Marie Moloney (Labour)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for taking this matter. A medical card has been issued to the patient in question since I submitted the matter but it is only right to allow this debate continue because the lady in question is representative of many people who have had a medical card withdrawn, particularly patients suffering with cancer. I have all the figures so I know nearly 2 million people qualify for the general medical services scheme and the Department must prioritise its scarce funding. I appreciate that and we all know that funding is currently scarce. There were changes introduced nonetheless, such as income assessment and elimination of travel expenses.

The withdrawal of a discretionary medical card from a cancer sufferer is wrong. The lady I am talking about was terminally ill and had her card withdrawn. The Minister of State will know that a person diagnosed with cancer will be worried, anxious, frightened and vulnerable. He or she should not have the added worry of wondering whether he or she can afford medical care. The lady's family went to collect her medication because she was unable to do so but were informed they could not have it because the card had been cancelled. It was harsh and cruel to do that to somebody at that stage of her illness. It was despicable.

I hope the Minister of State will tell me tonight that cancer patients will be looked after. I do not want him to say that if a person is terminally ill he or she will get a card. As someone else said last week, receipt of a medical card is like a death certificate because it confirms that one is terminally ill. I want to hear his response and will comment further at that stage.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I thank the Senator for raising the matter. As the Senator and the House will be aware, under the provisions of the Health Act 1970, assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants.

While people with specific illnesses such as cancer are not automatically entitled to medical cards, the legislation provides for discretion by the HSE to grant a medical card where a person's income exceeds the income guidelines. The HSE takes a person's social and medical issues into account when determining whether there is "undue hardship", the phrase used in the Act, for a person in providing a health service for himself, herself or his or her dependants.

The HSE has an effective system in place for the provision of emergency medical cardsfor patients who are terminally ill, or who are seriously ill and in urgent need of medical care that they cannot afford. For persons with a terminal illness,no means test applies. Emergency medical cards are issued within 24 hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure such people get their cards as quickly as possible.

With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card arising from their means or undue hardship, and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, currently emergency medical cards are issued to a named individual with a limited eligibility period of six months. The HSE ensures that the system responds to the variety of circumstances and complexities faced by individuals in these circumstances.

The person referred to by the Senator was issued an emergency medical card in July 2012 for a period of one year. In March 2013 she was issued a renewal notice as she then became eligible for the over-70s scheme. Based on her declared income she qualified for a GP visit card, but her application was referred to the medical officer for consideration on medical discretionary grounds. The medical officer recommended that her full medical card be retained and remain valid until 31 January 2014. I am informed that at no stage was the person without medical card cover during this process.

Michael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Does Senator Moloney have a final question for the Minister of State?

Marie Moloney (Labour)
Link to this: Individually | In context | Oireachtas source

Yes. I thank the Minister of State. Whoever composed his reply did not give him the correct information. The woman was without medical cover last week and her medication could not be accessed by her family at the chemist. The reply is incorrect.

The Minister of State said: "While people with specific illnesses such as cancer are not automatically entitled to medical cards..." Anyone that I have ever dealt with in my area has always received a medical card the moment they commenced active treatment for cancer, as the Minister of State knows, and they were assessed through the system. They have always been given the discretionary medical card. This is the first time I have heard of a cancer patient being refused a medical card. It is a harsh decision. The withdrawal of medical cards from cancer patients is an all-time low. It is unacceptable. How can one say to a cancer patient who is terminally ill that he or she must apply for a medical card? Most people diagnosed with cancer want to fight the disease. They want to fight it hard so will not admit even to themselves that they are terminally ill. Often, doctors do not tell a patient his or her diagnosis is terminal until after every course of treatment has been tried first. A doctor will not tell a patient straight out that he or she is terminally ill unless the cancer is extremely aggressive. A doctor will fight to save the life of a patient even though the end result may be the same. I find it harsh that we have resorted to removing medical cards from cancer patients.

Michael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will allow the Minister of State a final word.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

It has never been the case that people with cancer were automatically entitled to a medical card. That has not ever been the case and that is the position.

Marie Moloney (Labour)
Link to this: Individually | In context | Oireachtas source

Perhaps people in the Kerry area were very generous.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

That is the position. I know this is a sensitive matter. I agree with the Senator that people who receive a diagnosis of cancer will be in a distressed state and the last thing they should be dealing with is the question of entitlements, etc. Without taking at all from that statement, people are diagnosed with other catastrophic illnesses and conditions that are not cancer and we should consider them in the context that the Senator has raised. When I say it is not just cancer, I am not trying to diminish the awfulness of a diagnosis of cancer.

The Government, the HSE and I must have a system - I shall not repeat the figures because the Senator appealed to me not to - that is credible and transparent so that everybody knows where they stand and what the score is. I do not mean to trivialise the matter by using the term "knows what the score is". I mean that there should be clarity in regard to the matter. We have introduced clarity in that respect and there is also an appeals system. For example, if a person receives a letter asking about their means in order to review a medical card, and co-operates, which is the case in most situations, he or she does not lose the medical card. It has been suggested that people are having cards whipped from them, but that is not fair. Where there is engagement with the system, the card is not taken from the individual.

Michael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State and Senator Moloney.