Seanad debates

Tuesday, 20 January 2015

Commencement Matters

Medical Card Eligibility

3:05 pm

Photo of Colm BurkeColm Burke (Fine Gael)
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I welcome the Minister to the House. The matter I raise relates to Huntington's disease. A presentation was made to the Joint Committee on Health and Children last Thursday by Dr. Niall Pender, principal clinical neuropsychologist with Beaumont Hospital. Huntington's disease is an inherited, progressive degenerative brain disease. There is currently no cure. In Ireland at present, approximately 700 families are affected by the disease and they have no access to special services. The neurological consequences of Huntington's disease make those affected extremely vulnerable. Behavioural and psychiatric changes lead to fracturing of normal family supports and those affected are at increased risk of serious injury, homelessness, suicide, drug and alcohol misuse and exploitation. There is no known treatment to slow down or cure the pace of neurodegeneration, which generally leads to death over a 20-year period after clinical diagnosis. The clinical manifestations of the disease vary widely, but they generally include dysfunction in cognition, mood and voluntary motor control. There is currently no dedicated treatment team for patients with Huntington's disease in Ireland and it is in that context that I have raised the matter. Only 700 families are affected.

Last Saturday I spent some time with a family filling up an application form for a medical card. In this family, the wife must provide full-time care to her husband, who has Huntington's disease. On the basis of income it would seem they will not qualify for a medical card, yet it is clear that they need it on the basis of what they have to go through. For instance, the clinic they use is located in Dublin, which necessitates travel there every so often. Another issue is access to medication. The wife is not looking for carer's allowance; all she asks is that they get a medical card. Their only source of income is a pension. Given the small number of people affected, when dealing with medical card applications the Health Service Executive must take the disease into account when assessing entitlement. I accept that people might not fulfil the qualifying criteria financially, but the disease will not go away and there is no cure, although doctors might be able to stabilise the condition for a period. I have asked the Joint Committee on Health and Children to correspond with the HSE's medical card application office to ask that Huntington's disease be recognised and that when applications for medical cards are made people are not put through the appeals process or made to go back to the drawing board if they are unsuccessful. I urge the Minister to make the HSE aware that this condition should be given serious recognition when applications are made for medical cards.

3:10 pm

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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I would like to thank the Senator for raising this important issue.

Under the Health Act 1970, as amended, eligibility for health services is based primarily on residency and means. The Senator will be aware of the publication of the report of the expert panel on medical need for medical card eligibility, and the medical card process review in November 2014. A key recommendation of the expert panel was that a means test should remain the main qualifier for a medical card. The panel concluded that it would not feasible, desirable, ethical or just to list medical conditions in order of priority as a means of determining medical card eligibility.

Discretion continues to be an integral part of the medical card assessment process. If an applicant's means are above the financial thresholds as set out in the national guidelines, the HSE routinely examines for indications of medical or social circumstances which might result in undue financial hardship in arranging medical services and, exercising discretion, may grant eligibility for a medical card on that basis.

The Senator will no doubt be aware that the temporary reinstatement of discretionary medical cards has been extended and holders of discretionary medical cards, including the terminally ill, are no longer included in random reviews. The Senator may be interested to know that the number of discretionary medical cards in circulation has increased from about 50,000 to 75,000, in part due to the reforms announced by the Minister of State, Deputy Kathleen Lynch, and I last year, although the implementation of the ten actions remains a work in progress.

I am aware that the HSE has developed more integrated and sensitive processing of applications, involving greater exchange of information between the central assessment office and the local health offices in relation to people's medical circumstances and needs.

I can also advise the Senator that the HSE currently funds a range of community services and supports to persons with Huntington's disease. The HSE's role is to apply a multi-disciplinary team approach which includes the provision of health and personal supports and incorporates hospital and primary care and community services. In this context, people with Huntington's disease receive interventions from a wide range of services and facilities, either directly from the HSE or through a range of voluntary service providers. One such voluntary service provider is the Huntington's Disease Association of Ireland, which works in partnership with the HSE to ensure that all of the resources available for people with disabilities are used in the most effective manner possible.

The HSE provides assisted living services, including personal assistant services, and therapeutic assistance, including physiotherapy, occupational therapy and speech and language therapy, as well as a range of medical interventions. People with Huntington's disease may be eligible for assistive devices such as medical or surgical aids and appliances that facilitate or maintain mobility or functional independence, and assessments are carried out by a range of multidisciplinary staff.

Photo of Colm BurkeColm Burke (Fine Gael)
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I thank the Minister for his reply. I am raising this matter in the context of what has occurred in recent weeks. Applications were made to the HSE's medical card office by people with serious illnesses, yet discretionary cards were not granted. There has been quite a lot of media comment on that. I fully accept what the Minister has said about Huntington's disease because I have dealt with another family on this matter. When the health and social services did get involved, they provided a comprehensive package which was extremely beneficial for the family.

As regards discretionary medical cards, I think there is a lack of understanding within the HSE of particular medical conditions. They are making a judgment on a financial basis rather than based on medical conditions. For instance, if a person submits only a GP report for assessment, in nine out of ten cases his or her application for a discretionary card is refused. However, if a medical consultant's report is submitted the applicant has a greater chance of obtaining a medical card. That is one of the issues I have noticed.

Because such a small number of people suffer from Huntington's disease, the HSE should highlight the issue with staff so that they will be aware of the condition. In that way, they will apply discretion rather than forcing people through the appeal process.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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I studied this matter a lot last year and I have considered it repeatedly since then. The conclusion I came to - and I still take this view - is that until we have universal health care and everyone is entitled to health care, one will always have anomalies and injustices. There will always be somebody who is just above the threshold and does not meet the assessment criteria.

However, we are trying to improve the system, and that is what the ten actions that the Minister of State, Deputy Kathleen Lynch, and I announced last year were all about. Among those actions was the establishment of a clinical advisory group which will give the HSE new and revised guidelines on discretion. It is intended that this group will be appointed in the next couple of weeks. I hope that the guidelines the group gives will make it easier for HSE staff and medical officers to assess such cases, although it will never be perfect until universal health care exists.