Dáil Éireann debate -
Thursday, 26 Jan 2012

Vol. 753 No. 1

Topical Issue Debate

Copyright Regulation

Deputy Catherine Murphy

I thank the Ceann Comhairle for selecting this important topical matter for debate. I have serious concerns about the wording of the statutory instrument published by the Minister of State, Deputy Sherlock, this afternoon. The statutory instrument which contains some vague language could have serious consequences for established online freedoms in Ireland. It appears to give the courts open-ended powers to grant orders against Internet service providers, even though no legislative instructions have been introduced to set the boundaries. Like the vast majority of people who have contacted me, I recognise that artists have an absolute right to profit from their work. That aspect of the matter can be parked immediately. However, it is just part of the issue. Under the current wording, a court may seek to block any website with which a user has linked to access infringing material. It leaves it entirely to the courts to decide the grounds on which an injunction may be granted.

The Government is abdicating its responsibility by not introducing primary legislation. I do not doubt the Minister of State's personal intent. However, it is not a question of what he intends to do, rather it is a question of what he is enabling the courts to do. The vagueness I have mentioned could result, by stealth, in this country having laws that resemble the toxic SOPA approach that has been resisted in the United States. This must be enacted through primary legislation. We must give the courts something to interpret. Our job is to do the groundwork by introducing legislation. It is important for us to safeguard this country's international reputation in the technology sector.

Will the Minister of State confirm that under the proposed wording, it will not be possible to take out an injunction against a company such as Google, eBay, Facebook or Twitter? Google alone employs 4,000 people in Ireland. This controversy has been discussed on one of the most referenced websites in the world, www.wired.co.uk, which is read by those working for technology companies. We are constantly told to be conscious of the country’s reputation in the money markets. I know the Minister of State appreciates that this is a important area for us. However, I am concerned about the vagueness of the language and the powers being transferred to the courts.

Deputy Derek Keating

I thank the Minister of State for coming to the House to discuss this important issue which is the subject of considerable confusion. This debate gives him an opportunity to clarify the issues involved and put people's minds at ease. The anti-counterfeiting trade agreement which is seen as an international version of the controversial SOPA legislation in the United States aims to tackle counterfeit goods. However, it is possible that start-up and more established online businesses might suffer as a result of it. Potentially, a broad range of images, videos and tracks could be deemed to infringe copyright. Does the Minister of State have a plan in place to provide assistance for parties that might need help in this regard? Has he considered how such a proposition might hinder this country's information technology industry? We depend on businesses in sectors such as information technology, tourism, sport and social media. Many think we need protection and clarification in this area. The Minister of State has an opportunity to provide it today.

Minister of State at the Department of Jobs, Enterprise and Innovation (Deputy Sean Sherlock)

I will begin by confirming that this is absolutely not a version of the SOPA legislation. It is a restatement of a position on copyright that the Government has held to be the case. The Charleton judgment in the case of EMI v. UPC held that Ireland was not ad idem with the EU copyright directive. We are implementing a statutory instrument to give voice to that judgment and bring us into line with the directive. The Copyright and Related Rights Act 2000 was implemented in the State. Every member state of the European Union has the right to seek an injunction, in line with EU legislation, in the event of a perceived infringement of the copyright of a party. Prior to the Charleton judgment, to which we were not a party, our position was that we were in line with EU legislation.

Acting Chairman (Deputy Jack Wall)

Will the Minister of State make a copy of his speech available?

Deputy Sean Sherlock

I do not have one. When Mr. Justice Charleton issued his judgment, we considered it was best to remove any doubt by restating our position, as set out in the 2000 Act. That is what is before us today - an amendment to the Act to ensure we are in line with the judgment. Every member state has the right to seek an injunction in the event of a perceived breach of copyright. Before a judge makes a decision he or she will need to have regard to the e-commerce directive which states there are inherent rights in the EU Charter of Fundamental Rights to freedom of expression and that the copyright directive provides that an Internet service-provider has the right to conduct a business and to have regard to the right of ordinary users to be able to use the Internet freely and openly. We would not seek to prejudice this right in any way. I am the Minister of State with responsibility for research and innovation. The State funds new technologies, the development of web-based technologies to the tune of millions of euro annually and we very conscious of the need to continue to do so.

I take Deputy Murphy's point about the abdication of responsibility. However, I respectfully suggest to the Deputy that we need to see a dialogue, an engagement, between the Internet service-providers on one hand, the copyright holders on the other side and a space in between for a very highly active Internet web-based community. They all need to sit down together to chart a way forward. Personally, I am not averse to the notion of primary legislation but no matter what action is decided upon, we must have regard to the Charlton judgment. If, prior to this judgment, the State already held that a person could seek infringement proceedings where a breach of copyright is perceived and there have been no sites closed down as a result, we are merely restating what is in the Copyright Act or adding to it, then it is logical to assume there will not be a move to close down further websites.

Acting Chairman (Deputy Jack Wall)

The Minister of State should conclude.

Deputy Sean Sherlock

I apologise. This is an issue which warrants more time but I will speak again if I may.

Deputy Catherine Murphy

The issue definitely warrants more time. The programme for Government states the intention to introduce primary legislation to deal with EU regulations but this has not happened. A debate is urgently required. There has already been an e-mail storm on this issue and we are about to see a hurricane if people are not satisfied.

There is a contradiction in some of the points made by the Minister of State. On one hand he does not want the courts to enforce unlimited blocking of websites yet on the other hand he wants the court to be able to grant injunctions which would block a site in its entirety. This is my understanding.

Deputy Sean Sherlock

That is not what I said.

Deputy Catherine Murphy

I do not wish to confuse the issue any further but there is a strong need to have complete clarification before any statutory instrument is signed. Because of its vagueness, this has the potential to do damage. If there is sufficient time allowed to have a debate, a question and answer session, much of the questions could be properly teased out. If this topical debate is the beginning and end of the debate, it will be insufficient. A debate on this matter is needed within the next week.

Deputy Derek Keating

This matter warrants more time for debate. I ask the Minister of State to consider how we could have an extended debate on this issue. In the days and weeks ahead, I ask him to consider how we could avail of the opportunity of informing more people and allaying their fears, particularly those in industry, business, education and those who avail of the services of the social network. There is significant concern and this may be as a result of misinformation but we need to avail of the opportunity to allay people's fears.

Acting Chairman (Deputy Jack Wall)

The Minister of State has two minutes.

Deputy Sean Sherlock

I reiterate the point that no national authority or court can require an Internet service-provider to carry out general monitoring of the information it transmits on its network. That gives rights to the Internet service-provider and to the individual IP address or the individual user. This means the ISP cannot be asked to monitor all the data of each of its customers in order to prevent any future infringement of intellectual property rights. This is clearly stated in EU law.

We are attempting to balance the right of the copyright holder and to transpose that which is already in EU law and then to recognise the rights of the individual user, the individual business and not to limit the freedoms of the Internet. Nobody wants to limit the freedoms of the Internet because this is counter-intuitive. We live in a democracy and we thrive on the businesses we have created in this country, through State intervention and subsidies which support those types of businesses.

The business model pertaining to the music industry is increasingly and arguably - I will not use the word outmoded - an evolving process. So long as it is a case of never the twain shall meet, then no matter how one legislates primarily in this field, as soon as one legislates, the Internet, of its very nature, will evolve in a way to circumnavigate the legislation. In my view, the stakeholders must sit down together in an organic fashion because if they do not reach an agreement then no matter what Government is in power, it will never be able to legislate for this issue. Given the level of activity on the Internet, which is to be welcomed, and the level of innovation, no one member state, no one geographical boundary, can set laws to try to control it. This is a commonly-held view to a certain extent. I think a liberal view is taken, in the main, regarding the power of the Internet and its inherent good. However, as an EU member state, Ireland must have regard to copyright law. Anyone who generates intellectual property has a right but that right is not superior to the right of the Internet service-provider nor superior to the right of the individual user. When governments legislate, they must be very careful.

Acting Chairman (Deputy Jack Wall)

The Minister of State should conclude please.

Deputy Sean Sherlock

I assure Deputies that I will give this matter more study. We will be implementing the statutory instrument, I will be very straight about that-----

Deputy Catherine Murphy

When will that be?

Deputy Sean Sherlock

It is imminent. I cannot give the Deputy an exact time but a note will be prepared for Cabinet.

Deputy Catherine Murphy

Will the debate be held before the statutory instrument is signed?

Deputy Sean Sherlock

I will have to defer to the Chief Whip's office in that regard. The central point is that those people within that community need to start coming together. The ISPs and the music industry people need to sit down with each other. They have been tinkering around the edges of this issue for a long time. Ireland needs to take a strategic view as to how it pitches itself-----

Acting Chairman (Deputy Jack Wall)

We must conclude on this matter.

Deputy Sean Sherlock

-----in terms of legislation. I apologise for going over my time.

Deputy Eoghan Murphy

On a point of order, this is a complicated issue and I commend the Minister of State's command of his brief which is most impressive-----

Acting Chairman (Deputy Jack Wall)

There is no provision for raising a point of order on the Topical Issue Debate.

Deputy Eoghan Murphy

The Minister of State's reply was not made available in written form.

Acting Chairman (Deputy Jack Wall)

We will ensure it is provided to Members.

Deputy Sean Sherlock

A Chathaoirligh, I did not write a speech.

Acting Chairman (Deputy Jack Wall)

With regard to the Topical Issue Debate, it is common practice to make a written response available to the House because other Members may not have an input into the debate but they may need the response for further reference. This may not be a requirement but it is good policy.

Deputy Derek Keating

It will be available in the blacks.

Community Development

Deputy Seán Crowe

The common denominator in the four jobs in question is that the areas in which they are located are areas with high unemployment levels, many social problems and a significant drug problem.

Many of the workers are 20 years in the job, with ten years done on a voluntary basis and ten years being paid by the Department. These people have been told funding is being cut by 75%, although I am told these cuts are happening elsewhere also. The common denominator is that the areas being attacked have suffered through the years from deprivation. These cuts are seen as a direct attack by the Department.

The work being done is second to none and cannot be replicated. There is a suggestion that the local authority or Garda might replicate this work but they cannot. A wide range of activities is organised to address the high levels of anti-social behaviour, including diversionary programmes for young people and a particular focus on anti-social behaviour. I will provide an example for the Minister of State. In the past week two houses in the area I represent have been petrol bombed and a pipe bomb has been left outside a family's door. These exemplify some of the problems happening in the areas.

These workers are the glue holding the communities together. What can the Minister of State do to reverse the cuts? These workers are involved with anti-racism action, Tallaght Travellers, the Society of St. Vincent de Paul, senior citizens, the RAPID programme, anti-social units, social inclusion, the planning and roads department in the local authority, housing projects, local schools, coffee dock management, the developing and support of a local creche, the Dodder Valley partnership, drugs task forces, the HSE, young mothers, new communities, family support and estate management. The Minister of State is talking about removing such a service in March, which is absolutely crazy. We must formulate alternatives.

Deputy Eamonn Maloney

There are two projects in my constituency, one each side of the N81. There is one in the Fettercairn estate and the other is in Killinarden. They are unique as their origins are from within the community; the people who organise and work within the projects live in the community. The activities just mentioned are carried out within these projects, and there is a wide variety of responsibilities within the community. Both of these are traditional working class estates and we could be here until midnight listing the sort of work they have done over the past 20 years. These are difficult times and the people involved, who I have met, appreciate that. If there is some way around this, we would be grateful for the Minister of State's help.

Deputy Michael Conaghan

The damage and devastation of heroin addiction is so widespread and great that it is often referred to nowadays in biblical terms with words like "scourge" and "plague". Heroin addiction represents a great problem for individuals, families and entire communities. It is a challenge to every one of our social structures and our political system, which has not always responded well. Perhaps the best political response came from Labour Party Minister, Deputy Pat Rabbitte, who initiated the local drugs task forces when a Minister of State. These enabled communities to intervene with the likes of the Ballyfermot Support, Treatment, Aftercare and Rehabilitation, STAR, programme. It empowered Ms Sunniva Finlay and her team with great skill, competence and insight to intervene in individual lives and work with strategies, therapies and initiatives to allow individuals in big numbers to rediscover themselves, learn new skills, get in touch with themselves and be strengthened to see off the false lure of heroin addiction. We must stand by projects like STAR in Ballyfermot and safeguard the work done by Ms Finlay and her team.

Minister of State at the Department of the Environment, Community and Local Government (Deputy Jan O’Sullivan)

I appreciate the concerns of the Deputies and have spoken to them individually with regard to these projects. I realise the work being done in the areas concerned. My Department had responsibility for the funding of the five mainstreamed drugs projects. Unfortunately, as part of the Government's comprehensive review of expenditure and the 2012 Estimates process, difficult decisions had to be taken in prioritising funding for core services in all programme areas. The funding Estimate to support my Department's mainstreamed drugs projects under the housing programme in 2012 is €100,000, compared with €400,000 in 2011, which is a reduction of 75%. That is the figure I am faced with and because of this significant reduction in the sub-head, it is not possible for my Department to continue funding the projects.

Once the 2012 funding position became clear, my Department contacted both Dublin City Council and South Dublin County Council, which administer the funding on behalf of my Department, in respect of the mainstreamed drugs projects. My Department requested the councils to notify the projects of the funding position immediately, given that the projects and the relevant local drugs task forces were in the process of determining budgetary matters for 2012, and to ensure that informed decisions could be made in that regard.

A consultation process is under way between the projects in question, Dublin City Council, South Dublin County Council, the relevant local drugs task forces, the Department of Health and the HSE with a view to identifying alternative funding mechanisms for the projects for 2012 and beyond. Accordingly, while this consultation process is under way, my Department has agreed to provide pro rata funding of €47,500 and €52,500 to Dublin City Council and South Dublin County Council, respectively, in respect of the mainstreamed drugs projects for the first quarter of 2012. This represents the final housing budget contribution to the projects and it will be a matter for all the public funding bodies, as part of the consultation process, to identify resources to deliver on the overall objectives of the reconfigured projects beyond end March 2012. For example, the mainstreamed drugs funding provided by my Department to the STAR project in 2011 of €129,200 represents only 8% of the project’s overall projected expenditure of €1.59 million in 2011. Similarly, my Department has recently met representatives from South Dublin County Council with regard to broader public funding for the projects and asked them to consider the potential for the estate management projects to be reconfigured in line with the council’s housing management role.

More broadly, and in the context of the public funding provision of €260 million for drugs programmes across all Departments and agencies in 2011, my colleague, the Minister of State, Deputy Shortall, who has responsibility for the national drugs strategy, is currently undertaking a review of the structures that underpin the strategy at local, regional and national level. This will take in how the current funding structures can be improved or streamlined, particularly with local and regional drugs task forces.

I know this sounds stark but I have listened to the strong cases being made by the Deputies. There is a period to the end of March where funding is in place and there is ongoing consultation. I will examine the issue again in light of the cases that have been made.

Deputy Seán Crowe

I welcome that the Minister of State will reconsider the issue but she should bear in mind what I said. Nobody will replicate the work being done by these people across the board and nobody has the required level of local knowledge. That would be accepted by all the agencies I mentioned who work with these people.

It will be like a house of cards and if those individuals are pulled from the communities, there will be a knock-on effect on a significant number of projects. It is not just what these projects are being funded for; in many cases these people do extra work, and they participate on a voluntary basis on boards, for example. It is a package. I know the work involves many Departments but somebody must take up the slack. If the Minister of State's Department cannot do so, the Department of Justice and Equality may be able to do so. If we save two or three children from going into the justice system, that should save a fortune for the State. That is a potential outcome.

Acting Chairman (Deputy Jack Wall)

Deputies Maloney and Conaghan have a minute between them.

Deputy Eamonn Maloney

I would be in the Guinness World Records if I could work within that. I thank the Minister of State for her reply and note from her contribution that she is acting proactively. I know the Minister of State is only in office a wet day and I am not here to criticise her efforts. I compliment the Minister of State's efforts. She is going in the right direction. If anyone can solve the issue, she will. The people in Killinarden and Fettercairn will thank her.

Deputy Michael Conaghan

I thank the Minister. I congratulate her on her promotion and wish her well. The STAR project in Ballyfermot is very aptly named. The project has shone the light into many lives where there was a great deal of darkness. A star can act as a guide. It is apt that the national drugs task force has chosen the STAR project in Ballyfermot as a guide to best practice for other projects. These are key criteria to underscore the value of the STAR project which I briefly sketched out.

Deputy Jan O’Sullivan

Much work is ongoing in my Department, in particular in terms of aligning work being done by local authorities, local community organisations and others. In that context discussions are ongoing on how we can share services and resources. I realise that specific work is being done in these projects and that we want to protect the work that is being done. I accept the point that was made in that regard.

Discussion is ongoing on a continuous basis and will continue. I undertake to ensure that I engage in the process. Unfortunately, that is all I can say today because I have inherited a budget that was cut by 75%. Budgets within the Department have been assigned for specific purposes. There is a process of engagement and funding has been provided up to the end of March. I will continue to communicate with the Deputies on the projects.

General Medical Services Scheme

Deputy Simon Harris

I thank the Minister of State, Deputy Jan O'Sullivan, for responding to this matter. I congratulate her on her promotion. I am pleased to have the opportunity to raise in the House the need to re-examine the current system of issuing prescriptions in light of what I believe are inefficiencies and inequities created by requiring GPs to reissue all prescriptions from hospital consultants, in particular in the area of mental health services for medical card holders.

As the Minister of State will no doubt be aware, the roll out of primary care centres was discussed at the Committee of Public Accounts in great detail this morning. I believe wholeheartedly, as does the Government, in the rationale behind the move to primary care centres and the need to ensure we can treat as many patients as possible within their own communities, in an effective and streamlined manner.

The programme for Government commits to an ambitious programme of reform in this area, one which is essential to the delivery of the best possible standard of health care in this country. The progress made last year by the special delivery unit shows that advances can be made even at a time when the health service has to face severe financial cutbacks. To do this, it is essential that all resources are utilised in the most effective manner possible. It is in this wider context that I wish to raise the need to re-examine the way in which prescriptions are issued to medical card holders.

I have been contacted by many constituents frustrated by the system currently in place, where families attending hospital or psychiatric services have to revisit their GP in order to get their prescription re-written as a GMS order to access their entitlement to receive it for free. This is most pressingly a problem in the case of prescriptions. Mental health prescriptions are obviously prescribed for very good reason, and often require individuals to take them consistently over a prolonged period. Depending on the circumstances, prescriptions for these long-term medications are sometimes issued on a weekly basis, requiring the patient to visit the GP for a GMS order every time a prescription is required.

Some modern health medications for treating conditions such as autism can cost up to €300 per month. If parents are not in a position to see their GP, as I understand was a concern for some families over the Christmas period, they may not be able to afford the cost of the prescription. That has real consequences for the children and families concerned, and pharmacists have little or no discretion in issuing such prescriptions without a separate GMS order. The system appears to be extremely bureaucratic. I would appreciate if the Minister could outline the rationale behind having GMS orders issued in this way, given that it appears to result in a duplication of resources. Patients see a specialist in a particular field, who prescribes the medication they feel is most suitable. They then have to revisit their GP in order to obtain a GMS order for the prescription. This same process takes place when a prescription is issued by a hospital. That is causing widespread waste of time and inefficiencies and is wasting the time of doctors at a time when the health service is clogged up. I am informed that while hospitals can use a special form to issue a prescription for up to seven days, in practice this is often not used. It is not the most practical measure. The current system can result in additional, unnecessary visits to GPs. I look forward to engaging with the Minister on the matter.

Deputy Jan O’Sullivan

The Medical Council's guide to professional conduct and ethics states that "it is in the best interests of the patient that a general practitioner, GP, supervises and guides the overall management of their health". There are approximately 2,600 GPs in active practice, of which approximately 2,300 hold a contract with the Health Service Executive, HSE, for the provision of services under the general medical services, GMS, scheme to medical card and GP visit card patients. Approximately 40% of the population is covered by the GMS scheme. GMS contracted GPs undertake to provide their patients with all proper and necessary treatment of a kind generally undertaken by a GP. That includes the issuing of a prescription for medicines or drugs as is determined to be necessary by the GP for his or her patient.

Since 1996 there has been an arrangement under the GMS scheme for the emergency supply of medicines for medical card holders on discharge from hospital. Community pharmacists participating in the GMS scheme are authorised to dispense a maximum of seven days' supply of medicines prescribed for persons who have been inpatients in a hospital or who have attended an accident and emergency department and because of the circumstances of their discharge and-or the urgency of the prescribed medication it would not be possible to attend their general practitioners to have the hospital prescription transcribed to a GMS prescription form. This arrangement relieves any difficulties that patients might encounter who are due to be discharged from hospital late in the evening or at weekends.

I believe that the Deputy is raising this matter, as he indicated, in the context of recent changes to the supply of medicines to some mental health patients in the area of the former Eastern Regional Health Authority. In line with the Health Service Executive's stated policy to standardise and streamline arrangements under the State drug schemes, to improve equity for service users and increase efficiency, local services have been advised to direct medical card holders requiring psychiatric medicines to attend their local general practitioner. This approach aligns the arrangements for the dispensing of drugs and medicines to persons on medication for a mental health condition, who reside in the greater Dublin area, with the arrangements that pertain in the case of persons living in all other parts of the country. This is also consistent with the arrangements for dispensing drugs and medicines across the full spectrum of medical conditions and is consistent with the policy of normalising and de-stigmatising this aspect of our health care service. It is also consistent with the key recommendations in A Vision For Change, the report of the expert group on mental health policy, pertaining to the treatment and care of mental health conditions in the primary care setting where it is acknowledged that treatment in this setting "enables the largest number of people to get easier and faster access to services".

This initiative ensures that general practitioners have a full involvement in their client's medications, including their psychiatric drugs. The process also ensures that pharmacists, who continue to provide this medication to eligible persons under the various scheme arrangements, can claim reimbursement in respect of these drugs with their other monthly submissions. These claims will be reimbursed by the HSE at the tariffs set by the Minister for Health under the applicable regulations. This change will not disadvantage medical card holders and it will reduce the administration associated with these arrangements and free up resources for other patient services.

In summary, I assure the Deputy that it is best clinical practice that a person in need of treatment should regularly attend their GP and that the GP is fully aware of the medications that any patient may be being prescribed. This is entirely consistent with the gatekeeper role played by the GP in the delivery of primary care. Furthermore, due to the reimbursement arrangements under the GMS scheme whereby a GP is paid a capitation fee per eligible patient on their list, there are no additional costs associated with an eligible patient attending. Rather, the rationalisation of previous local arrangements to fit with the national arrangements provides obvious administrative savings and increased efficiencies.

Deputy Simon Harris

I thank the Minister of State for her comprehensive reply. I am sure she will not mind me respectfully disagreeing with much of it. I cannot accept that this is best practice when it is a practice that only applies to medical card holders. If a private patient seeks psychiatric medical attention in the morning, he or she will get a prescription, go to the pharmacy, pay for the prescription and go home. If patients with medical cards seek prescriptions, they attend their mental health specialists, for wont of a better phrase, and get their prescriptions, which are useless to them for accessing medication. They must then attend their GP and endure the difficulty associated with getting appointments and waiting times in some areas. It is only then they can go to their pharmacies. All of this adds an additional layer of bureaucracy and inconvenience for medical card patients. Were the process standardised across the board, the response would have some credibility but that does not seem to be the case.

I welcome the fact that there is no extra cost but there is an extra inconvenience to patients. I value the role of the GP and the answer made a great deal of sense in that respect. We are all on the same page, in that we want to move to a situation in which mental health care is received in the community. Ideally, the GP should be situated in the same building.

This situation needs to be examined in light of the great technology that exists. We saw how Revenue could have used it to good effect in respect of pensioners recently. Computers should be able to talk to one another. The areas in question, for example, autism, are often specialties and specialists would be the best people to monitor the situation.

It risks stigmatising those on the General Medical Services scheme with mental health difficulties. There is an issue and I would appreciate it if the Minister of State relayed my comments to the Minister for Health.

Deputy Jan O’Sullivan

I will. The Deputy has made a good argument on the other side. I am not the Minister directly responsible but the notes I have been given state that the arrangements will be kept under review. That the Deputy's voice might be listened to might give him some comfort. There are reasons for taking these measures. I understand the Deputy's points and I will convey them to the Minister.

Deputy Simon Harris

I thank the Minister of State.

Deputy Robert Troy

I assume the Minister of State is taking this matter on behalf of the Minister for Health.

Deputy Jan O’Sullivan

Yes.

Deputy Robert Troy

I thank the Ceann Comhairle for selecting this Topical Issue for debate. I do not want to waste too much time, but I am disappointed that the Minister or the relevant Minister of State at the Department of Health is not present. One reason for turning Adjournment debates into Topical Issue debates under the heading of Dáil reform was to ensure the relevant Minister would take the debates.

When the Minister, Deputy Reilly, came to power, he arrived with great fanfare. One of his first actions was to step down the old HSE board. He is yet to appoint a new one. As he stated himself, he has taken control of the reins and the buck stops with him. Were he present, I would ask him whether he was satisfied with the fiasco that is the medical card situation. I am not the only Deputy to raise this issue, as I am sure that Members on all sides of the House have experienced a high level of engagement with constituents in this regard. Those constituents have been frustrated with the situation since the centralisation of the application process last July. I could give example after example. On Joe Duffy's phone-in radio show today, there was an hour and a half of examples of people experiencing extreme levels of frustration and anxiety. They are sick and are only looking for their entitlements, yet they have been given excuse after excuse.

I have been contacted by a lady who applied for a medical card last August. She needed a serious operation and her card was due to expire at the end of August. We telephoned at the end of the month and were told to telephone again in September. When we did so we were told to telephone again at the end of the month. The situation went on and on until, in December, the card was extended by one month to cover her operation.

I have with me a letter to the HSE's Primary Care Reimbursement Services, PCRS, in Finglas dated 15 June 2011 regarding a medical card in the name of Mr. X. The letter referred to the appeal received on behalf of Mr. X and, as he was within the limits for a medical card for a married couple, asked the PCRS to arrange to process the medical card at its earliest convenience. Today is 26 January 2012 and the man is still awaiting his medical card. He is lucky, as his doctor facilitates him when he has his weekly check-ups, but his pharmacist has understandably refused to accept him. In another example, a single man with two children applied last September, submitted further information in October and is still awaiting a decision.

The buck stops with the Minister for Health. How does he intend to resolve this matter? It is generating unnecessary anxiety among a large number of people. On Joe Duffy's radio show today, the manager of a GP surgery spoke about the unbelievable number of forms that she must re-fill because she has been told the originals have been lost. Deputies are told that we can only make two inquiries per call. People are not allowed to submit more than one medical card application per envelope. This is lunacy. What will be done about it? Deputies from all parties will submit parliamentary questions to beat the band to get answers on the position regarding people's medical cards. This will cost more money than an efficient and effective service would. Under the Croke Park agreement, if there are not enough people working in the service, additional staff could be redeployed to it to process medical cards within 15 days. At present it is taking 15 weeks at a minimum.

Deputy Jan O’Sullivan

I thank the Deputy for raising this issue. The Minister of State, Deputy Shortall, is on official business in Northern Ireland and telephoned me to ask if I could take this debate for her. I apologise on her behalf but she could not be present.

This debate provides me with an opportunity to set out the steps being taken to address problems that have arisen in the processing of medical cards. The final part of the centralisation project took place on 1 July with the centralisation of medical card processing and associated tasks for the entire country in the PCRS's office in Finglas, Dublin. For the first time in the State's history, a single uniform system of application processing has been put in place. It replaces the different systems previously operated through more than 100 offices across the country. Some of the changes that have been introduced include the www.medicalcard.ie website and the standardisation of medical card assessments.

The new arrangements should ultimately provide for a far more accountable and better managed medical card processing system. However, there have been difficulties. These issues are a matter of concern and the Minister of State has held several meetings with the HSE to raise them. She has been hands-on in addressing the matter. As a result of those discussions, a number of changes are being introduced to the medical card application system to assist in accelerating the turnaround for applications by easing the level of pressure on the medical card system, particularly with respect to the review process, which has placed a large demand on the resources of the centralised office due to the timing of the re-issuing and, hence, review of a large cohort of medical cards.

In 2010, the central office introduced a self-assessment review process for people aged 70 years and over, as that cohort was managed entirely by the central office. Following on from this development, from January on the HSE will ease the review process for all pensioners. This change will mean that reviews for medical cardholders who are 66 years of age or older will operate on a self-assessment basis, as currently happens with those aged over 70 years. The self-assessment review model will also be extended to medical cardholders under 66 years of age who were granted their medical cards on the basis of a means assessment and who the HSE is satisfied is living in this jurisdiction. The HSE is also standardising eligibility periods from two years to three years for people aged under 66 years, with a new four-year eligibility period for medical cardholders aged 66 years or over.

Notwithstanding this, there continues to be an obligation on all cardholders to notify the HSE of any change in their circumstances that would no longer entitle them to hold a medical card. The HSE is in the process of arranging access to data in the possession of the Revenue Commissioners and the Department of Social Protection to allow them to conduct reviews without troubling medical cardholders for further documentation. It is also intended to increase the fine applying to false claims in a forthcoming Bill.

Discretionary cards, emergency cards and cards held by people in a small number of other categories will continue to be reviewed in the normal way but the HSE is confident that the extension of the self-assessment model to the great majority of medical cardholders will simplify the process substantially, improve the service to the client and continue to improve turnaround times for reviews. It is hoped that ultimately 80% of renewals will be dealt with in this way.

The new process also focuses attention on active users of the medical card in order to ensure those most in need are captured within the streamlined process. In addition, from 1 February, the HSE will implement a new system which gives GPs the additional ability to identify and assist the most vulnerable medical card holders. GPs will be able to maintain the eligibility of these patients where they are going through the renewal system. They will also be able to add newborns to the medical card system online.

The Minister of State, Deputy Róisín Shortall, wishes to emphasise that in no circumstances should a medical card holder who genuinely engages with a review have his or her entitlement withdrawn before that review is complete. This is unacceptable. Some such cases were brought to her attention in recent weeks. The HSE is taking steps to ensure the rule is properly implemented.

In addition, the primary care reimbursement services's central office is working to deal with some of the processing issues that have arisen. This has included reviewing and refining the systems for the receipt and logging of applications and documents sent in following requests for additional information. In addition, the PCRS has received further staff resources this month as a result of a transfer from the Central Statistics Office. This should make an impact on processing times. My colleague, the Minister of State, Deputy Róisín Shortall, will continue to monitor the situation and has arranged to meet the HSE on a regular basis to discuss any issues that may arise with respect to medical cards.

Deputy Robert Troy

I thank the Minister of State for her reply which included some positive elements, particularly the four year eligibility period for medical card holders aged 66 years and over and the extension of the self-assessment process to include those above that age. However, not everybody over 66 years should have to undertake an assessment. Instead, assessments should be made at random, as is the case with the Revenue Commissioners in respect of tax returns.

The Minister of State painted the new centralised processing facility in Finglas in a very positive light. Unfortunately, that does not tally with the experience of service users. If there is a need to redeploy more staff to the unit, it should be done. As it is, it is neither efficient nor effective.

I welcome the Minister of State's undertaking that there will be no more cases of people losing their medical card before the review period is complete. What concrete steps will be taken to ensure the 15-day turnaround time is achieved in all cases? I know from my constituency office that most medical card applications are 100% complete when submitted, yet additional items of information are being requested before they are processed. There is a certain view, not entirely unjustified, that these delays are part of a stalling strategy the purpose of which is to secure cost savings. Will the Minister confirm that there is no cynical tactic on the part of the Government in this regard? To employ such a tactic would be despicable.

This is an issue affecting the most vulnerable in society, including seriously ill persons who cannot afford to wait for their medical card to be granted or renewed. I acknowledge that there are occasions when applications are submitted without all of the necessary information, in which cases one cannot expect an answer within 15 days. However, in the case of fully completed application forms, the 15-day turnaround target should always be met.

Deputy Jan O’Sullivan

We all acknowledge that the centralisation process which began some years ago has resulted in some problems in the processing of medical card applications. The Minister of State, Deputy Róisín Shortall, regularly meets the HSE in an effort to iron out any the difficulties that arise. As the Deputy acknowledged, there are proposals which will make it easier for people, including self-assessment and so on. These are being implemented on a gradual basis.

As I said, the reviewing and refining of the systems for the receipt and logging of applications and documents is ongoing. As public representatives, we have all seen cases in which a person is adamant that he or she has submitted all the required documentation only to receive a request for more information. That issue is being addressed, but I accept it is frustrating. I will convey the Deputy's concerns to the Minister of State who is taking a hands-on approach to this issue. I agree that as we are talking about very vulnerable people, we should ensure the information is available. As I said, a person whose case is under review will continue to hold his or her card until the review is completed. I recognise this is a cause of great worry.

Deputy Robert Troy

Will the Minister of State clarify that the delays which have occurred are not the result of a stalling tactic the purpose of which is to achieve cost savings?

Deputy Jan O’Sullivan

I am assured they are not.