Paul Coghlan (Fine Gael)
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Is the Minister of State taking all the Commencement matters?

Finian McGrath (Dublin Bay North, Independent)
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I am working overtime today.

Paul Coghlan (Fine Gael)
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Obviously.

Finian McGrath (Dublin Bay North, Independent)
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I am so glad to be here after the past few days.

Jennifer Murnane O'Connor (Fianna Fail)
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My motion relates to medical cards, for cancer patients in particular. I will offer one of many examples from people in my constituency who have come to me. In November 2016 I heard from a woman who applied for an emergency medical card. We went to the primary care unit in Carlow. The forms were completed and presented along with a letter from the doctor outlining the diagnosis and the medical history as well as bank statements.

The person started treatment within days of submitting the application. Following the initial application, the medical card section was contacted and asked about the status of this application. We were told that further information was requested. The process is like going for a mortgage. First, those responsible wanted proof of the mortgage and a statement from the bank with details of monthly payments made. This was requested despite bank statements showing the money going out of the account. The officials still needed confirmation that the person was paying the mortgage. A letter from the mortgage protection provider with details of cover and how much was paid monthly was sought. A copy of the car log book and proof of address of place of work was sought to work out travel expenses. A copy of the house insurance policy, including the details of fire and contents cover was sought. Confirmation of payment for insurance cover was sought. A copy of the insurance policy showing cover for fire and contents was sought. Completed medical forms from other members of the family detailing medical information to be completed by the GP were sought. A further letter from the oncologist indicating that he supports the application for an urgent medical card was sought.

This person is still undergoing treatment. Under normal circumstances, sourcing and submitting all this information would take time, never mind during treatment while caring for three children as well as producing all this information.

That information was submitted in November. This week, we were told that if all the information was not submitted by 28 February, the application would be closed. That is a disgrace.

This is the process for what we call an emergency medical card. This is what a person undergoing cancer treatment has to submit. The person in question is in the middle of radiation treatment. She is going up every day to get treatment and she stays over. The cost for car parking is €8 for the day. That is another issue. This is unacceptable.

I have applied for cards for several people seeking palliative care medical cards. That is a separate issue. People can get them quickly and I am aware of that because I have got them. Those involved are very good with palliative care. However, the system is falling down in the case of emergency medical cards and this needs to be changed.

I will outline another bugbear of mine. People who have medical cards still have to pay. Every time a person goes to the doctor for blood tests, that person has to pay €20. That is unacceptable. Let us suppose a person has a medical card and is undergoing treatment. That person has to pay €20 for blood tests.

There is a broader issue at play. I call on the Minister of State to bring this back to the Minister for Health, Deputy Harris, and to ask for emergency medical cards to be issued on the same basis as palliative care medical cards - they are the same. As I said, the woman in question is getting treatment but she has been waiting for four months for her medical card.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Murnane O'Connor for her contribution and for raising this important issue.

While we have made significant progress in the treatment of cancer in Ireland, a cancer diagnosis obviously has a major impact on the patient both physically and psychologically. A cancer diagnosis can also have social as well as financial impacts. The diagnosis often has a significant effect on a patient's family and friends.

I have met many cancer patients and their families during my time in the Department of Health. This has given me a profound appreciation of how difficult and varied the effects of a cancer diagnosis can be.

Eligibility for a medical card is determined by reference to the means, including the income and expenditure, of the applicant and the partner or dependants. Therefore, the legislation was neither designed for, nor would it permit, the granting of a medical card solely or primarily on the basis of a person's medical condition. In 2014, following considerable public and political controversy regarding the basis on which people’s eligibility for a medical card was determined, the HSE was asked by the Minister for Health to establish an expert panel to examine the range of conditions that should be considered as a basis for eligibility and seek to prioritise such conditions. The Report of the Expert Panel on Medical Need for Medical Card Eligibility, the Keane report, was accepted by the Government and forms the basis for the current operation of the medical card system. The report explicitly considered the potential for the award of medical cards on the basis of a person's medical condition and recommended that a person's means should remain the main qualifier for a medical card; the panel concluded that it would not be feasible, desirable nor ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility and that a financial assessment remains the most equitable method of allocating scarce resources in the health sector.

Following the expert group report, a clinical advisory group was established by the director general of the HSE to assist in the development of guidance on assessing medical card applications involving significant medical conditions. Now, as a result of this group's deliberations, the HSE, when assessing a person for a medical card, has procedures in place which as well as looking at income have regard to their overall financial position, including medical evidence of cost and necessary expenses.

The HSE also has a system in place for the provision of emergency medical cards for patients who are terminally ill or who are seriously ill and in urgent need of medical care they cannot afford. Emergency medical cards are issued within 24 hours of receipt of the required patient details. Where a patient is terminally ill in palliative care, the nature of the terminal illness is not a deciding factor in the issue of an emergency medical card in these circumstances and no means test applies. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure the person gets the card as quickly as possible.

To sum up, the HSE is ensuring a more integrated and sensitive approach towards the processing of medical card applications, including those from persons with a diagnosis of cancer involving greater exchange of information between the central assessment office and the local health offices in relation to people’s circumstances and need.

Jennifer Murnane O'Connor (Fianna Fail)
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I acknowledge that considerable work has been done in the area of medical cards but there are still concerns. I outlined to the Minister of State, the details being sought by the HSE prior to it making a decision on the awarding of an emergency medical card. Therefore, what he said in that respect is misinformation. It is tough enough for people who are suffering with cancer or who have other illnesses and who are trying to manage their illnesses without having to fight with the HSE to get their entitlements. People's applications for medical card, whose incomes are only €2 or €3 over the threshold for qualification for a medical card, are being refused on a regular basis. Some leniency needs to be shown but that is not happening. I firmly believe that there are people who are genuinely entitled to a medical card but their applications are being refused because their income is slightly over the threshold. However, the issue of emergency medical cards needs to be addressed. I compliment the medical card section of the HSE on the granting for medical cards for those in palliative care. Those medical cards are processed within 24 hours. I know that because I have secured several for people. However, emergency medical card applications are dealt with similarly to normal medical card applications and that is unacceptable.

Finian McGrath (Dublin Bay North, Independent)
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I accept the Senator's concerns. It is difficult enough for people with serious illnesses like cancer who are in emergency situations without having to take on this battle as well. I will convey that message to the Minister. I agree with the Senator that the granting of medical cards for those who are in palliative care works very well. I will bring the two key issues that the Senator has raised to the attention of the Minister, Deputy Harris. One is the emergency card issue. I agree with the Senator on another point she made. I dealt with a similar case in my constituency last week where there was a lack of flexibility shown. That happens when people's incomes are only €2, €2.50 or €3 over the threshold. I know this is an issue for every Senator and Deputy. The keys issues that I will convey to the Minister are the emergency medical card issue and the flexibility issue.

Colm Burke (Fine Gael)
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I thank the Minister for being available to dealt with this matter.Over 1,500 people attend day care services in the Cope Foundation in Cork. One good result of the care being given to people with disabilities is that they are living longer. Many parents using these services drive their children, although some of them are in their mid-50s, to the Cope Foundation's facilities in Cork city each day and collect them in the evening. These parents are getting older, however. I know of several families where the parents are in their late 70s and early 80s and who drive their children to the facilities provided by Cope in Cork city. They are coming under more pressure as they cannot drive in the same way as they could before and, sometimes, they cannot do it every day. They are finding there is no support mechanism for them if they stop taking their son or daughter to these facilities. Another issue is if their child is over 18 years of age, no allowance is made for them either.

This is an issue that is beginning to come up more and more. I have come across cases nearly every second week in my constituency clinics. It is a matter which needs to be examined. Can a system be put in place to support those parents who have been so good, in the sense they saved the State significant amounts of money through the years? In one case I have encountered, the person availing of the services is over 50, meaning the parents have looked after their child for over 50 years at little cost to the State.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Colm Burke for raising the issue of transport for people with disabilities and commend him on his work for people with physical and intellectual disabilities. I welcome the opportunity to outline the current position on the issue of transport for people with disabilities attending HSE-funded day services. Over the past 12 months, I have visited and met over 4,000 people with physical and intellectual disabilities in many services across the country. Recently, I visited the Cope Foundation in Cork and met the parents and families of its clients.

The provision of transport to adults with a disability attending HSE-funded day services is not a core health service. I am fully aware, however, of how important transport is for people with disabilities who attend day services. As a general rule, public transport should be used in all circumstances where it is an option. This is in keeping with the principle of mainstreaming with a clear focus on ensuring persons with a disability have access to the normal range of services and participate in community life as far as possible.

It must be noted that, in general, day service users are in receipt of disability allowance and are automatically entitled to the free travel pass, meaning there should be no additional cost burden at an individual level. New developments being put in place to meet the service needs of school leavers with disabilities who require continuing HSE-funded supports each year will be located as close as possible to where people reside, to reduce the travel time for each person and enable them to be more connected with their local community. Funding is not provided to service providers for the transportation of young people to and from day services.

However, when all other options are exhausted and people cannot avail of a day service because they do not have transport to attend, the service provider is advised to use some of the service money to cover the transport costs. This may result in the provision of a reduced quantum of service to the service user. However, it is also my experience that the HSE will do its best to provide transport in certain cases without reducing services.

While day service users in receipt of disability allowance are automatically entitled to the free travel pass, I am also conscious of the fact that the travel pass is not worth much if there are no buses on which to use it. This may be the case in rural areas. I am also conscious of the social isolation which many people with disabilities feel on a daily basis.In that regard, I am pleased to see that the HSE has committed to establish a high-level cross-divisional working group this year to rationalise the provision of transport and to maximise equitable access and efficiencies. The HSE also intends to liaise with the National Transport Authority and disability service providers to explore ways in which the authority’s services could assist people with disabilities. I understand that the National Transport Authority has a total of 17 transport co-ordinating units called Local Link, which provide safe, secure and reliable public transport services in local and rural areas of Ireland through a combination of scheduled public transport services and door-to-door services. The HSE plans to explore the opportunities these units may provide to people with disabilities to access day services and allow them to fully participate in the social, educational and economic life of their own local communities.

Colm Burke (Fine Gael)
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I thank the Minister of State. I appreciate that this is a complicated area. It will be a growing problem and I welcome that a group has now been set up within the HSE. I am concerned about it in that in some cases, the parents will end up having to have their son or daughter admitted into full-time care in a community setting. Then one has a huge cost in that as well. I am concerned that numbers are growing. We need to plan very quickly for it and to do so within the next 12 months. I was delighted by the Deputy's visit to the Cope Foundation in Cork and to St. Paul's School, which have been providing superb service in Cork. We have been very fortunate in Cork with all the services we have but there are major challenges and we need to look at them.

Finally, the interesting thing with vehicle registration tax is that, while it is available for someone getting a vehicle who has registered a vehicle in his or her own name, there is no allowance of any description for parents who are providing transport for their child. It is a problem they have as well. In this case, a parent who is driving 15 miles each way, morning and evening, to make sure the child can attend a service gets no allowance of any description and has not for the past 25 or 30 years.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Colm Burke for this issue. I welcome his comments on the setting up of this group and I accept his point that we need to move on this particular issue on transfer for people with disabilities and that we need to deal with it over the next 12 months. I also want to say something on the strong economic argument which is used regularly with service providers. I came across one service provider recently which gets a grant of €90 million a year and yet it was looking at cutting back transport services to very complex young adults with physical and intellectual disabilities. That is not acceptable to me and we told it to go back to the drawing board and to not cut transport services. We told it that if it wants to do other reorganisation to its finances it can go ahead but to not do that. That goes on.

The Senator made a very strong and important point and my plan is to try to get services in the local community as near to families as possible. The Senator's argument, which I will relay to my officials and the people in the HSE, is that if we do not provide transport for these young adults with these intellectual and physical disabilities and if they go into residential care, they will actually cost the taxpayer more money. That is a very valid economic argument. In addition, the human rights argument - which I have always pushed very strongly - is that the best idea is to try and get services running from their home to the service provider. Children and young adults in rural areas have to be looked at as well. At present, I am looking at and working closely with this group and I am going to deal with this issue. I will deal with the issue of the high cost of transport as well. The Senator mentioned a figure there related to the issue of mobility and families who bring disabled children or teenagers around the place. I am considering legislation for transport mobility and there are in the region of 4,700 such people in the wider community. These are all issues that we have to deal with. As the fellow says, if we get two or three years to deal with these things, I will be delighted.

Paul Coghlan (Fine Gael)
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I thank the Minister of State and the Senator.