Stephen Donnelly (Wicklow, Fianna Fail)
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Heart Failure is an important public health issue. The detection and prevention of heart failure is a priority and the National Clinical Programme for heart failure supports many approaches to improving quality of life for people living with the syndrome. The programme (HSE) is currently engaging with the European Society of Cardiology who have an excellent platform to enable registry development on not only heart failure but other cardiovascular conditions. Working under the guidance of Dr Peter Kearney the National Heart Programme are working to initiate the EuroHeart programme cardiovascular database project in Ireland.

There are clear, evidence-based guidelines and excellent Irish case studies of effective models of care in heart failure however it is recognised that further focus and development is required to prevent unnecessary hospitalisations and deaths and maximise people’s quality of life. While progress has been made there are proportions of the population that are not being reached.

To understand the challenges more, a National Review of our adult Specialist Cardiac Services which includes heart failure was commissioned. The Reviews recommendations will inform the future provision of cardiac services nationally including requirements for data to support development. The Report is now finalised and is being prepared currently for my consideration.

Stephen Donnelly (Wicklow, Fianna Fail)
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Under the Health Act 1970, eligibility for a medical card is based primarily on means. The Act obliges the HSE to assess whether a person is unable, without undue hardship, to arrange a particular service which is available to persons with full eligibility (medical card holders) and general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure.

The issue of granting medical or GP visit cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.

However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

Furthermore, the HSE also has a system in place for the efficient provision of medical cards in response to emergency situations i.e., in circumstances where persons are in need of urgent ongoing medical care or are receiving end of life care. In these cases, a medical card is issued within 24 hours of receipt of the required patient details and completed medical report by a healthcare professional. Additionally, patients who have been certified by their treating Consultant as having a prognosis of 24 months or less are also now eligible for a medical card without a means assessment.

I can assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any changes are considered in the context of Government policy and other issues which may be relevant.