Private Members’ Business – Discretionary Medical Cards


Dáil Éireann 8 October 2013

Thank you for the opportunity to speak on Private Members’ Business.

Since July, I, like many other Deputies in this chamber, have met on a daily and weekly basis with constituents affected by the huge reduction in the number of discretionary medical cards.

I have identified three problems with the manner in which this was carried out, first the timing of the decrease, secondly the manner it was communicated or rather not communicated with people, and thirdly, the dire position that this cut leaves many acutely ill people in.

We are all aware of the pressure that this Government is under to find savings to enable the Irish people to balance their books, and I know the major part that the health budget plays in expenditure and thus, when Government budgets are cut, that must be reflected in the health budget.

However, when cuts are being made, it is important that the manner of the cuts does not add to the difficulty being experienced by people, and I believe that this has been the case in the recent reduction in the number of discretionary medical cards.

Surely it is a gross waste or resources within the medical card office and the HSE Appeals Offices if people who were granted discretionary medical cards in Spring had them removed just months later, necessitating their re-entry into the application and appeals process. Surely the time to effect the reduction in cards was as they fell due and not just in one fell swoop in July, as appears to have been the case?

The lack of communication in relation to what was happening was another cause of great confusion to people.  People deserve to know what is happening and while the HSE communications offices are well able to communicate good news, I think it is only right that when medical cards are being removed from a large section of the population, more than envisaged in the HSE’s own service plan, that those same communications officers should be obliged to share this information with the general public.  Instead what happened was that very ill people had their lives thrown into turmoil when a letter arrived stating that their medical card had been cancelled, but failing to provide a reason or a context for this decision.

Communication continues to be a problem, especially the question of medical cards for the chronically ill. Three examples come easily to mind; firstly a lady who was paralysed following an accident last year. After a mammoth battle this lady, who was rendered tetraplegic after the accident, and who required extensive rehab in the National Rehabilitation Hospital, was granted a medical card in early 2013.  In July she was informed that it was cancelled.  An application to have the card reinstated was turned down and the matter is now under appeal, but in the meantime she is left without a card.

The second case is similar, a man who suffered an accident over 30 years ago which left him paralysed and in a wheelchair.  This man has always held a medical card and was informed in July, without warning, that his card was cancelled.  Now he faces the prospect of cutting back on the number of colostomy tubes and bags that he uses because the cost is prohibitive without the medical card. Undoubtedly this will result in increased infection and this man will have to present at A&E before the winter is out.  To add to his difficulty, since his card was withdrawn, this man has developed high blood pressure, due in no small part, his family believe, to his worry about medical bills that could accrue if he has to be hospitalised.

To add insult to injury, the last time he was granted a medical card (which was on discretionary grounds due to his disability), his wife received a GP Visit Card. They took the time to ring the medical card office to say that she didn’t need the GP Visit Card and hadn’t looked for it and were told that it had been granted and to keep it.

The third case is just as surreal.  A man who is on the transplant list, awaiting a kidney transplant, and who is attending dialysis three days a week.  Without his medical card, the cost burden on his family is proving great.  Surely it doesn’t take weeks for a medical assessor to determine that someone on the transplant list has exceptional medical needs?  On top of this man’s health worries, he is now worried that if his transplant operation comes through, he will be faced with astronomical medical bills.

Why did the HSE once again use a sledge hammer to crack a nut?  Is there absolutely no common sense in the allocation of medical cards?  Surely, someone on the transplant list is defined as having an exceptional medical need?  Can a programme not be put in place whereby the Medical Card office has access to the current transplant list so that these ill people can be spared the stress of waiting weeks to see whether or not their application is successful?  Details of all three cases will be provided to the Minister and I have already been in contact with the medical card office in relation to all three cases.

It is quite obvious to me that there is also a problem in the assessment of medical evidence.  Surely it is not impossible for the Primary Care Reimbursement Office to provide guidelines to people as to what constitutes exceptional medical circumstances which would warrant a discretionary medical card and how best to prove this with medical evidence?

I understand that the HSE Service Plan included a plan to reduce the number of discretionary medical cards from 63,000 to 55,000 this year but I believe that the manner in which this was conducted was nothing short of a disgrace, especially given that the people worst affected were those with the greatest medical needs.

I understand that there may have been a very small proportion of people in possession of discretionary medical cards who didn’t merit them, but I believe that the manner that the HSE has handled this has ensured that the greatest burden and stress was placed on those most in need.