Paul Bradford (Fine Gael)
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I appreciate the Minister is under time pressure. My question is one I could have placed by way of parliamentary question if there was such a facility n the Seanad but unfortunately there is not.

I raise the issues of medical cards, the financial guidelines in place and the deductions allowable, with particular reference to those who suffer from Alzheimer's disease. I appreciate the disease is becoming more prevalent and affects thousands of people nationally. Although a medical service of a good standard is available to most sufferers and the Minister and his officials are planning further developments in this regard, I have been approached recently by a number of constituents with family members who suffer from the disease and who are ineligible for a medical card because of the income limit. One case, about which I have not yet written but which I am sure will be appealed, concerns a constituent whose mother, who is in her mid-70s, has been refused a medical card on financial grounds. I appreciate that the income limit of €35,000 per annum for those over 70 is generous but, in this case, the family must pay €3,000 per month for care and help in the house for the mother.

A number of deductions can be made in the case of people under 70. Expenses such as child care expenses, mortgages and the cost of travelling to work, and so on, are taken into account but no such considerations apply to those over 70. Where home care for almost 24 hours per day is required, there should be a reduction in the income limit in the calculation of medical card eligibility. I ask the Minister to review the financial guidelines, in particular the deductions that could apply to persons over 70. I make the case for sufferers from Alzheimer's disease in particular because of the high level of care required. I look forward to the Minister's response. I am sure this is a matter we can discuss in more detail in the future.

James Reilly (Dublin North, Fine Gael)
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I thank the Senator for his inquiry. I will explain how the Health Service Executive assesses eligibility for a medical card and takes account of one's circumstances. Eligibility criteria for health services are set out in the Health Act 1970, as amended. In accordance with the legislation, eligibility is primarily determined by reference to a person's residence and means. Ordinarily, residents in the State are entitled to full eligibility or limited eligibility for public services. Full eligibility is determined by reference to section 45 of the Health Act 1970, as amended. Section 45(1) provides that persons who, in the opinion of the HSE, are unable, without undue hardship, to arrange general practitioner medical services for themselves and their dependants shall have full eligibility. Persons with full eligibility and their dependants are awarded a medical card by the HSE.

Under the Health Act 2004, the HSE is responsible for assessing a person's entitlement to a medical card. All medical card applications are assessed against the criteria set out in the HSE's national assessment guidelines for medical cards. Section 45(2) of the Act provides that, in deciding whether a person should have full eligibility, the HSE shall have regard to the person's overall financial circumstances in view of his or her reasonable expenditure in regard to himself, herself or his or her dependants. Therefore, medical cards are granted primarily on the basis of a person's means and individual circumstances. As such, all people seeking a medical card must be assessed under the undue hardship principle. The HSE has discretion in cases of exceptional need to provide assistance to individuals who do not qualify for full eligibility under the national assessment guidelines but where undue hardship would otherwise be caused if they were not awarded a medical card.

In view of the legislation, there are no plans to grant medical cards in respect of particular groups. I take issue with that and do not believe we can allow circumstances to obtain in which we do not look after people with particular needs. That is not to say specific groups, such as those with Alzheimer's disease, can be looked after in the immediate future, but I have said we are considering the circumstances of special groups and would like to be able to do something in this regard. We are caught between a rock and a hard place with regard to money. I am sure the Senator already knows there was a €70 million overrun at the beginning of the year, and a three month overrun in the hospitals. The budget has decreased by €1 billion. We are, therefore, not in a position to do what we would like to do as quickly we would like, but we will extend the medical card next year to those on long-term illness cards. Specific groups, including those with diabetes, will be looked after in that regard. The main benchmark is income guidelines.

A group of doctors, comprising the PCRS, has been appointed within the HSE to consider discretionary medical cards. The case to which the Senator alluded will be referred to it for adjudication. I hope it will make the decision the Senator seeks. In the past, discretion lay with the CEO of the health board, but this post no longer exists. The PCRS will take on that function. I have asked it to consider, in particular, those with terminal illnesses and other groups such as those mentioned by the Senator.

Paul Bradford (Fine Gael)
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I thank the Minister. This is the first time in my many years in the Oireachtas that a Minister more or less ignored his script and, fortunately, went off message.