John Kelly (Labour)
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I thank the Minister of State for taking this Adjournment debate. Like many other Deputies and Senators, I have grave concern over what is happening with medical cards of late. I had grave concerns when responsibility for issuing medical cards was first centralised in the PCRS. I spent 28 years dealing with medical cards as a community welfare officer. I have never previously experienced such anger over the withdrawal of medical cards and it never happened before the PCRS took over.

I know a young lad in my area who cannot walk or talk and cannot eat other than through a tube. He requires care 24 hours a day and seven days a week. He had a medical card for years and it was withdrawn. We spent five months fighting to get the card back for him.

There are many other cases of people with, or recovering from, cancer, people with all kinds of disabilities, 90 year olds who have medical cards until 2015, which all of a sudden are being reviewed. One of the problems at issue is in the primary care reimbursement service, PCRS, where staff have been stressed out for a long time and cannot cope.

For 21 of the past 28 years the guidelines for medical cards increased, not by much, on 31 December. For the past six or seven years there has been no increase. That is a problem. Everybody from the young to the old, the disabled to the deserving, feels intimidated by the review process. Cards validated into the future are being withdrawn or reviewed. People feel that the Health Service Executive, HSE, is trying to find the €37 million for the under-six medical cards by taking it from those who need it most.

What is worse are the procedures applied. In every case the PCRS asks for further information. In most cases the information is already submitted but it loses it or cannot find it. When I send in medical card applications I scan everything first and send it off but the PCRS tells me that some information I have e-mailed has not arrived although it has. This buys time for the PCRS. When I send in the information again the PCRS will not read the application for a further 15 working days. During that time people have no medical cards and the process goes on much longer.

I have it on very good authority that the situation in the PCRS is like Bedlam. The powers that be thought it would be a panacea for medical card delivery but it is not. When this was dealt with at local level compassion was shown, there was knowledge of the cases and delivery was expedient. That has all gone in order to take cards away from deserving people. They are deserving not only because of illness but also because many have financial difficulties, which are not taken into account. People have loans that are not assessed for medical card purposes.

I do not know if the Minister of State is aware that the HSE has brought in a German company to review the medical cards. One could almost say that Chancellor Angela Merkel is reviewing medical cards in this country because that is how it appears. Due to the moratorium on recruitment this company, Arvato, which has no experience of reviewing medical cards, is here. It shows no compassion whatsoever. If one is over the limit by €1 one is no longer entitled to a medical card.

There is no need to consider a third tier medical card. If the work was sent back and dealt with locally, as it was for years, we would not have this problem. The process in the PCRS is a complete and utter failure.

Kathleen Lynch (Cork North Central, Labour)
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I have every sympathy with the Senator's matter on the Adjournment. I am taking this on behalf of the Minister of State, Deputy White. I thank the Senator for raising this issue. The Senator may be aware that approximately 40% of the population, or almost 2 million people, qualify for a medical card or GP visit card. The scale of the administration of the general medical services, GMS, scheme is very significant. The people in the PCRS are doing a very good job although the scale of the job is significant. Over 700,000 individuals were assessed by the HSE in 2013 and well in excess of 95% of completed applications were processed within the target of 15 working days. The HSE is now completing medical card reviews for approximately 86,000 individuals per month.

The HSE operates under the legislative framework of the Health Act 1970, as subsequently amended. In the interest of probity, the HSE is obliged to ensure that a person's eligibility is correctly recorded in line with the eligibility legislation and the national guidelines. The HSE aims to ensure that every person who is entitled to a medical card or a GP visit card is given the opportunity to avail of his or her entitlement. The current structured processes in operation in the PCRS concerning medical and GP visit card applications, reviews and appeals must be supported with a range of documentation, as outlined on the application forms. The processing time for incomplete applications is dependent on the furnishing of the required supporting documentation by the applicant. I understand the Senator's point on that. Where such supporting documentation is not supplied or is incomplete to enable the assessment of an application in accordance with the national assessment guidelines, the HSE will issue correspondence to the applicant, specifying the additional information required to progress the assessment of their application.

It is important to be aware of the protection in place for persons undergoing a review even where delays occur. First, any medical card holder undergoing a review to renew a medical card, who genuinely engages with the HSE, will not have his or her entitlement withdrawn before the review is complete, regardless of the expiry date shown on the medical card. Second, in cases where a decision is made not to grant a medical card, the applicant is informed of the decision and is notified of his or her right to appeal this decision. Contact details for the appeals office are provided to the person. Where a person submits an appeal to a decision not to renew a medical card within 21 days of that decision, he or she also retains the medical card or GP visit card until the appeal is decided.

Efforts are also being made to improve the quality of medical card processing through increased cooperation between State agencies. Increased data sharing between the Revenue Commissioners, the Department of Social Protection and the HSE has the potential to reduce the level of documents and information required from families as their eligibility status is reviewed. The processing of medical card applications and reviews is continuously monitored by the HSE. The Senator may be aware that, each week, the HSE publishes the turnaround time for medical card processing and this data is available on the PCRS website. In view of the assessment processes involved, I am satisfied that every effort is made to assist, support and facilitate persons undergoing review and, particularly, in a timely fashion. I do understand the Senator's point and will convey his thoughts to the relevant Minister.

John Kelly (Labour)
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I appreciate that the Minister of State is taking this matter on behalf of another Minister of State and that this is a written response from the HSE for that Minister of State to read out. I have already pointed out the failings in some of its answers. It receives material which is then lost. It would be better to lift the moratorium and recruit staff than to bring in a foreign company to do something about which it knows nothing.

In response to the first sentence in the Minister of State's reply, 40% of the population has had medical cards since the 1980s. This did not happen overnight or since the PCRS took over. It was always 40% and on occasion more.

I thank the Minister of State for her response and I appreciate her taking this matter.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Senator. The population of Ireland has increased significantly as has the cost of medicine. The Government is seriously concerned about this and no later than this morning we met to discuss the issue. I thank the Senator for tabling the matter. It is very topical and people are concerned about it. I hope we will be able to resolve it.