Fiona O'Loughlin (Fianna Fail)
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When anyone is faced with a difficult health diagnosis, particularly if it is terminal, it is simply life shattering for that person and his or her family and close friends. Apart from the emotional impact and the stress about diagnosis, treatment and the financial impact, there is the significant concern about whether a person can afford to pay for treatment or get a medical card and if he or she was eligible, how long it would take get that medical card. All of us in politics know how complex and difficult it is to get a medical card. There are many difficulties and complexities involved. Dealing with paperwork and bureaucracy while terminally ill is the last thing a person needs. These people need to be able to get on with their lives along with their loved ones for however long they have left.

Currently, only those with a 12-month prognosis qualify for an end-of-life medical card. However, it is understandably very difficult to get consultants to provide a definitive timeframe such as this and those who fall outside the 12-month parameter find it very difficult to obtain a card. Even those who do qualify are means tested - I would call it a mean test as opposed to a means test - and must renew it every six months. People facing a life-ending illness should not have to worry about a financial burden imposed by their medical expenses. Added to that is the length of time it takes to get a card. All applications need to be screened initially for serious or terminal illnesses and fast-tracked. We have a problem when we have 1.5 million people on medical cards - more people than ever before - but those who really need them do not have them. We have all heard of John Wall, the Clare man who is terminally ill with stage 4 prostate cancer, who has been an incredible advocate for people in this situation. His medical card was revoked twice after reviews by the HSE.It was reinstated, with an apology. Fair play to him. He continues to campaign to get better access to medical cards for those with a terminal illness. In a letter dated 15 August, 2019, the Ombudsman stated that he had "considerable concerns" about "inconsistencies" and "misleading information" given to Mr. Wall. This is incredibly worrying. I speak as someone who has gone through this situation with a family member. The final report of the clinical advisory group is due soon and I certainly hope it will contain good and positive news for people like John, who should be spending their days with their families and not campaigning for fair treatment. I welcome the news of a meeting last Friday between John and the Minister for Health, Deputy Donnelly. I hope that positive progress has been made and that we will be informed of that in the coming days.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank Senator O'Loughlin for raising this matter. She has quite rightly referred to John Wall in her speech. It is some 12 months since we were in the audio visual room in Leinster House when Mr. Wall made a presentation to Members. Brian Lynch from Gort, in my constituency, was also there on the day. At that point the situation with self-employed people was part of one of the issues. When we talk of means testing we also must look at those people who are self employed, which was part of the campaign. It is an important issue that has been the centre of much commentary and debate recently, namely, the ability of terminally ill patients to have access to a medical card.

At the outset, it is important to provide clarity for our patients and to reassure them that the process provides for a person who has a terminal illness to be eligible for a medical card, and that it is possible through a number of ways.

Where the HSE is informed that a patient is receiving end-of-life treatment, which is when the patient unfortunately has a prognosis of less than 12 months, a medical card is awarded to these patients. These patients are not required to undergo a financial needs assessment, nor are they ever reassessed. There are currently almost 1,800 medical cards granted under end-of-life criteria.

Terminally ill patients who do not meet the end-of-life criteria may also qualify for a medical card under the general assessment process, or they may initially be granted a medical card on an emergency basis for up to six months. I understand that not all persons with a terminal diagnosis will necessarily meet the end-of-life criteria when initially applying for a medical card, due to the staging or severity of their illness. I also appreciate and understand that this is a source of upset and concern to those patients. This is why the programme for Government provided a commitment to extend access to medical cards to persons who are terminally ill. A key part of the process to deliver on this commitment was the establishment of the HSE clinical advisory group in December 2019 to review the issue. The work of that group has concluded and on behalf of the Minister, Deputy Donnelly, I would like to publicly thank the clinical advisory group for the work it undertook to examine and review the many complexities that arise from this issue.

The report of the clinical advisory group was submitted to the Department in September and it was carefully considered. The report highlighted the practical and legal challenges with extending eligibility for medical cards to terminally ill patients within the framework of the current process. Nonetheless, this Government is committed delivering on this issue and therefore I am pleased to confirm that a detailed memo on the findings of the report and next steps was considered by Government this morning. The Minster is eager to move ahead on this matter and has requested that an ambitious work programme be immediately undertaken by officials that will ensure delivery on the programme for Government commitment. The Minister, Deputy Donnelly, has confirmed that the report of the clinical advisory group will be published imminently.

Finally, I wish to reassure patients that the Government is committed to ensuring that terminally ill patients have access to services they require, especially when their health needs are greatest.

Fiona O'Loughlin (Fianna Fail)
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I thank the Minister of State, Deputy Rabbitte, for being here to take this matter. I also thank her for clarifying exactly where we are with regard to this. Of course, I acknowledge that this was in the programme for Government. I have fought for this and have been very struck by those going through this, no more than during the presentation in the AV room, which the Minister of State mentioned, and it is something that we absolutely need to do.It is welcome and the Minister of State confirmed that a detailed memo on the findings of the reports and next steps were considered by the Government this morning. Those next steps are hugely important. I accept and appreciate the fact that the Minister has requested that an ambitious work programme be undertaken and that the report will be published imminently. However, I would like if the Minister of State could put some type of timescale around that. When would we expect to see the report of the group? What are the next steps and when would we take them? I appreciate the Minister of State's reassurance that the Government is committed to ensuring that terminally ill patients will have access to these services but I have to draw the Minister of State back to what the Ombudsman said last year in terms of misinformation that can be given out that is misleading and that contains inconsistencies. It is so important that we get all of that right.

Anne Rabbitte (Galway East, Fianna Fail)
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The Senator is right that it is all about the communication and the messaging. As an elected representative, no different to Members of this House, I pick up the telephone and deal with constituents who get mixed messaging all of the time. It is all about the messaging and that is what I would say clearly to those in the Department or the HSE who are listening in. We need to be clear in our communication. We are dealing with very vulnerable people who will have received shocking news. That is to be dealt with empathetically but it must be the correct information and not misinformation. Whether one is a PAYE worker, self-employed or not working at all, one needs to know exactly what category one falls into. Most importantly, if one is hit with that unbelievable diagnosis, be it an end-of-life diagnosis or a terminal illness, we need to know to what that constituent and patient is entitled and give it clearly to them. We must not put them around in rings trying to figure it out, adding to their frustrations and adding to the complete tension and anxiety they are experiencing.

I am clear that the Senator's request is for me to give her a timeline. The Minister, Deputy Stephen Donnelly, was at Cabinet earlier today and I have not spoken to him since but I am sure that as soon as he gets a moment, he will let everybody know. Most importantly, he will be talking clearly to John Wall as well, to bring him an update. John Wall has campaigned through his own illness to fight for others.