Dáil Éireann debate -
Wednesday, 2 May 2018

Vol. 968 No. 4

Topical Issue Debate (Resumed)

Medical Card Eligibility

Deputy Eamon Scanlon

It is imperative to ensure that those persons who experience financial hardships due to very serious illness will receive a discretionary medical card. Page 56 of A Programme for a Partnership Government says: "We will maintain a humane approach for discretionary medical card provision." I received a reply to a parliamentary question on 25 April 2018 where I was told it was "neither feasible nor desirable to list medical conditions in priority order for medical card eligibility." This effectively denies cancer patients an automatic entitlement to a medical card. As far as I can find there is nothing about the medical card application process that is compassionate or humane.

I am baffled that there appears to be no political will on the part of the Minister or the Government to extend the medical card to cancer or terminally ill patients.

Patients and their families face a financial crisis while they are going through their treatment. The 2015 report, The Real Cost of Cancer, showed how a significant number of patients face a severe drop in income while at the same time running up extra bills on a range of items such as childcare, travel, prescription charges, hospital stays and consultant visits.

We cannot lump on any additional financial stress to medical care by making patients jump through bureaucratic hoops, but this is what is happening currently.

Deputy Frank O'Rourke

I join my colleague Deputy Scanlon in raising this issue and in seeing how it can be made easier. The reality for people who are suffering from cancer or chronic and long-term illness is extremely difficult. These people have a lot of things going on in their lives; they are trying to deal with the illness and trying to live some sort of a life while dealing with other issues outside of their control with their illness. The painful process of making an application for a medical card is absolutely horrific. I know one young girl who has been diagnosed with a terminal illness and she is currently trying to finish her studies and get on with her life. She has made the application for the medical card and has been refused. She was looking for information from external sources, outside of her control. Because her application went outside the three-month window they closed down the application. When I called they said they were sorry but that was it and nothing could be done. This is shocking. I know another young man who has stomach cancer. He is on social welfare and is trying to fight the system to apply for a medical card, an application which is actually getting refused. He has had no success in getting co-operation in this regard. This is wrong. It should be made easier for people who are suffering from cancer or chronic and other long-term illness to access a medical card without going through this horrific process.

Deputy Mary Butler

Ireland has an ageing population, but thankfully life expectancy has increased. Some of us, unfortunately, get sick, develop cancer, terminal illness or chronic conditions. This is a time when some people who do not qualify for a medical card need it most. The application process can be quite difficult if one is ill, recently diagnosed, traumatised and vulnerable.

Many Oireachtas Members have staff throughout the State who, at times, assist when people find it difficult to fill in forms, especially those people who are not online. A diagnosis of terminal illness is an automatic entitlement to a medical card, but a diagnosis of cancer, which also has a poor outcome but maybe a longer timeline, does not entitle the patient automatically to a medical card. Some people who apply for a medical card find the process difficult enough in normal circumstances. When one is extremely sick and devastated with a prognosis such as cancer, this can prove very difficult and trying.

Minister of State at the Department of Health (Deputy Jim Daly)

I thank the Deputies for raising this issue. The HSE has a system in place for the provision of medical cards in response to an emergency situation for persons with a serious medical condition in need of urgent or ongoing medical care that they cannot afford and for persons in palliative care who are terminally ill. These cards are issued within 24 hours of receipt of the required patient details and a letter which confirms the medical condition from a doctor or consultant.

With the exception of terminally ill patients, all medical cards granted in an emergency are issued on the basis that the patient is eligible for a medical card on the grounds of means or undue hardship and will follow up with a full application within a number of weeks of receiving the medical card eligibility. It is also useful to note that in July 2015, the Director General of the HSE made a decision to award medical card eligibility to all children under 18 years of age with a diagnosis of cancer with the card to be held for a period of five years. It is undoubtedly important that the medical card application system is responsive and sensitive to people's needs, especially arrangements relating to the issuing of medical cards on a discretionary basis. To that end, the HSE has sought to implement revised processes to provide a more compassionate and more efficient process in the assessment of medical card applications. Such measures include the development of a burden of illness questionnaire which is now being rolled out in selective circumstances where the assessing doctor in the HSE's national medical card unit requires a more comprehensive assessment of an applicant's medical and social circumstances and any resulting undue financial hardship. In addition, in January this year, the new streamlined online medical card application system was launched. This will enable applicants to find out immediately if they are eligible for a medical card and will bring considerable benefits for people in turnaround times, convenience and security. Implementation of the measures above will aid the HSE's national medical card unit in providing an enhanced service to applicants, ensuring that the application process is as efficient and timely as possible.

It is nonetheless important to note that eligibility for a medical card remains primarily on the basis of financial assistance. This position was endorsed by the HSE's expert group on medical need and medical card eligibility which examined the issue of awarding medical cards on the basis of illness. That group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility and that a person's means should remain the main qualifier for a medical card. This position remains unchanged. To summarise, I recognise that patients require a responsive and efficient health system to meet their medical needs, which may often be required urgently. The processes in place in the HSE for granting an emergency medical card, the new measures of the burden of illness questionnaire and the online application system are aiding the national medical card unit to provide an enhanced service to applicants, ensuring that the application process is as efficient and timely as possible.

Deputy Eamon Scanlon

I am aware of doctors who are not aware of this emergency form that they can apply on. There must be greater awareness. I had a case of a lady who applied online in January. She got her medical card last week despite that she is very ill with cancer and is getting cancer treatment. That is very unfair. There should be people in the medical card office who will look at the applications when they come in and decide whether they need more information on an application or not. Information is being requested two or three weeks later and it is not good enough, particularly in cases where people suffer from cancer.

Deputy Frank O'Rourke

With respect, if the Minister of State's reply was the case, we would not need to be here, raising this with him. He outlined and highlighted a process. I had a constituent who was a patient in hospital with cancer, and applied through the hospital for that emergency fast-track system. That patient was told that the condition was not severe enough to allow the person to apply in this way, although it was signed off by a consultant, and that the patient should apply in the normal way. It was horrific. What about the student who was terminally ill and cannot get the paperwork in in time? Her application was closed down after three months. What should happen here, and maybe the Minister of State will discuss it with the officials, is that when an application is made for someone with long-term terminal illness such as cancer or another diagnosis, and the application is accompanied by a letter from a consultant, that should have some fast-track system to get through to get a medical card awarded. That would be instead of the painful, slow process which happens, where people who are suffering dramatically are tortured by the system for information and asked ridiculous questions and for supporting documentation for a terminal condition. It is wrong. If this was happening as the Minister of State says, we would not need to have this Topical Issue debate.

Deputy Mary Butler

The programme for Government commits to a humane approach to discretionary medical cards for patients undergoing cancer treatment. The guidelines used to award discretionary cards for patients undergoing cancer treatment must be more lenient. They must be more caring. They must be patient-focused. The patient has to come first. They have to look at individual circumstances, case-by-case, as opposed to income only. I am disappointed to see that in the third last paragraph the Minister of State said: "It is nonetheless important to note that eligibility for a medical card remains primarily on the basis of financial assistance." I was contacted during the week by a woman whose dad was diagnosed with stomach cancer at 83 years of age. The man had previously applied for a medical card but unfortunately he only qualified for the doctor only card, being €20 over the weekly limit. The doctor only card was sufficient up to then but now he is 83 and has stomach cancer, so it has to change. I put the emphasis on the patient having to come first.

Deputy Jim Daly

I accept what Deputy Scanlon says about greater awareness. The burden of illness questionnaire is very new and many people do not know about it. I had occasion to write to the Secretary General of my own Department recently about my concerns with the application of a constituent. We, as politicians, will always come across the bad cases and the cases that were not dealt with properly, while there are almost 1.6 million in the system who have full medical cards and another 500,000 have general practitioner, GP, visit cards, amounting to over 2 million of the population, but we as representatives will always pick up the cases that were wronged by the system. Our view of the world through that can be overly negative but that does not take from every individual having a right to get what they should, and there should be a process that backs it up. I accept the Deputy's point about increased awareness and I will take that up with the Department to make sure that every GP is aware of the burden of illness questionnaire.

Deputy O'Rourke mentioned somebody who is terminally ill and cannot do the paperwork. In that situation, a consultant can write a letter to the medical card section on the part of the patient. I have witnessed these situations. A medical card would be issued immediately without any questions asked if somebody is so terminally ill that he or she cannot do the paperwork. There is a system to deal with that but, as with all systems, it is not perfect and there are always glitches. I welcome the opportunity and attention that people have brought to the issue.

Deputy Butler addressed eligibility and financial means. At the end of the day, the medical card will not make anybody better. It will not assist their treatment if they have cancer. We have to be clear on that. All it will do is ensure that they are not under financial burden and we have to be careful with that. People could be diagnosed, as I was myself a number of years ago, with a skin cancer which is something very mild. I do not need a medical card. I did not need it then and I do not need it now. There is not a need for everybody who has been diagnosed with cancer to be given a medical card. It just does not stack up. While it sounds like it would be a good idea, it does not stack up in all cases. It is still about financial eligibility and making sure that there is no additional financial burden whatsoever on people. That is the role of the medical card as opposed to treating the person.

Northern Ireland

Deputy Maureen O'Sullivan

One year ago today, a Parole Commissioners for Northern Ireland hearing took place over four days. One part of it was an open hearing, during which Tony Taylor was questioned, and then there were two closed material hearings. A month later, the summary was delivered and Tony Taylor and his legal team were told that he would not be released. A core element of the justice system is the right for a person to know the case against him or her. With closed material, the defendant is at a severe disadvantage. A special advocate is appointed by the parole commissioners but this special advocate cannot discuss the case with Tony Taylor. That is not the first example of the injustice of the parole commissioners hearing. I refer to the case of Martin Corey, whose licence was also revoked. He ended up in jail and eventually got a parole commissioners hearing. Four years later, he was released from jail with no charge and no trial. There is also the manner in which Tony Taylor's licence was revoked. He was surrounded by armed personnel in front of his family. One of his children is a child with special physical and mental difficulties. After more than 800 days, Tony Taylor is still in jail and there does not appear to be any way in which he can be released unless there is some proper intervention in the interest of justice.

Deputy Éamon Ó Cuív

I dtosach báire glacaim buíochas leis an Tánaiste as ucht teacht isteach go pearsanta anseo. I thank the Tánaiste for coming in. He is aware of this case. To summarise it on the public record, as Deputy O'Sullivan has said, Tony Taylor is in prison following a revocation of licence. The problem with all of this procedure is that the person whose licence is revoked in the closed procedure never finds out the detail of what is alleged against him or her, nor is there a chance to answer the charges in detail.

It is all carried out in a closed system. There had been hope recently that another hearing would take place in the coming months. but I understand it has been deferred for six months by the Secretary of State. The matter must be expedited and a further hearing held in order that Tony Taylor can be released. As the Tánaiste is aware, the group to which he belonged announced a total cessation of violence on 23 January. We must build on it. We must build peace and get action in this case.

Deputy Clare Daly

There is no doubt that this is an outrage and a gross violation of human rights. I recall the testimony given to the Committee on the Implementation of the Good Friday Agreement by Ms Lorraine Taylor, wife of Tony Taylor, on the devastating impact the swoop operation which picked up Mr. Taylor more than two years ago had had on their family. He was taken into custody on the vague assertion of the Northern Ireland Office that he was a risk to the public. That claim has not been verified by a court, but he is still incarcerated two years later and no evidence has been presented to him. This is internment by another name and utterly shocking. It is a fundamental right of a democratic justice system that an accused should know the case against him or her. If this was happening anywhere else, we would be up in arms giving out about it. This gross violation of human rights is happening on this island and we must intervene to ensure there will be an early hearing and that this man will be allowed to go back to his family.

Deputy Mick Wallace

The arrest of Tony Taylor on the revocation of his licence in March 2016 was unlawful and did not conform to Article 28(2)(a) or (2)(b) of the Criminal Justice (Northern Ireland) Order 2008. Detention in the absence of lawful authority is contrary to Article 5 of the European Convention on Human Rights. This incarceration does not make any sense. It is not positive for Northern Ireland or for building peace. Putting people such as Tony Taylor in prison for no good reason, not charging him and leaving him in limbo is not the way forward. One could be forgiven for suspecting that some people may have a vested interest in the Troubles continuing because this matter is not helping those who are trying to maintain peace.

Minister for Foreign Affairs and Trade (Deputy Simon Coveney)

I thank the Deputies for raising this important issue. My officials and I have been following and engaging on this matter on an ongoing basis.

Mr. Taylor, who is from Derry, was a member of a dissident republican group in recent years. In 1994 he was sentenced to 18 years in prison after he had been seriously injured in a premature explosion in Derry. He was released under the terms of the Good Friday Agreement. He served a further three-year sentence from 2011 to 2014 for the possession of a rifle. In March 2016 he was returned to prison after his early release licence was suspended by the then Secretary of State, Ms Theresa Villiers.

As I have indicated previously to Deputies, Mr. Taylor’s case has been discussed regularly with the Northern Ireland Office through my officials at the Belfast secretariat. My officials have twice visited Mr. Taylor in Maghaberry Prison, most recently in the past few weeks.

The Northern Ireland parole commissioners held a parole hearing in May 2017 on Tony Taylor’s revocation of licence. The decision reached at the hearing was to continue the revocation of licence. A further review by the parole commissioners is under way and there was an expectation that it would conclude in the coming weeks. We understand from discussions with the Northern Ireland Office and Mr. Taylor’s legal representatives that there may be a delay in that process, as referred to by Deputy Éamon Ó Cuív.

I am aware that Mr. Taylor has publicly renounced any future engagement in dissident republican activity. I have received a letter from his wife, Lorraine, and I am aware of their difficult family circumstances. I am also aware that there is a level of concern in the nationalist and republican community in Northern Ireland about the basis for and nature of Mr. Taylor’s ongoing detention. They have all been reflected in our ongoing engagement with the Northern Ireland Office on the matter. The recent indication that Mr. Taylor’s new parole hearing may take much longer than expected is of particular concern as he has now been in detention for more than two years without being charged with or convicted of any new offence.

My officials and I will continue to monitor developments in the case and raise it with the Northern Ireland Office. I will write to the Secretary of State, Ms Karen Bradley, about the case and will raise it when I meet her in London tomorrow. There are legal sensitivities of which we must be aware, but I understand the growing concern about this matter. Having been in Derry last week, I appreciate how it is contributing negatively to community tensions in an unwelcome way.

Deputy Maureen O'Sullivan

I thank the Minister for his reply. It is welcome that he will raise the issue with the Secretary of State tomorrow. The injustice of the treatment of Tony Taylor is undermining the Good Friday Agreement. I want to believe there is a fair and just system and due process in Northern Ireland, but it is not being followed in his case. It seems that delays are in the DNA of the parole commissioners because they were previously encountered in the case of Martin Corey, as I mentioned. The decision to revoke Tony Taylor's licence was taken by the then Secretary of State, Ms Theresa Villiers. She has admitted that it was illegal, but he is still in jail. It is a terrible injustice for him, his family and, in particular, the son for whom he was the prime carer. I hope there will be a resolution of the case and that we will not accept the parole commissioners stating there will be another delay.

Deputy Éamon Ó Cuív

I thank the Minister for his succinct answer. Certain issues are within the control of the political system in Northern Ireland. One is the closed and unjust system under which a licence is revoked and one does not know the charges one faces and is not present for the inquiry.

A second issue is administrative delay. The Tánaiste was correct when he stated the hearing was expected to take place in the coming weeks, with which we were willing to go along. As he is aware, there should be no fear of releasing this man. The Tánaiste has recognised that Mr. Taylor has stated he will not be involved in sectarian activities. We also have the statement from the organisation to which he belonged. This is not building peace, rather it is doing the opposite.

I have written countless times on behalf of a group of Deputies to the former Secretary of State, Ms Theresa Villiers, and the current Secretary of State, Ms Karen Bradley, on the case and requested a meeting with the latter for four Deputies in this House. Will the Tánaiste convey to her our disgust that a Secretary of State does not see fit to meet representatives of the Oireachtas in reasonable time when they request a meeting to discuss a serious matter. I hope that if British MPs wished to meet the Tánaiste, he would immediately give them that courtesy. I have no doubt that he would.

Deputy Clare Daly

I thank the Tánaiste for his reply. There is a strange irony in the similarity of the cases of Tony Taylor and Ibrahim Halawa. People were justifiably outraged by occurrences in the latter case such as court dates being cancelled, the accused having no clue as to the charges against him and both he and his legal team being left in the dark. That is exactly what is happening on this island to Tony Taylor and his legal representatives. It is setting an incredibly worrying precedent which is adding to political instability in Northern Ireland at a time when some dissident groups have renounced violence and committed to peace. It is undermining that process. It is the continuance of a non-transparent, quasi-judicial legal system that involves gross violations of human rights and it should be consigned to history.

I am glad the Tánaiste notes the particular concern and I hope he will raise it, not just with the British authorities but also with his EU counterparts to try to make the British Government sees sense in terms of an early hearing on this issue.

Deputy Mick Wallace

I too welcome the Tánaiste's response. He showed a clear understanding of the problems, the challenges and the injustice. The notion that allegations of wrongdoing could not even be raised against someone and they had to spend more than two years in prison is soul destroying. This is a human rights issue. As the Tánaiste is aware, we go to Maghaberry Prison regularly and it is a scene from hell. In a report published last year it was deemed one of the worst prisons in Europe. Just as some members of the republican side did not accept the Good Friday Agreement, unfortunately, some people on the other side did not accept it either. While there has been huge reform in certain areas in Northern Ireland and the Police Service of Northern Ireland, PSNI, is a serious improvement on the RUC, other areas in the prison service in Northern Ireland leave much to be desired. It would be welcome if the Tánaiste could challenge them on their irrational behaviour.

Deputy Simon Coveney

It is important to say in the context of this debate that while there are genuine and real concerns about this case, I know that all in this House will agree there is no place for violence or the threat of violence in the pursuit of political aims in Northern Ireland or anywhere in this island. We again call on all those dissident republican groups that have not yet done so to renounce violence and to commit to exclusively democratic pursuit of political aims. I also pay tribute to the work of An Garda Síochána in dealing with ongoing activities and threats posed by dissident groups that have not committed to a peaceful way forward. It is important to say that.

I take the Deputy's concerns but there are issues here that clearly others believe are relevant in terms of the ongoing detention of Mr. Taylor. We will continue to raise the concerns that have been raised in this House. They are legitimate. I will be talking to the Secretary of State, Karen Bradley, tomorrow but I will put those concerns in writing also. Those conversations have taken place between my officials and officials in the Northern Ireland Office.

As I say, our approach will be to continue to monitor this case closely because the case, and the way in which it is handled, has broader repercussions in terms of the broader community in Derry. It needs to be handled sensitively and appropriately and we will engage, as we always do, with the Secretary of State for Northern Ireland and her team in that regard.