Martin Conway (Fine Gael)
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I welcome to the House my good friend and colleague for many years, the Minister of State, Deputy Feighan, and I congratulate him on being elevated to a very important position. I know he will give it 100% commitment as he did to everything he has done over the years.

I had submitted this particular Commencement Matter for consideration last Wednesday week but that Seanad was abandoned that day. It had been accepted and I have been submitting it since. Luckily enough, it was accepted today. The reason I tabled it in the first place is because those aged over 70 now have a legitimate expectation that they will receive medical cards. In the budget last October, there was a commitment that there would be a change in the criteria for those aged over 70 with regard to qualification for medical cards and that it would come into operation on 1 July. Many old people were waiting to apply for their medical cards on 1 July. What happened subsequently was that the Dáil was dissolved but apparently legislation was required for this to happen. In July, in the last week of the first term of the new Dáil, the Seanad passed the necessary legislation to facilitate the Minister signing the regulations to change the criteria. My question is very simple. When will it be done? Why have we had this delay? The legislation was passed on 31 July. It is now 25 September and, as of yet, there is no indication whatsoever for the thousands of people aged over 70 who are waiting patiently to apply for their medical cards. The primary care reimbursement service is telling people it is not aware of this change and has not been given any indication. On what date will those aged over 70 be able to apply for their medical cards under the new criteria? Senator Wall will speak about those who are terminally ill for whom this debate is equally important. I look forward to hearing the reply.

Mark Wall (Labour)
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I welcome the Minister of the State to the House and I thank Senator Conway for sharing time on this very important matter.The Minister of State will no doubt be aware of the delays in these income limits, as has been outlined by Senator Conway. We are now just three weeks away from budget 2021 and the Government has not yet delivered on these simple budget commitments from last year. The budget commitments meant income limits for medical cards should have increased by €50 per week to €550 for a single person and to €1,050 for a couple by July.

It is unacceptable that up to 56,000 elderly people are waiting on medical cards due to the Government failing to relax the income limits it promised. As Senator Conway asked, the Minister of State might let us know when these new limits will be brought in.

I received assurances in this House from the previous Minister for Health, Deputy Harris, that the medical card renewals would be delayed and medical cards would be extended to 2021 because, as it was said, we are all in this pandemic together. Unfortunately, my experience is the opposite. My office deals with a large number of renewals each week. Will the Minister of State confirm why we asked medical card holders to renew their cards during this pandemic? Should we not allow those with medical cards the comfort blanket having a card gives to so many during these unprecedented times?

I had the pleasure yesterday to speak to Mr. John Wall. I am sure The Minister of State is fully aware of his campaign to extend medical cards to terminally ill patients. On his behalf and on behalf of those he campaigns for, what is the update on the provision of cards for those who are terminally ill at this time? The campaign seeks to extend these cards by 12 months for those at this stage of their life to take away the worry of filling in another form or worrying their family will be left with large medical bills. I am informed that extending this card by another year would have little financial consequences to the State. To those who are seeking them, however, it would be that comfort blanket which, I am sure, the Minister of State will agree is the least they deserve at this difficult time.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Conway for his kind remarks. It is great to be back here in the Seanad. I am delighted to see Senator Wall here. I serve with his dad in the Oireachtas so it is great to see him back here as well.

Before addressing the medical card limits for the over-70s, which both Senators have raised today, it is important to acknowledge the difficult year that older persons in our society have experienced as a result of Covid-19. In particular, social distancing and cocooning were and remain challenging for many older persons. They continue, however, to show tremendous strength and resilience in helping to fight the spread of Covid-19.

Budget 2020 provided for an increase in the medical card thresholds for persons aged 70 and over. Although it was intended that this measure would be implemented from July, as Senator Conway stated, it was not possible to legislate for the necessary amendments to provide for this measure until there was a fully constituted Dáil and Seanad. It is welcome, therefore, that the Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act 2020, which provides for the increase of the income thresholds, was passed by the Houses of the Oireachtas and subsequently enacted on 2 August 2020. However, relevant sections in this Act which provide for the increased income limits have not yet commenced, and this has undoubtedly been a source of frustration to those people aged 70 and over who may be eligible under the new thresholds.

While the delay is regrettable, it is important to understand that this budget 2020 commitment was contingent on the realisation of certain savings within the health budget. Those savings, however, could not be achieved this year due to the impact of the Covid-19 pandemic and a substantial allocation of additional funding to the health service to deal with this pandemic. It is in this context that decisions on the associated funding and implementation of the measures are being actively considered by Government. I will bring to the Minister the Senator's issue of the thousands of over-70s who have raised their concerns.

Turning to Senator Wall's query regarding reviews of eligibility, the HSE temporarily suspended all reviews of eligibility at the outset of the pandemic in March until last month. All cards that were due to expire during that period had their eligibility extended for up to one year and will be reassessed on a planning basis. This step demonstrates the practical and compassionate approach taken by the HSE during unprecedented times.

While periodic eligibility reviews have since resumed, it is important to recognise that the HSE operates a sensitive assessment process and may also exercise discretion and grant a medical card where individuals exceed the income guidelines but face other difficult circumstances such as extra costs arising from an illness.In the case of terminally-ill people, the HSE has a compassionate system in place for the provision of medical cards when it is informed a patient is receiving end-of-life treatment. This is where patients unfortunately have a prognosis of less than 12 months. These applications do not require a means assessment nor are they reassessed. However, not all terminally-ill patients may qualify for a medical card and this understandably causes upset and concern. To that end, the HSE clinical advisory group, CAG, was established in December 2019 to review this issue. The work of the CAG has now concluded. A report was submitted to the Department and is currently under investigation and consideration. Senator Wall outlined what a comfort blanket the card can be for terminally-ill people with 12 months or less to live and their families, which I fully accept. I will bring the issue to the Minister's attention.

Martin Conway (Fine Gael)
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I thank the Minister of State for his reply but it clearly states that the commitment was contingent on savings being achieved at the Department of Health. We all know that not alone have no savings been achieved but the Department's budget has been substantially increased. It also says the matter is being actively considered. Is the commitment there to implement the measures contained in the Act passed last July? There is no commitment to a timeline. If it is being actively considered, when will such consideration end and a decision be made? That is what I am trying to ascertain.

Mark Wall (Labour)
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I thank the Minister of State for his kind comments. I recently dealt with a 69-year-old gentleman who spent five months in hospital and then came home to County Kildare. The first letter he got from this Government was not congratulations on beating Covid or the disease he had, it was instead a renewal letter for his medical card. His first comment to me was, "Do they want to put me back in there again?", such was the distress the letter caused him. I am sure the Minister of State is aware of that but it needs to be brought back to the Minister. We need to suspend renewals again while we are in the pandemic. We are being told the pandemic is not over. The HSE section dealing with medical cards needs to realise that.

Terminally-ill people are looking for an extension of 12 months only. They do not want to have to fill in medical card applications again or go back to doctors to get them to do likewise. That is all they are asking for and I am told it will not cost the State much. I ask the Minister of State to bring that back to the Minister.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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Senator Conway mentioned savings being achieved and obviously that has not occurred, due to Covid. As was said, currently 75% of people aged 70 and over have a medical card and if the potential beneficiaries of this measure - an estimated 56,000 people - materialise then an increase in the income thresholds will result in over 88% of this cohort now being eligible for a medical card. The Senator suggested we stop the active consideration and making a commitment and I will bring that back to the Minister. There is no doubt, however, that this would prove to be a very beneficial measure for these additional eligible persons who will now have access to a range of health services at an affordable level. It is therefore important to assure Senators Conway and Wall that decisions on the associated funding for this measure and a potential implementation date for the commencement of this provision are being actively considered. The Senators want a commitment which I cannot give today but I will bring it to the Minister.

It should be noted that the programme for Government, Our Shared Future, also includes a commitment on the matter of medical cards for terminally-ill patients and a further update will be provided on this to Senator Wall once the report of the clinical advisory group has been fully considered. I take the Senator's point that this could cause a lot of pressure and undue hassle for a 69-year-old man who had just spent five months in hospital and I hope it will be resolved.