Mary Moran (Labour)
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I welcome the Minister of State to the House. I have raised this issue several times. It relates to the removal of medical cards and the need to implement medical cards for children with disabilities, including moderate intellectual disabilities. In recent months, I have been inundated by representations from people whose medical cards have been removed.

That is despite the fact that there have been severe cutbacks in the services they are trying to access. Their respite care grant has been cut, while waiting times for such services have become longer. I appreciate that there are more medical cards now than a few years ago, but some of these people have been told that they earn €58 or €62 too much to qualify for medical cards. One must consider, however, how much it costs for parents of the children involved, in addition to those aged over 18, to access services they cannot obtain in the public domain. They are spending far in excess of those who are in receipt of medical cards.

More discretion should be exercised when it comes to granting medical cards for those with disabilities. For example, I know of one family whose child requires special orthopaedic shoes. Such shoes would cost over €900 a pair. A child might need three pairs of shoes annually, yet the parents may be told that they earn too much to get a medical card. The cost of private physiotherapy and occupational therapy far outweighs what it would cost to grant a family a medical card on financial grounds. The Minister of State should examine the situation. Hopefully the forthcoming budget will provide better access to health care services. The Minister of State should consider those who greatly require medical cards for their children with disabilities. They do not abuse the system by visiting the doctor every day, yet they need the security a medical card can offer to access the medical care and attention they require.

Alex White (Dublin South, Labour)
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I thank Senator Moran for raising this issue to which I have given much time, attention and thought.

Medical cards are provided to persons who are, under the provisions of the Health Act 1970 and in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants. The assessment for a medical card is determined primarily by reference to the means, including the income and reasonable expenditure, of the applicant and his or her partner and dependants. Under the legislation, determination of eligibility for a medical card is the responsibility of the HSE. The Health Act 1970 is the legislative basis upon which people are granted medical cards.

The HSE has produced national assessment guidelines to provide a clear framework to assist in the making of reasonable, consistent and equitable decisions when assessing an applicant for the General Medical Services scheme. These guidelines are publicly available and can be downloaded from the HSE's medical card website.

While there is no automatic entitlement to a medical card for persons with specific illnesses or with a disability, the HSE has discretion to award a medical card to avoid undue hardship, even where the person exceeds the income guidelines. The HSE has established a panel of community medical officers to assist in the processing of applications for medical cards on a discretionary basis where a person exceeds the income guidelines but where there are difficult personal circumstances, such as an illness or physical disability. The community medical officer reviews and interprets medical information provided by the applicant to the primary care reimbursement service, PCRS, on a confidential basis. He or she liaises with general practitioners, hospital consultants and other health professionals, as appropriate, to determine the health needs of the applicant and his or her family and dependants. The community medical officer then applies discretion, within the guidelines, to determine whether the applicant is suffering from medical hardship. This thorough process of assessment ensures medical cards are issued to medical applicants whose income is above the guidelines but where illness or disability would cause undue hardship to them in providing GP services for themselves and their dependants.

The HSE also has a system in place in relation to the provision of emergency medical cards for patients who are terminally ill or who are seriously ill and in urgent need of medical care that they cannot afford. 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. This can be initiated through the local health office by the office manager who has access to a dedicated fax and e-mail contact within the PCRS.

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 on the basis of 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, emergency medical cards are issued to a named individual, with a limited eligibility period of six months.

The arrangement is slightly different for persons with a terminal illness. 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 the person gets the card as quickly as possible.

The HSE ensures the system responds to the variety of circumstances and complexities faced by individuals. Where it is drawn to my attention or that of the Department or the HSE that there are problems, for whatever reason, with operating the system I have just described, I will attend to such problems and address them.

The Senator said it would be appropriate or desirable to have more discretion in granting medical cards. However, the Health Act 1970 distributes medical cards on the basis of means. That is what the law states and we must operate within the legal parameters. Earlier this year, I examined the question of universal access to GP care, which is a broader project in the programme for Government, including the roll-out of free GP care. The original proposal in the programme for Government was to start with people on the long-term illness scheme and then move on to high-tech drugs and others. There were huge difficulties and legal complications associated with awarding a medical card on the basis of an illness or condition. It was extremely difficult because of the diagnosis of particular illnesses. The basis for a diagnosis of a particular condition, illness or disability is never straightforward. It was always going to be extremely difficult to draw up new legislation that would set out a scheme for awarding medical cards on the basis of an illness or condition. That is because our system, under the 1970 Act, is based on means and hardship rather than on illness, condition and disability. I am making that point to emphasise how difficult it would be to go down that route.

I earnestly hope that we will have universal access, without fees, to GPs and primary care for every citizen irrespective of means or state of health. It is a commitment in the programme for Government and we will do it, but we obviously have to do it in stages. We want to have a preventative primary care system so that everybody will get access to it. Nothing is free because it has to be funded, but we will have universal access to GP care. That is what I want to see happening.

Mary Moran (Labour)
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I thank the Minister of State for his answer and take on board everything he has said. In recent years, however, there has been a clampdown on medical cards for people with disabilities. I am talking about people who are wheelchair bound and have a distinct, severe disability, be it mental or physical.

For example, in the past week I have been contacted by three people, an 18 year old, a 15 year old and a 20 year old, all of whom, despite being medical card holders all their lives, have been denied medical cards. Every year their medical card entitlement is reviewed, they fight their cases and their medical cards are returned. This is an unnecessary and burdensome process on people who already have an awful lot on their plates. I ask that the Minister of State take another look at situations where it has been proven time and again that a medical card has been reinstated so as to ensure people with an obvious and severe medical or mental disability do not have to endure ongoing battles every year to have their medical cards reinstated.

I will bring the cases mentioned to the Minister of State's attention.