Colm Burke (Fine Gael)
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I welcome the Minister of State to the House. I wish to raise a matter that was mentioned at a meeting of the Joint Committee on Health and Children last Thursday, which has been on my agenda for a while. It relates to emergency medical cards. The advantage of divisions being called in the Dáil during health committee meetings is that HSE and departmental officials are available to Members and we can have detailed discussions with them. I encourage the Dáil to call divisions regularly on Thursday mornings from now on. The issue I raised with Mr. Tony O'Brien, which was also raised by Senator van Turnhout, is my experience in working to secure emergency medical cards for people. I get a great reaction. In some cases, I have to fight for a week or two - in one case it took two months - for a card. The people on whose behalf I advocate are under a great deal of pressure. For example, the last application I dealt with was on behalf of someone with a brain tumour who had also been diagnosed with other cancers. When the medical card was approved and issued for six months, I wondered whether officials had come to the conclusion that he would not even live that long.

I propose that emergency medical cards approved on medical grounds should be issued for 12 months to provide stability. The financial issues should be reviewed in that period, as well as the question of whether the health issue has been resolved. We need to examine this because successful applicants do not have the card that long before they suddenly find they must furnish all their financial details and go through the entire process again, which can create anxiety and pressure for people who have serious health conditions. This should be examined.

Alex White (Dublin South, Labour)
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I thank the Senator for raising this issue. Under the provisions of the Health Act 1970, the 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. As set out in the Act, medical cards are awarded to people who are unable without undue hardship to arrange general practitioner, GP, services for themselves and their family, typically where their means are below the HSE's income thresholds.

Discretionary medical cards are awarded to people who are unable without undue hardship to arrange GP services for themselves and their family even though their means exceed the HSE's income thresholds. In these cases, social and medical issues are taken into account when considering whether undue hardship exists for the applicant. However, the HSE can provide medical cards in emergency circumstances to patients who are in urgent need of medical care that they cannot afford. Medical cards can be issued in emergency circumstances within 24 hours of receipt of the required patient details and letter of confirmation of condition from a doctor or consultant. Medical cards issued due to an emergency are generally requested by a manager in a local health office or a social worker. A medical card can be requested in response to an emergency from the central office in respect of a person in palliative care, who is terminally ill; a homeless person in need of urgent or ongoing medical care; a person with a serious medical condition in need of urgent or ongoing medical care; a foster child in need of urgent or ongoing medical care; or an asylum seeker with a serious medical condition in need of urgent or ongoing medical care. An emergency medical card can only be issued to an individual named person - that is, no dependants will be included, unless a case is made separately for any other member of the family on medical emergency grounds. With the exception of those for terminally ill patients in palliative care, all emergency medical cards are issued for six months on the grounds 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, along with all the normal documentary evidence required to assess eligibility, within four weeks of receiving the emergency card.

It can take a day to physically produce the plastic card and a further day in the post, but the medical card number can be provided to the local office or social worker within 24 hours if requested. Once approved, any primary care contractor can validate the entitlement of a customer through the online system.

Where a doctor or consultant certifies that there is a terminal illness, the nature of the terminal illness is not a deciding factor in the issue of a medical card and no means test applies. The HSE monitors such cases and can renew a client's eligibility, if necessary. In such circumstances, again, there is no assessment of means.

I am satisfied that, given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure a person receives a medical card as quickly as possible. In addition, the individual is afforded time to furnish the requisite follow-up documentation, as required. As the HSE ensures the system responds to the variety of circumstances and complexities faced by individuals in these circumstances, there are no proposals to extend the six month period to 12 months. However, I have listened carefully to what the Senator has said and as he and the House will be aware, there has been much discussion recently about this entire area and observations or insights Senators have in respect of the operation generally of the medical card scheme, including the discretionary and emergency aspects of it, will be taken carefully into account by me in the discussions, contacts and deliberations we will continue to have with the HSE on the administration of the schemes. There is considerable interest in and some concern on the part of colleagues about certain aspects of the schemes. The insights of Senators, including Senator Colm Burke, will be taken on board and considered by me in the discussions. There is no intention or proposal to extend the period, as suggested by the Senator.

Colm Burke (Fine Gael)
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The Minister of State has said terminally ill patients in palliative care are an exception. In the case concerned, the person was deemed to be terminally ill. It took time to get the medical card and it was only valid for six months. Where it is clearly indicated that the person is terminally ill, I do not understand why a medical card would only be issued for six months because it is causing anxiety. I suggest that in the case of a person with a terminal illness a medical card be issued for 12 months rather than six. I urge the Minister of State to examine the issue.

Alex White (Dublin South, Labour)
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We will note what the Senator has said. Perhaps I might contact him separately to elaborate further on the thinking behind this approach.