Lorraine Higgins (Labour)
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With the agreement of the House, I propose to share time with Senator Marie Moloney.

Paddy Burke (Fine Gael)
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Is that agreed? Agreed.

Lorraine Higgins (Labour)
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I welcome the Minister of State and thank him for agreeing to discuss on the Adjournment the need to provide cancer patients with discretionary medical cards.

This matter arises about as a result of a recent visit I had to Gort Cancer Support. This is a voluntary group that operates in Gort and which carries out undoubtedly invaluable work for cancer sufferers in that area. The service supplies drivers to bring cancer sufferers to and from hospital on a daily basis if needs be and whenever they need treatment. I understand that up to 60 people in any one month could avail of the service. I was very impressed in my engagement with those on the committee and the work they have been doing. They raised several issues with me, including this issue, which I believe merits some national attention.

Cancer patients who have been diagnosed with cancer endure undue financial hardship as a consequence of their illness. We are all in agreement with that. I know several people who have been afflicted with this illness who were self-employed with children and without private health insurance yet were not eligible for a medical card. There is no doubt this situation has left them in a completely vulnerable position financially. Only for the involvement of their own family members who helped them to manage basic expenses such as heating and travel to and from hospital for treatment, they would have been left in a precarious financial situation. This is a degrading situation for anyone to find themselves in. It is bad enough to be diagnosed with this illness and having to concentrate on recovering from it, but worrying about the requisite health cover too is unfair on these people. Without the type of support from groups in my area such as Athenry Cancer Care, Gort Cancer Support, Galway Hospice Foundation and Cancer Care West, which have been known to assist sufferers with financials in the aftermath of their hospitalisation, these people would be at a loss. I believe the Irish Cancer Society financial aid scheme provides more than €1 million per year to cancer patients who need financial help in the aftermath of hospitalisation and this figure has grown in 2013.

Groups like these are overextended at present given the reduction in the number of people who are voluntarily donating to their causes as a result of the recession. People who are suffering from cancer worry a good deal about the cost of having the illness and it is a sad reflection of this situation that they must endure it. They need to focus on recuperating, that is the first priority. I realise several cancer sufferers have medical cards granted by the Government and they do not need the same level of attention. However, there are others who have fallen through the net.

When one of my constituents became aware that I was bringing up this issue today on the Adjournment, she spoke to me in respect of her husband who has Huntington's disease. I am unsure if the Minister of State is familiar with the situation with this disease but there is no cure for it and those who have it are terminally ill. She mentioned to me that several people she knows who are afflicted with the illness have been refused medical cards in the recent past.

While we need better health for everyone in every community I am compelled to ask the Minister of State to deliver on some improvements in this area to help with the medical and financial experiences of the many thousands of individuals who are availing of cancer health services every day as well as those suffering from Huntington's disease. I acknowledge the Minister of State is in a very difficult financial position as a result of the mess that we inherited from the last Government but I call on him and his Department to consider it, even if it is not something that can be granted immediately, that it would be something that would register on the radar and that may be provided within the term of this Government across the board to all cancer sufferers and people suffering from Huntington's disease. I look forward to the response of the Minister of State.

Marie Moloney (Labour)
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I thank Senator Higgins for allowing me to speak on this issue. As the Minister of State is aware, this was the subject of an Adjournment debate I put forward some months ago. I reiterate my call on the Minister of State today to revisit the whole situation for cancer sufferers. The Minister of State will be aware that when a person is diagnosed, the word "cancer" drives terror into the hearts of people and often they are fearful that they will be unable to be provided with the medication necessary to help them to overcome this terrible illness. It is a great concern for people.

The guidelines for medical cards are so low that people on an average industrial wage or low-income families do not qualify unless they have a mortgage to offset it. They are very concerned. This has escalated over the summer and people have found themselves terrified that the will be unable to afford the medication. In the Minister of State's reply to me at the time he stated that there were many other illnesses that would have to be considered as well if we considered cancer. However, many of the very bad illnesses are considered long term and those suffering have a long-term illness card whereas cancer sufferers do not. I call on the Minister of State to revisit this and perhaps to give a directive to the medical card office to ensure that all cancer sufferers are looked after with the medical card.

Alex White (Dublin South, Labour)
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I thank Senator Higgins and Senator Moloney for their contribution on this issue. As Senators 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 or dependants. People with specific illnesses such as cancer are not automatically entitled to medical cards. This has been the legal position since 1970. It is not possible for the Minister for Health or any Minister to issue a directive to change that position. There would have to be new legislation passed by the Oireachtas because this is the law passed by the Oireachtas in 1970. The basis for obtaining a medical card is on foot of an assessment of a person's means. That is what the law provides. I understand the point Senator Moloney made but it is not something that is amenable to being changed by ministerial directive. It could not be done by ministerial directive because the Act of 1970 would have to be amended.

Having said that, the HSE has discretion to grant a medical card where a person's income exceeds the income guidelines. The discretion must be exercised by the HSE but the fundamental provision in the 1970 Act is that a person is assessed on the basis of his means. The question asked is whether the person can provide for his own health care and treatment without undue hardship. The opportunity for the exercise of discretion is in place to deal with the types of cases raised by Senators Moloney and Higgins, that is, people who are above the income limits but who still face genuine hardship in terms of providing for themselves. It still cannot be done on the basis of someone having an illness.

I am always mindful of how harsh it sounds for a Minister to say that we do not give medical cards to people simply on the basis of an illness. It is a hard and crude way of answering the question. However, I am simply setting out for the benefit of the House what the law provides. There is no basis for extending a medical card to a citizen on the basis of his having a particular illness. That is not the current state of the law and if we were to change it, it would have to be done by legislation.

The Government has a commitment set out in the programme for Government for universal access to a free general practitioner service. I accept this is not the full General Medical Services, GMS, scheme but it is a free GP service for the entire population. This is for the entire population; whether they are well or ill we want everyone to have access to a free GP service. The aim is to develop primary care and do all the things in primary care that we need to do in this country in terms of identifying the area of health care which is closest to where a person lives and where they are. They should be treated there and should have available to them treatment in the community. We should have available all the preventative strategies that we need to have in the health service that have not been sufficiently well-developed. The idea is to involve and assist people and encourage people across the board not only when they are ill, although obviously that is the most sensitive and difficult time.

I do not take from anything that the Senators have said and what Senator Moloney said may be true in terms of the guidelines being so low. However, fully 43% of the population satisfy the guidelines. Medical cards have been extended to 43% of the entire population. That is a statement of how incomes have been affected generally as a result of the recession because so many among the population can satisfy what Senator Moloney has described as low figures. It reflects the situation in which the country finds itself.

Marie Moloney (Labour)
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It is nothing to be proud of.

Alex White (Dublin South, Labour)
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No, absolutely not, on the contrary. In respect of medical cards extended on a discretionary basis, social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. This applies even where the person is above the income guidelines and the person can apply to be dealt with under the discretion which is available to be exercised. That discretion is applied automatically during the processing of the application where additional information has been provided which can be considered by staff or a medical officer, where appropriate.

At the request of the Minister for Health, Deputy James Reilly, the HSE has set up a clinical panel to assist in the processing of applications for a discretionary medical card where a person exceeds income guidelines but where there are difficult personal circumstances such as an illness.

The community medical officer reviews and interprets medical information provided by the applicant on a confidential basis. He or she then 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 if the applicant is suffering from medical hardship. It is important to stress the medical card system is founded on the undue hardship test. The Health Act 1970 provides for medical cards on the basis of means. As I have indicated, this is what the law states and no Minister can go outside the legal parameters that are set out. One could best describe the discretionary system as being an exception to the general rule that one must satisfy the income limits.

The Health Service Executive, HSE, also has a system in place for the provision of emergency medical cards for patients who are terminally ill or who are seriously ill and in urgent need of medical care they cannot afford. Emergency medical cards are issued within 24 hours of receipt of the required patient details. With the exception of terminally ill patients in palliative care, all emergency cards are issued for six months on the basis that the patient is eligible for a medical card on the basis of means or undue hardship and will follow up with a full application within a number of weeks of receiving the emergency card. Where a patient is terminally ill in palliative care, the nature of the terminal illness is not a deciding factor in the issue of an emergency medical card in these circumstances and no means test applies. 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.

Lorraine Higgins (Labour)
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I thank the Minister of State for his detailed response and welcome everything he is doing in respect of the provision of discretionary medical cards to those who are in need. I also acknowledge the high percentage of people in receipt of medical cards. However, as I stated with regard to cancer patients predominantly, as well as those who are suffering from Huntington's disease, to avoid discrimination against groups, consideration might be given to an amendment to the legislation at some time in the future, when the Minister of State considers this to be possible. However, I understand that much consultation and analysis would be required for this to happen.

Marie Moloney (Labour)
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I again thank Senator Higgins for allowing me to contribute during her Adjournment matter debate, as well as thanking the Minister of State for his reply. Perhaps an amendment to the Act could be examined in due course. Were they to table such an amendment, Members first would enter into discussion with the Minister of State, who one would hope would agree to accept it.

Alex White (Dublin South, Labour)
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I will certainly consider what the Senators have said. As have other colleagues, they have taken a close interest in the issue. Members will recall the programme for Government included a plan to extend general practitioner visiting cards to the population that was to start with people with long-term illnesses and was then to move on to those who needed high technology drugs. I should note that when considering this plan earlier this year, the Government ran into huge legal obstacles regarding the definition of illnesses. I acknowledge that sounds strange and one might ask how it could be difficult to define an illness, but I assure Members it is not as straightforward as it sounds to draft primary legislation defining a particular illness, even a long-term illness, and then the statutory regulations to be drawn up by a Minister providing diagnostic guidance as to when a person is to be deemed to have a particular illness or otherwise. While I do not try to put unnecessary obstacles in the way of the Senator's proposals, the matter is not so straightforward. While there may be a case for doing this, it would change completely the scheme of the basic legislation, which is to help people on the basis of a problem with their means rather than a particular illness. However, I understand the concern expressed by the Senators. I know where they are coming from and have thought a lot about this issue because, obviously, it is a live one in many people's minds.