Martin Browne (Tipperary, Sinn Fein)
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I, too, extend my best wishes to the Minister of State, Deputy Chambers, on his promotion to his new position. I am disappointed, however, that the Minister for Health is not present. I thought someone with responsibility in the area of health would be present. I have asked-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Minister of State, Deputy Chambers, is a doctor.

Martin Browne (Tipperary, Sinn Fein)
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So be it, but the Minister for Health has a habit of not appearing in the Chamber for Topical Issues, and this has been raised before.

I have asked for this matter to be discussed because it is reflective of the difficulties that can be experienced by people with life-long conditions and their families. The constituent of whom I am speaking is a 17-year-old girl. When she was born she was diagnosed with Treacher Collins syndrome, cerebral palsy and chromosomal abnormalities. She requires access to a variety of medical materials which are sourced through the HSE medical card scheme, and several elements need to be renewed on a regular basis. These include a suction machine, a portable nebuliser and a tracheal dilator. The list is extensive. I am only providing an outline. This young lady needs access to the general medical card.

Natalia has had a medical card since birth, which has given her access to a range of operations, procedures, appointments and medical interventions, both here and in France. It has also given her access to vital medical supplies. The family says the care they have received at all levels has been superb and they want to stress that. The issue they have is with a letter they received from the national medical card unit in January 2024, which set the scene for months of over and back within the medical card unit. They will be the first to admit that they had assumed that, given Natalia’s complex diagnosis and her situation, her medical card would automatically be renewed on a discretionary basis. They have described the process that followed as nothing less than tortuous. They had to submit 80 pages of documentation. They had to make an inordinate number of phone calls and ultimately had to devote a substantial amount of time and energy to reconfirm Natalia’s conditions, which, I must reiterate, are lifelong.

I should note that while they have been devoting all this time and energy to the review, Natalia’s parents have continued to look after her complex psychological and emotional needs. In all, they have questioned the process they have been subjected to and they have done this against the background of the concept of care and how it reflects on the State’s approach to care for people with disabilities and long-term conditions in the area of medical card provision. Their suggestions are constructive. I ask the Minister of State to accept their suggestion that life-long medical cards be considered in instances where life-long conditions, such as those I have described, are registered with the Department.

I also ask that a second suggestion be borne in mind. When people have disabilities that are not lifelong, the national medical card unit could issue a more concise document to alleviate the disruption that the reviews in their current form impose. I acknowledge that the Department cited the considerations of its 2014 expert panel on medical card eligibility. It stated that to list medical conditions in priority order for medical card eligibility was not justifiable. It added that a person’s means remained the main qualifier for a medical card and that discretionary medical cards can also be issued. The Department also referenced its pledge to keep medical card issues under constant review to ensure the medical card system is responsive and sensitive to people’s needs.

Given the complex and ongoing nature of the conditions certain people have and the demands they will always have for access to treatment and aids, surely there is an onus on the Department to resolve the complexity and arduous nature of the process that people have to endure. Those who have conditions that are complex and affect every part of their lives should be given a commitment that their needs will be provided for without the painful process that the reviews in their current form involve.

Jack Chambers (Dublin West, Fianna Fail)
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I thank the Ceann Comhairle and Deputy Browne for their kind wishes.

I also thank Deputy Browne for raising this important issue. Eligibility for a medical card is primarily based, as the Deputy knows, on a financial assessment, which is conducted by the HSE in accordance with the Health Act 1970. The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn per week and still qualify for a card. It is specific to the individual’s own financial circumstances.

As of 1 June, there were almost 1.59 million medical card holders in Ireland, and just over 667,000 GP visit card holders. Persons aged 69 and under are assessed under the general means tested medical card thresholds, which are based on an applicant’s household income after tax and the deduction of PRSI and the universal social charge. Certain expenses are also taken into account. Examples of allowable expenses include rent, mortgage, certain insurance costs, childcare, maintenance and nursing home net costs. This helps to increase the amount a person can earn and still qualify for a medical card. Some social welfare payments, for example, child benefit and fuel allowance, are also exempt from medical card income assessment.

The issue of granting a medical or GP visit card based on having a particular disease, diagnosis 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 or ethically justifiable to list specific 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. Against this background, medical cards issued are generally subject to review by the HSE in the usual way, taking account of individual and other relevant circumstances. 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.

I assure the Deputy that in order to ensure the medical card system is responsive and sensitive to people's needs, the Minister for Health and his Department keep medical card issues under review. Any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary Estimates process and the legislative requirements arising from such a review.

Martin Browne (Tipperary, Sinn Fein)
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I thank the Minister of State for his reply. I know every effort is made by the HSE to keep it within the framework of the legislation. Will a simpler system be brought forward so that families like Natalia's and Natalia herself, who has lifelong complications, are not faced with an 80-page document, dozens of phone calls and over and back trying to source a medical card? Will the Minister consider the two suggestions they made? One was that a medical card be given straight away to people with life-long conditions. They are registered at birth as having these life-long conditions. It is not the case that in three years, these conditions suddenly disappear for that family. The second was an easier system for those who do not have life-long disabilities. Surely, at this stage, we can have a more compassionate approach to issuing medical cards in these instances. If we are to introduce universal healthcare, which everybody in this House agrees on, there must be a need that should be put first in developing that system and where better to start than with those with lifelong medical conditions being given medical cards without all the bureaucracy and red tape? It is continuous. It is heartbreaking. Families have so much going on when looking after children with these conditions. I have had healthy children and grandchildren and there are times when you are filling out forms that it is unreal. Families dealing with conditions like these should not be faced with 80-page documents to try to source a medical card for a child.

Jack Chambers (Dublin West, Fianna Fail)
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I appreciate the difficulty for certain individuals and families. We all, as constituency TDs, try to work with families and individuals to support them in the application process. The HSE and all Departments and agencies should strive to make sure that applying for public services is a user-friendly process for everyone involved. As the Deputy mentioned, lengthy documents or a lot of over-and-back can be particularly difficult for people applying. I will reflect that feedback to the Minister for him to engage with the HSE. As I said, eligibility for a medical card is based on a financial assessment conducted by the HSE in accordance with the Health Act 1970, as amended. There are nearly 1.6 million medical cardholders and more than 660,000 GP visit cardholders. Budget 2023 facilitated better access to affordable high-quality healthcare, including an expansion of GP care without charges to children aged under eight and to people earning no more than the median household income, the abolition of all public inpatient hospital charges for adults and the extension of the free contraception scheme. In addition, up to approximately 500,000 additional persons who otherwise would have attended their GP on a private basis are expected to become eligible for free GP care under this expansion. This wider expansion means more than 42% of the population has access to free GP care. As outlined, the issue of granting medical or GP visit cards based on a particular diagnosis, disease or illness was previously examined and it was said it was not feasible or ethically justifiable to specifically sequence or list medical conditions in priority for eligibility for a medical card. In following the group's advice, a person's mean remains the main qualifier. In circumstances in which an individual might be in excess of these immediate income guidelines, the HSE makes every effort to support applicants by taking full account of difficult circumstances such as extra costs arising from an illness, and it may exercise discretion and grant a medical card in such a consideration.