John Kelly (Labour)
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I thank the Minister of State for attending the Chamber to respond to this issue. On 1 July, the HSE will take control of medical cards and centralise them in Finglas, Dublin . By doing so, the HSE is taking away the discretion shown by community welfare officers in regard to certain family situations that arise. The community welfare officer knows the clients and knows where there are gambling difficulties, alcohol addiction or illness in a house. They show discretion in 10% of cases and this means that people are less stressed. I am particularly concerned about cancer patients and those who suffer from MS, along with many other medical problems. The HSE and community welfare officers always showed a level of sympathy and because of this, discretionary medical cards were granted to these people. Once the service is centralised, discretion will go out the door. People will be dealing with faceless bureaucrats who do not know them and who live 200 miles away in some cases. In those cases, many people will be refused medical cards. Over the years, GPs have advised cancer sufferers to get a medical card from the community welfare officer because they were entitled to it. Consultants gave out that information but this may have been because they were fed incorrect information. Cancer patients are treated the same as everyone else for medical card purposes. They must undergo a means test and if they qualify, they receive it. That is why we introduced discretion in these cases. It is cost neutral because of that.

I call on the Minister for Health to grant medical cards to cancer patients who are undergoing treatment until their illness is cured. This will take away the stress for them. As a community welfare officer, the last thing I wanted to do was means test someone who visited me. People did not realise whether they were terminally ill. We have already learned from the takeover of the over-70 medical card by the Primary Care Reimbursement Service, PCRS, in Finglas that many elderly people had problems in processing their applications. They cannot get through to the centre on the telephone and the same thing will happen in this case. When people are telephoning Departments they use their mobile phones. They might start off with €20 credit and when credit is gone and no one has come on the other end of the telephone, that is the end of the issue. This issue must be addressed. The takeover should be deferred until we can get a commitment on discretionary cards. It will be a major issue and will affect every politician. Saying that everything will work out when this begins on 1 July is the same as saying that community welfare officers are being taken over by the Department of Social Protection, that they will be told all about the job when they start and that everything will be fine. We need to address this matter before it gets to that stage.

Róisín Shortall (Dublin North West, Labour)
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I thank Senator Kelly for raising this important issue, one with which I am familiar. I can provide information on the background to the initiative taken by the HSE to standardise the processing of medical cards throughout the country. Medical cards are provided to persons who, in the opinion of the HSE, are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants. While income guidelines are the principal benchmark used for deciding medical card eligibility, the HSE looks beyond the applicant's financial situation and has regard to other matters it considers appropriate in assessing a person for a medical card.

If a person's income and outgoings fall outside the HSE guidelines and there are personal and financial burdens arising from medical or social circumstances, the HSE may issue a discretionary medical card. The essential principle applied to such cases is that, if by bearing the cost of services covered by a medical card, an individual's or family's ability to meet essential costs is compromised, then a medical card will be issued. Taking into account the circumstances of each case, it is a matter for the experience and judgment of the decision-maker to determine if hardship exists within the context of the legislation and guidelines.

The HSE decision to centralise the processing of all medical card and GP visit card applications and renewals to the PCRS is part of the HSE value for money programme. There is a requirement on the HSE to make efficiencies in business practices in order to realise savings in a very challenging economic environment and provide a modern service to the public within sustainable levels of expenditure. The centralisation project is well under way and almost 40% of medical card applications are now processed centrally by the PCRS. Phased implementation of the centralisation project allows the situation to be continuously monitored and, if required, modified to address any issues arising. Local offices will also provide appropriate local services to the central office to ensure that when local input and information is needed it will be available and there is a resource to gather and provide it.

Under the centralisation plan, the HSE's local offices will continue to provide the public with assistance and information locally on medical card criteria and making an application, and the current status of the application or review. From a customer perspective, this means that at all times a person will be able to seek advice from his or her local health office. Local health offices can also deal with queries of a general nature about the medical card scheme and will continue to provide necessary supports to any person making an application. Local offices can also handle all inquiries from clients in respect of the medical card scheme, including assisting them in the completion of their application and advising them of their entitlements.

At the new national processing centre, medical card processing is characterised by standardised decision making aligned with the medical card guidelines. The process is transparent from application receipt through to completion, with customer service provided through multiple channels including phone, correspondence, online facilities and SMS messages. Applicants for medical cards, discretionary or otherwise, will benefit, under the centralised application process, from a quicker, more streamlined and more consistent approach to the appraisal of their applications than was available under the old decentralised system. That is the theory. The challenge is to ensure that happens in practice. We must learn from the experience of the early days in terms of the pilot project over the past 18 months. There are lessons to be learned. I wish to ensure that the HSE has taken those lessons on board and has adjusted and improved the service accordingly, and I undertake to ensure that happens.

John Kelly (Labour)
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I am glad the Minister said in her reply that it was the theory because in my 29 years' experience as a community welfare officer the theory is never put in place in practice. When this is taken away from local involvement it will be a disaster. How does the gambler, for example, ring somebody in Dublin to tell them their wages have been spent on gambling? How does the alcohol abuser do the same? Who listens to them?

The Minister said local offices will provide assistance. They will not. They know nothing about this, except that they will no longer be dealing with medical cards. To which local offices is the Minister referring? Is she referring to the staff in the sections that dealt with medical cards after the community welfare officer? My understanding is that they will be redeployed to other posts within the HSE so they will not be there. As regards dealing with these matters online, it does not work. The telephone also simply does not work. The correspondence that will take place will be purely by letter. People will send in their application, receive a refusal and appeal it. It will be paperwork back and forth unless it is addressed.

Paddy Burke (Fine Gael)
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Senator, there is no provision for even a question so I have given you a great deal of latitude.

John Kelly (Labour)
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Thank you, a Chathaoirligh. We must address the issue of the cancer patients and give them medical cards. That will solve many of the problems.

Róisín Shortall (Dublin North West, Labour)
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I have a great deal of experience with this because my constituency was the first to move into the centralised system. It was quite problematic in the beginning and there were many teething problems. It is fine if an application is straightforward and the person is under the income limits. The system is very efficient and there is a 15 day turnaround. The difficulty arises where discretion is required.

First, there is the question of it being an efficient service. There were teething difficulties and I hope they are ironed out. I wrote to the HSE today asking it to assure me that there are adequate numbers of staff in place to ensure that it is an efficient service. Second, there is the matter of discretion. We need an assurance, which I have requested, that the decision makers are adequately trained and understand the hardship caused to people who are trying to get by on relatively low incomes which are a little above the income limits and to cope with all the additional expense a serious illness causes.

I have written to the HSE to seek those assurances. I wish to be satisfied that it has learned the lessons from the early days and the pilot project and that we will have a service that works for the benefit of the people applying for medical cards and who need them desperately. I will be happy to report back to the Senator when I hear from the HSE.