part of this decade. The idea that the Government would remove services from a county such as Donegal at a time like this does not make sense. I have challenged the Government in respect of numerous issues. I had a discussion with someone recently as to whether there should be fewer Ministers and Ministers of State and he stated that we should get rid of them all because all we need is a "Minister for Cop On". An element of cop on is missing from some of the decisions being made by the Government at present and, in the current climate, it certainly does not make sense to remove services from Donegal.

Will the Minister of State outline the plan with regard to the centralisation of services? Will she confirm that such a centralisation is not going to take place? I am sure she is aware that IMPACT, the union which represents the ten workers in Donegal to whom I refer and the other 300 who are employed in various other offices throughout the State, is in the process of balloting its members on industrial action. The results of that ballot will be known at the end of the month and I have no doubt that IMPACT is ready to defend not only those it represents but also the services these people provide to medical card holders in Donegal and other counties.

It is important that this centralisation of services should not proceed as planned. It is also important that sense should prevail, that the ten jobs in Ballybofey should be protected, that the service should continue to be provided in Donegal and that the 84,000 people there who hold one type of card or another should continue to be able to access it and that the compassion and knowledge to which I referred earlier should be retained in the county. I ask the Minister of State to indicate that what is proposed is a fantasy of the Minister for Health and Children and that it will not proceed.

Photo of Áine BradyÁine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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I am taking this matter on behalf of the Minister for Health and Children, Deputy Harney.

The assessment of eligibility for medical cards and general practitioner, GP, visit cards is statutorily a matter for the Health Service Executive, HSE, and is determined following an examination of the means of the applicant and his or her dependants. Up to the start of this year, medical card and GP visit card applications were processed in the 32 local health areas. However, under the HSE's service plan for 2009, the processing of all medical card and GP visit card applications will be centralised and will transfer to the executive's primary care reimbursement service, PCRS, in Dublin. This change is being implemented on a phased basis and commenced with the PCRS processing all medical card applications for persons aged 70 or over.

The decision by the HSE to centralise the processing of applications has been made in the context of the requirement to realise the savings in this very challenging economic environment. The change will provide an enhanced standardised service to the client population. It will also deliver services for the public within sustainable levels of expenditure and with the aim of achieving efficiencies by the greater usage of shared services. In view of the fact that medical card applications will all be processed centrally, this will result in a more consistent and transparent approach being applied. There will be no adverse impact on patient care or the quality of service provided. In addition, there will be no adverse affect on the assessment of people whose income exceeds the income guidelines but who have a case to be considered on medical or hardship grounds.

Under the new arrangements, the HSE will be aiming for a turnaround time of 15 days or less for all medical card applications. Emergency applications will be dealt with immediately, with a card issuing within 24 hours. People whose income exceeds the income guidelines but who have a case to be considered on medical or hardship grounds will continue to have their applications considered by the PCRS.

The HSE has advised the Department of Health and Children that there are no plans to close any of the local health offices. These offices will continue to deal with queries of a general nature about the medical card scheme and will provide any assistance needed with the application process. In conjunction with the national helpline, they will also deal with inquiries from clients in respect of their medical card entitlements and the completion of application forms. However, the process will involve a reassignment of existing human resources within the HSE.

This is a good example of the type of innovation signalled in the transforming public services programme announced by the Taoiseach last November. It demonstrates how improved services can be delivered within the more limited resources available in a way which meets the needs of citizens in a modern society.

I wish to highlight that the number of persons with medical cards has increased by over 240,000 since the start of 2005. Almost 1.4 million people are now covered by the card. In addition, over 90,000 people have GP visit cards.

Photo of Pearse DohertyPearse Doherty (Sinn Fein)
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Regardless of my level of disappointment with it, I thank the Minister of State for the information provided. Everyone is aware that the HSE is both a monster out of control and a bureaucratic nightmare. The Government is intent on creating a second monster. Processing the applications of 1.4 million people at one call centre in Dublin does not make sense.

I recently spoke to Cora Harvey, a Sinn Féin councillor who lives in Ballybofey, who indicated to me that the people in the office there understand the needs of those throughout Donegal who possess medical cards. I do not understand how staff in an office in Dublin who will be obliged to deal with over 1.4 million people will be positioned to operate in the same way. For those who live in rural areas, the office in Dublin might as well be located in Timbuktu or China. It does not make sense to centralise the service to Dublin and I am of the view that the office here will not be efficient.

The call centre or hub in Dublin currently deals with medical card holders who are over 70 years of age and misses an average of 350 calls per week.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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The Senator should put a question to the Minister of State.

Photo of Pearse DohertyPearse Doherty (Sinn Fein)
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The centre will soon be obliged to deal with calls from over 1.4 million people. How can the Minister of State stand over her claim that services to the public will not be diminished, particularly when she is aware that the hub cannot even deal with the number of calls being made to it by those who are over 70?

Photo of Áine BradyÁine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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I have noted the Senator's concerns and I have already made my reply.