Maria Byrne (Fine Gael)
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I welcome the Minister of State, Deputy Catherine Byrne. The reason I tabled this matter is that I am encountering a lot of frustration in my office about medical cards. How many appeals have been upheld in the mid-west? Limerick, north Tipperary and Clare all come within the same catchment area. I have dealt with several people who have terminal illnesses and who have received four or five items of correspondence from the HSE questioning whether they are sick or are still sick. It is terrible. I recently dealt with one medical card application for someone who was ill. It took seven months to be delivered. When people are at a vulnerable time in their lives and are ill, it is not acceptable that it should take seven months for a medical card to be delivered. I do not say everyone should qualify for a medical card, but there are people at vulnerable times in their lives, perhaps with terminal illnesses, which is the case with most of the people to whom I refer. It is frustrating that they keep receiving back more forms and red letters asking questions that have been asked, which is the reason I tabled this matter. It is frustrating not only for the people dealing with this, but especially for the person who is ill. I am dealing with someone who is going through treatment for the fourth time. They still have not received their medical card, which is totally unacceptable because they have been through an awful lot. They were given some very bad news during the week and the same day a letter arrived from the HSE still questioning how ill they were. I wanted to raise this with the Minister of State because she needs to be made aware that there is a lot of frustration out there and that people are not receiving an acceptable level of courtesy. Perhaps she could address the issue of delivery of the card as well.

Denis O'Donovan (Fianna Fail)
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It is extraordinary that the Senator has to raise the matter, but anyway, I will allow the Minister of State respond.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank the Cathaoirleach and Senator Byrne. I am taking this matter on behalf of the Minister, Deputy Harris.As the Senator will be aware, eligibility for a medical card is determined by the HSE in accordance with the provisions of the Health Act 1970, as amended. Applicants must complete and submit a medical card application form to the Health Service Executive national medical card unit for assessment.

Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for medical cards and, in particular, to take full account of the difficult circumstances in the cases of applicants who may be in excess of the income guidelines. The national medical card unit receives approximately 39,000 medical and GP visit card applications per month. A large percentage of these applications will be deemed unsuccessful for reasons such as insufficient information provided or failing to meet the qualifying criteria. Where a person is unhappy with a decision concerning entitlement to a medical card, he or she has the right of appeal to the HSE appeals officer. The HSE's national appeals office plays an important role in ensuring procedures, guidelines and legislation are correctly and fairly followed. The appeals officer will review the original decision and make an independent decision, taking into consideration relevant legislation and guidelines. In particular, the appeals officer considers if income and expenses have been appropriately assessed and if the applicant is in a category of people who are exempt from the financial means assessment.

Community healthcare organisation, CHO, 3 region covers Clare, Limerick and north Tipperary with a population of almost 400,000 people. In 2018, only 25 medical card appeals from the CHO 3 region were submitted to the HSE’s national appeals office. In these cases, the independent and impartial appeals officer reviewed the original decision made, and ultimately deemed the 25 applications to be subsequently eligible for a medical card. This demonstrates the important role of an appeals mechanism, ensuring that good governance, impartiality and due regard are given to the nature of decisions related to medical card eligibility.

The HSE also recognises the importance of having a compassionate and holistic process in the assessment of medical card applications. To this end, a number of measures have been implemented, including the development of a burden of illness questionnaire. This questionnaire is now being rolled out in circumstances where the assessing doctor in the HSE's national medical card unit requires a more comprehensive assessment of an applicant's medical and social circumstances and any resulting undue financial hardship.

I hope this clarifies the matter for Senator Byrne and reassures her that the medical card appeals process is operated in a fair, impartial and efficient manner and within its legislative framework. I have listened to what the Senator said and if there is any way that I or the Minister's office can help in dealing with some of the cases she has raised, particularly those involving people who are terminally ill or fighting an illness and dealing with the emotions and everything else that goes with having a severe illness, we will do so. If she provides details, I will certainly bring the cases to the attention of the relevant authority.

Denis O'Donovan (Fianna Fail)
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Anybody with a terminal or long-term illness should not have to fight for a medical card but the point is taken.

Catherine Byrne (Dublin South Central, Fine Gael)
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I agree but there are legislative protocols in place.

Denis O'Donovan (Fianna Fail)
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I know. There is no utopia.

Maria Byrne (Fine Gael)
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What I take most from the Minister of State's reply is the reference to a holistic and compassionate approach. While some people can be very nice to deal with, I cannot believe that somebody who is on a fourth round of treatment still has to fight for a medical card. Discretion is still being held impeded by red tape and more compassion and discretion needs to be shown. Writing to people and asking if they are still ill on their fourth round of treatment is not the correct way to go about it. I understand that it is not the Minister of State's fault but it is something that needs to be raised and highlighted. I would appreciate if the Minister of State would take that message back to the Minister.

Catherine Byrne (Dublin South Central, Fine Gael)
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I will.

Denis O'Donovan (Fianna Fail)
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If the Senator raised the matter on local radio, someone might listen.