Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Kathleen Lynch, to the House.

Mary Moran (Labour)
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I thank the Minister of State for coming to the House to take this Commencement Matter. Once again I am raising the issue of medical cards. I understand the task force has stated eligibility must be assessed on the basis of financial means but I deal with the whole area of discretionary medical cards every week. People who have been diagnosed with terminal or very serious illnesses are coming to me. They have never claimed from the State, always paid their taxes and have children in college without a grant or any form of assistance from the State and yet when they are extremely ill, having been diagnosed with cancer, and look for support to cover their medical expenses, their applications are refused. I have raised the case of one family in my area. The person has been diagnosed with stage 3 cancer. This person applied for a medical card earlier this year and the application was refused. Additional and pertinent information was submitted and the application was again refused.

This person applied for a medical card as an individual. The application was not on behalf of an additional member of the family, a spouse or anyone else and yet when the response came back, the whole family was ruled ineligible. The point being made was that the application was not in respect of the family but rather the individual and that, please God, when the person would recover, that would be it. The card was wanted for the duration of the illness alone.

We should be examining the issue. There was a time when things were examined at a local level, people knew the genuine cases and they were looked on favourably. It is an additional stress for people who have been diagnosed with terminal or very serious illnesses that the card is not afforded to them. The circumstances as such do not matter but it is particularly stressful for people who have worked all their lives, paid all their taxes and done everything for the State. These people have never claimed anything. Several of these families have pointed out to me that if they had never worked and spent their lives on the dole, they would automatically be entitled to a medical card.

Will the Minister of State re-examine the situation? Also, when these medical cards are being applied for, what exactly is being applied for should be examined. This case did not involve an application for a family medical card. The application was on behalf of an individual and yet every time that was pointed out, a letter was received stating it is family related.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Senator for raising the issue. We have the details of the particular case to which the Senator refers but it would be inappropriate to discuss an individual’s circumstances in public in the Seanad. I know Senator Moran agrees with that. However, I understand from the HSE that this application was unsuccessful as the means were in excess of the qualifying threshold for a medical card or GP visit card. I have been advised by the HSE that additional information has been provided and the case has been referred for a discretionary review.

The Senator will be aware that, in accordance with the Health Act 1970, as amended, full eligibility and a medical card are awarded to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants. That is the reason the letters received by the individual refer to dependants. In accordance with the Act, 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. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines but where they face difficult financial circumstances, such as extra costs arising from an illness.

The Senator is aware of the Keane report, to which she referred on several occasions, on the expert panel on medical need for medical card eligibility, published in November 2014. A key recommendation of the report was that a person’s means should remain the main qualifier for a medical card. That was the main issue of contention. It has been repeatedly stated that one cannot issue medical cards or GP visit cards for condition-specific reasons alone. It also recommended that it is neither feasible nor desirable to list conditions in priority order for medical card eligibility. The rationale behind the recommendation will be clear to the Senator. On foot of the report, my Department and the HSE are undertaking a suite of measures to improve the operation and administration of the medical card scheme. A number of those are already in place and are having a positive impact on how the scheme operates.

A key element of the programme is the work of the clinical advisory group on medical card eligibility which was established by the director general of the HSE. The group has been tasked with developing a framework for assessment and measurement of the burden of disease and appropriate operational guidelines for the medical card scheme. The clinical advisory group made an interim recommendation to award medical card eligibility to all children under 18 years of age with a diagnosis of cancer. The director general of the HSE accepted that recommendation and it has been implemented since 1 July 2015. The clinical advisory group is continuing its work on the development of guidance on assessing medical card applications involving a significant burden due to an illness.

I am pleased to advise the Senator that, on foot of these reforms, the HSE is exercising greater discretion. That is evident in the number of discretionary medical cards in circulation which increased from approximately 52,000 in mid-2014 to nearly 96,000 at the beginning of November this year. Until we have universal health care and everyone has eligibility for health services, one will always have anomalies. There will always be someone who is just above the means threshold, who does not have the prescribed disease or whose condition is not sufficiently severe and, as a result, those individuals will not meet the assessment criteria. Universal health care, to which I am committed, is the only solution to address this issue. However, as Senator Moran can see from the reply, we are taking another look at this application.

Mary Moran (Labour)
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I am pleased to hear the Minister of State will look at the matter again. The Irish Cancer Society figures show that when a person has cancer, it can cost up to €10,000 extra a year. It has been pointed out to me that in some cases, after expenses for treatment are taken into account, some people would be better off on welfare. That should not be the case. Given the additional expenses in the case I have outlined, including for heating, transport to consultant appointments and treatment, I am very pleased with the Minister of State's response. I hope the outcome is favourable.

Kathleen Lynch (Cork North Central, Labour)
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I understand the value of a medical card. Sometimes it is not a case of what it can provide but the security it represents in terms of a person not having to worry about medical expenses. People have enough things to worry about but when they have a medical card that is one less thing to worry about. I read the Irish Cancer Society's report on additional costs. Most costs relating to cancer treatment are met by the State whether or not one has a medical card because the treatment is in a hospital setting. That is right and proper and that is why we have such success in terms of treatments and outcomes. I hope Senator Moran's friend will have an equally good outcome. The security element of the medical card is really what it is about.

I accept there are additional costs for transport and being out of work. That is understandable when one has an illness that impacts as much as cancer. I also understand the security of not having that particular worry is essential in terms of how one faces the illness. We are taking another look at the case. Senator Moran is aware that I do not promise anything. The number of discretionary cards in the system is incredible, and rightly so because there are people who do not meet the criteria and probably never will but we must take other elements into consideration.