asked the Minister for Health if he will formulate standard procedure and obligations for all local authorities in regard to the administration of social welfare legislation, particularly in regard to the issue of medical cards, and thus eliminate the present differences in administration of the social welfare services which occur between the various local authorities.
Ceisteanna—Questions. Oral Answers. - Administration of Social Welfare Services.
11.
Apart altogether from schemes of social insurance and assistance which are not administered by local authorities, social welfare services include the provision of housing for the working classes, provision of labourers' cottages, provision of meals for school children, free or cheap fuel and footwear schemes, home assistance and medical services, all of which present their special problems relating to eligibility and standards. It would appear, however, from the Deputy's question, that he is particularly concerned with the functions of local authorities under Section 14 of the Health Act, 1953.
The procedure for the maintenance of the General Medical Services Registers and the issue of medical cards, in connection with the general practitioner service, under the section of the Health Act mentioned, is governed by Articles 9 to 13 of the General Medical Services Regulations, 1954. Each decision on entitlement is, however, a matter for the health authority and I have no power to specify standards or give detailed instructions to health authorities on the practical considerations which might govern such decisions.
As the Deputy will be aware, however, one of the Terms of Reference of the Select Committee of this House which will shortly be established is:—
"to review the existing arrangements for determining whether a person is or is not within an eligible category" (i.e. a category eligible for health services).
The Committee will also be required to make recommendations on these and such other matters related to the health services and their operation as they think fit. Dáil Éireann will, therefore, have the opportunity of considering in due course any recommendations which the Committee may make in regard to the administration of the General Medical Services as well as other services for which I am the responsible Minister.
Bearing in mind that the local authorities in the person of the managers usually have absolute autonomy in determining who should or should not receive a medical service card and that the Select Committee of the House is to investigate the health services, is the Minister not aware that the application of the means test in determining who should get a medical service card varies very much from local authority to local authority? Pending the findings of this Select Committee of the House, would he not try to get some uniformity in the application of the means test to those who apply for medical service cards?
I am afraid that would be quite impossible. Subject to what the Committee may say, my present view is that the question of eligibility for entry upon the general medical service register can best be determined by those who know the circumstances in their own area and can relate the circumstances of a particular person to those generally obtaining in that area.
They may apply a means test in good faith but may I ask the Minister has he any information to the effect that the means test as applied does vary considerably all over the country?
I have no indication that it does vary considerably. I will say it varies, but, taking all the circumstances into account, in a minimal degree.
Would the Minister at this stage consider it advisable to issue a direction to those concerned that medical cards should be issued on application without waiting for the unwieldy investigation which sometimes takes over a week, thereby denying to many people the medical services to which the medical card would entitle them in the interim?
The Deputy seems to overlook the fact that what is applied for is the right to have one's name inscribed in the general medical register. The medical card is proof that the name is there and, in general, the name is there for one year entitling the possessor of the card to general practitioner service for one year. If a person is in obvious need of medical attention, he may go at once to the persons designated by the health authority and apply for a card which will give him immediate medical service. That will not entitle him to remain on the register for a year and if it is found that the card has been issued on the basis of false representations made by him, then, of course, he is responsible for payment of the usual medical fee for the attention given to him.