Nicky McFadden (Fine Gael)
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I raise this matter because it has been brought to my attention that the HSE plans to centralise the processing of all applications for medical cards in Dublin. A pilot project has been established since 1 September 2009 and the new system is called the primary care reimbursement system. I have grave reservations about this change because I believe it will lead to chaos and confusion for medical card applicants.

When the automatic entitlement to a medical card for those over the age of 70 was removed earlier this year, the processing of applications for medical cards was centralised. Applicants have experienced long delays and elderly people have experienced poor access in terms of a response to queries because of this system.

A constituent brought to my attention the case of his father who was born in 1918 and was moving from Dublin to live in a nursing home close to him in Athlone. The man's family only realised that his medical card had been cancelled when his general practitioner requested a €50 fee. The man did not receive any communication from the centralised primary care reimbursement system advising him of that. I do not want this system to be a reflection of our society in terms of the way we treat our people who are vulnerable, sick, or less well off. Our health service must be patient-centred and must always act in the interests of the sick and vulnerable person.

The centralising of the processing of applications for medical cards will make the service slower and less accessible for all our citizens. It will dramatically reduce the system's responses to citizens, GPs and politicians. Neither I nor the Minister of State will have adequate access to it, although the Minister of State who is based in Dublin will probably find it easier than I to do so. It is discriminatory that it is not easy for rural-based politicians to check and monitor progress on the processing of an application for a medical card.

The new system will remove flexibility and safeguards from the process. Staff in the local office were able to proof an address. The local staff in the office in Athlone, from where I come, know every street and area in the town. Matters requiring such knowledge cannot be dealt with in Dublin.

There is also the aspect of the depersonalising of the service. I am speaking on behalf of elderly people. Not everybody has access to e-mail nor can everybody communicate even by telephone. There are people, in particular in lower socioeconomic categories, who do not have access to these technologies. I gave an example already of a man born in 1918 who did not even receive a letter from the Health Service to say that his medical card was being cancelled and who was requested by staff at the local office to bring in a utility bill as proof of address. How does a person with no son, daughter or relative to assist him or her at aged 89 or 90 years do this? I earnestly and fervently request that the service remain as is. I believe the local administrators do an excellent job in terms of medical card applications. I will be fighting this move tooth and nail. There is no question of this service being better for the patient or that replacement of the current medical card applications service will benefit from a depersonalised, nameless, faceless service in Dublin.

John Curran (Dublin Mid West, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague the Minister for Health and Children, Deputy Mary 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 an 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 2009 service plan, 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. The change is being implemented on a phased basis and has commenced with the PCRS processing all medical card applications for persons aged 70 years or over. This phased implementation will allow the HSE to monitor the situation and, if required, modify it to address any issues arising.

The decision by the HSE to centralise the processing of applications has been made in the context of the requirement to realise savings in this very challenging economic environment. The change will provide an enhanced standardised service to the client population. It will deliver services for the public within sustainable levels of expenditure and has the aim of achieving efficiencies by the greater usage of shared services. Centralised processing of medical card applications will result in a more consistent and transparent approach being applied and will not have an adverse impact on patient care or the quality of service provided. There will also 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. 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 relating to the medical card scheme and will provide any assistance needed with the application process and, along with the executive's national helpline, will deal with inquiries from clients in respect of their medical card entitlements and 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 fully support the HSE's decision to centralise the medical card and GP visit card application and review process to one location. The HSE has advised that when fully implemented the measure will ensure an improved turnaround time for the processing of applications, equitable application of eligibility throughout the country, consistency of service provision to customers, clearer lines of governance and accountability and improved unified data.

The number of persons with a medical card has increased by more 290,000 since the start of 2005. More than 1.43 million people are now covered by the card. In addition, more than 93,000 people have a GP visit card.

Nicky McFadden (Fine Gael)
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I thank the Minister of State for his reply. Will local offices be connected to the centralised computer to access information and track people's applications? Will there be a dedicated helpline or personnel available to assist politicians wishing to track people's applications for medical cards and so on?

John Curran (Dublin Mid West, Fianna Fail)
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I do not have those details to hand.

Nicky McFadden (Fine Gael)
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Perhaps the Minister of State will forward them to me.

John Curran (Dublin Mid West, Fianna Fail)
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I will do that. I am aware the local offices will have access to information but whether that is by way of a dedicated on-line system I do not know.

Nicky McFadden (Fine Gael)
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They do not.

John Curran (Dublin Mid West, Fianna Fail)
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I will obtain a response to the two questions raised by Senator McFadden.

Nicky McFadden (Fine Gael)
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I thank the Minister of State.