Mary Moran (Labour)
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I thank the Minister of State, Deputy Sean Sherlock, for taking this Adjournment debate. The individual concerned resides in a HSE funded residential St. John of God service that cares for people with an intellectual disability. The person has a physical and intellectual disability with associated very high care needs. For as long as the family can remember, the person has had a medical card. The person entered the care of St. John of God services some 12 years ago in 2002. A review letter was issued on 10 February 2012 to inform the individual concerned that the medical card was up for review on 31 May that year. The letter advised that the person would need to complete a review form for the PCRS by 1 May 2012 to ensure the application would be processed before eligibility expired. However, the PCRS has no record of a review form being returned to the office prior to 2012. A further letter was issued to the individual on 9 May 2012, advising that if the person wished to have eligibility for a medical card extended, they would need to complete the review form. The letter stated clearly that failure to return the review form would result in the person's medical card being cancelled, which is what subsequently happened. The medical card was cancelled in 2012.

This individual's family came to see me in 2014, saying the person's medical card had been removed. I began to make inquiries to discover the reason the medical card had been reviewed. The family are the next of kin of the individual, but they had never heard about this letter and were not aware a letter had been sent in 2012. They were not aware of any of the facts; all they knew was that the individual's medical card had been removed. I have the dates of all the letters sent in respect of the medical card review, but it was a member of staff in the St John of God service that informed the family that the individual did not have a medical card.

I find it very troubling that a HSE funded residential service can unilaterally decide to allow a medical card to expire without notifying the family in the first instance or seeking their consent. What if they had decided to remove the person from the service and the individual no longer had a medical card? What if the individual needed to be sent to a hospital and no longer had a medical card?

On behalf of the family, I queried the matter locally, as well as questioning the medical card section. I was informed by letter that until mid-2014, no resident living in the service had an individual medical card, which is extremely strange. It was further clarified when family members and I met the head of the service - although this person had taken up the position in recent months - that an individual did not need a medical card because the service employed a GP. If somebody is entitled to a medical card, why does he or she not have one? The individual is living in a congregated setting, but as we all know, this will be a thing of the past in a few years. Therefore, why do all of the current residents not have medical cards? Why would a service volunteer to pay for a GP service when an individual was entitled to a free service? Who is paying for the services of the GP? As I have stated, the individual has high medical needs. I question who has paid for their medication? Why would a service funded by the HSE do this if a resident is entitled to a medical card? There are many families involved in providing day-to-day care, as well as making decisions for an individual family member living in a residential service. At the very least, they deserve to be informed about the position on medical cards and the care provided for their family members. I find this issue very troubling and believe there is a serious lack of transparency in this case.

Seán Sherlock (Cork East, Labour)
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I acknowledge the issue raised by the Senator. I am taking this matter on the Adjournment on behalf of the Minister of State at the Department of Health, Deputy Kathleen Lynch, who is in the Dáil Chamber. I will not deliver the script provided.

The issue raised by the Senator arises from an exceptional set of circumstances. I do not wish to say it is a complete outlier in cases presented to the HSE. I think anybody with a degree of fairness would acknowledge the individual in this case was not dealt with properly. It is obvious that there was a systems breakdown. I have been given a script, but I do not wish to state there is no role for the Minister for Health in this case, about which I will speak from the script that I have been given.

I acknowledge the points made by the Senator about the fact that in the period from 2012 to date, the individual in question was locked out of the medical card system through no fault of their own. The question is why that happened. I am aware that the HSE has a protocol in place for a review process and that every effort is made to provide for ongoing engagement with clients during this process. That obviously did not happen in this case. Each month the HSE analyses the medical card register to identify those medical cards and GP visit cards scheduled for review within three months. That obviously did not happen in this instance.

Now all customers scheduled for review are notified and a balance of either full reviews or self-assessments is conducted. That did not happen either in this instance. In this case, the HSE has confirmed that the medical card lapsed. However, the person's medical needs were provided for by a resident doctor, which the Senator has already stated, and any expenses arising from medical appointments or drugs were funded by the service provider. I understand from the HSE that an application has been made, as the Senator has stated, to reinstate the person's medical card in 2014. The Minister of State at the Department of Health, Deputy Kathleen Lynch, has asked the HSE to remind service providers of their responsibility to ensure that such matters are attended to promptly in respect of residents in their care. I do not have an answer for the Senator in relation to what happened in this particular case, but I fully support the Senator's plea on behalf of the client that there be a review of the structures that led to a situation whereby that person was not in receipt of a medical card if that person was entitled to one for a particular period of time.

If I understand the Senator correctly, the medical card was cancelled but the family was not informed or was not in receipt of any documentation to that effect. To be frank, I think the very least the person is entitled to in this instance is some acknowledgement of that fact, but as Oireachtas Members we all, including me, have experience of circumstances where documentation has slipped through the cracks. I do not want to lay the blame on any particular entity, but a number of Oireachtas Members have sent in documentation to the service on behalf of various clients or constituents and it has got lost somewhere in the ether. I know from my own experience that service has been cleaned up considerably to be fair to the HSE and I am confident that this will continue, given today's announcement, for instance, but the case the Senator raises is worthy of further examination. I hope the most positive outcome would be an assurance that the person's medical card would be restored if that person is so entitled, as seems to be the case, but also that the medical needs, most importantly, are being taken care of.

Mary Moran (Labour)
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I have no problem with the HSE in this instance. It has provided me with every date and every piece of correspondence sent out. My argument is that the service, which is funded by the HSE, did not inform the family. There was no communication at all with them that the medical card was up for review. The service providers let it lapse, but what they said to me when I met with them was "They didn't need the medical card. We're providing the GP in our service." My question is why one would do that when everyone is strapped for cash and they are all looking for funding. Why would one volunteer to pay out of one's own pocket for medication when that person is entitled to it for free on a medical card? I have since been told that they had applied for a medical card. I checked with the medical cards office last week and it has no record of anything being applied for in the last year. There is a huge lack of transparency in this matter. Money is being provided to this service and the providers should be accountable for this. There are 123 people living in this residential service. Does that mean that 123 people had no medical cards and had doctor's services paid for when they were all entitled to free treatment?

Seán Sherlock (Cork East, Labour)
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I beg the Chair's and the Senator's indulgence I just acknowledge that point.

Paschal Mooney (Fianna Fail)
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Do not mind the Chair.

Mary Moran (Labour)
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It is very important and I-----

Seán Sherlock (Cork East, Labour)
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I acknowledge the distinction that the Senator has made. At the same time, historically there is a situation where the client - and I know it is an awful word-----

Mary Moran (Labour)
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It is an awful word

Seán Sherlock (Cork East, Labour)
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-----the person. I apologise if I am using inappropriate terminology; I do not mean to offend anybody. A system or a protocol must be put in place. That is the essential point that is being made by the Senator.

Mary Moran (Labour)
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Absolutely. Where family members are informed.

Seán Sherlock (Cork East, Labour)
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Where family members are informed. That is the key here. From a HSE perspective, they generate a great deal of correspondence but in this instance there is a certain responsibility on the HSE. That is my view. I will relay this to the Minister of State, Deputy Lynch, on behalf of the Senator.