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Seanad Éireann debate -
Wednesday, 23 Oct 2013

Vol. 227 No. 2

Adjournment Matters

Medical Card Eligibility

I welcome the Minister of State. I wish to raise a matter that was mentioned at a meeting of the Joint Committee on Health and Children last Thursday, which has been on my agenda for a while. It relates to emergency medical cards. The advantage of divisions being called in the Dáil during health committee meetings is that HSE and departmental officials are available to Members and we can have detailed discussions with them. I encourage the Dáil to call divisions regularly on Thursday mornings from now on. The issue I raised with Mr. Tony O'Brien which was also raised by Senator Jillian van Turnhout is my experience in working to secure emergency medical cards. I get a great reaction. In some cases, I have to fight for a week or two - in one case it took two months - for a medical card. The people on whose behalf I advocate are under a great deal of pressure. For example, the last application I dealt with was on behalf of someone with a brain tumour who had also been diagnosed with other cancers. When the medical card was approved and issued for six months, I wondered whether officials had come to the conclusion that he would not even live that long.

I propose that emergency medical cards approved on medical grounds should be issued for 12 months to provide stability. The financial issues should be reviewed in that period, as well as the question of whether the health issue has been resolved. We need to examine this because successful applicants do not have the medical card that long before they suddenly find they must furnish all their financial details and go through the entire process again, which can create anxiety and pressure for people who have serious health conditions. This should be examined.

I thank the Senator for raising this issue. Under the provisions of the Health Act 1970, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. As set out in the Act, medical cards are awarded to people who are unable without undue hardship to arrange general practitioner, GP, services for themselves and their family, typically where their means are below the HSE's income thresholds.

Discretionary medical cards are awarded to people who are unable without undue hardship to arrange GP services for themselves and their family, even though their means exceed the HSE's income thresholds. In these cases, social and medical issues are taken into account when considering whether there is undue hardship efor the applicant. However, the HSE can provide medical cards in emergency circumstances to patients who are in urgent need of medical care that they cannot afford. Medical cards can be issued in emergency circumstances within 24 hours of receipt of the required patient details and letter of confirmation of condition from a doctor or consultant. Medical cards issued due to an emergency are generally requested by a manager in a local health office or a social worker. A medical card can be requested in response to an emergency from the central office in respect of a person in palliative care, who is terminally ill; a homeless person in need of urgent or ongoing medical care; a person with a serious medical condition in need of urgent or ongoing medical care; a foster child in need of urgent or ongoing medical care; or an asylum seeker with a serious medical condition in need of urgent or ongoing medical care. An emergency medical card can only be issued to an individually named person, that is, no dependants will be included, unless a case is made separately for any other member of the family on medical emergency grounds. With the exception of those for terminally ill patients in palliative care, all emergency medical cards are issued for six months on the grounds that the patient is eligible for a medical card on the basis of means or undue hardship and will follow up with a full application, along with all the normal documentary evidence required to assess eligibility, within four weeks of receiving the emergency card.

It can take a day to physically produce the plastic card and a further day in the post, but the medical card number can be provided for the local office or social worker within 24 hours, if requested. Once approved, any primary care contractor can validate the entitlement of a customer through the online system.

Where a doctor or consultant certifies that there is a terminal illness, the nature of the terminal illness is not a deciding factor in the issue of a medical card and no means test applies. The HSE monitors such cases and can renew a client's eligibility, if necessary. In such circumstances, again, there is no assessment of means.

I am satisfied that, given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure a person receives a medical card as quickly as possible. In addition, the individual is afforded time to furnish the requisite follow-up documentation, as required. As the HSE ensures the system responds to the variety of circumstances and complexities faced by individuals in these circumstances, there are no proposals to extend the six month period to 12 months. However, I have listened carefully to what the Senator has said and as he and the House will be aware, there has been much discussion recently about this entire area and observations or insights Senators have in respect of the operation generally of the medical card scheme, including the discretionary and emergency aspects of it, will be taken carefully into account by me in the discussions, contacts and deliberations we will continue to have with the HSE on the administration of the schemes. There is considerable interest in and some concern on the part of colleagues about certain aspects of the schemes. The insights of Senators, including Senator Colm Burke, will be taken on board and considered by me in the discussions. There is no intention or proposal to extend the period, as suggested by the Senator.

The Minister of State has said terminally ill patients in palliative care are an exception. In the case concerned, the person was deemed to be terminally ill. It took time to get the medical card and it was only valid for six months. Where it is clearly indicated that the person is terminally ill, I do not understand why a medical card would only be issued for six months because it is causing anxiety. I suggest that in the case of a person with a terminal illness a medical card be issued for 12 months rather than six. I urge the Minister of State to examine the issue.

We will note what the Senator has said. Perhaps I might contact him separately to elaborate further on the thinking behind this approach.

Medical Card Data

I wish to ask the Minister for Health to put a procedure in place for the cancellation of a medical card number when issuing a death certificate. It is a simple concept. Recent reports in the Irish Independent highlighted the problem of GPs claiming more than €1.5 million a year in fees for people who were dead or did not exist. Even prior to that there was a clear need to establish a work practice to increase efficiency. Given that the Minister has said there is no more fat left to cut, this seems to be a simple procedure which could help to save us money. I discussed the matter with the Minister and it was also discussed at today’s meeting of the Fine Gael Parliamentary Party. The Minister mentioned that sanctions could be put in place for doctors who did not take people off their medical card lists when they knew a person was deceased. That was in the context of negotiations to allow GPs put babies on their lists. In a sense it was a quid pro quo, in that they would be given discretion to put people on their lists, but they also had to be seen to take them off them at the other side, for want of a better phrase.

There is a much wider debate whereby we could receive more information in-house. There is a responsibility on families when a person dies to return pension books and provide Departments with various information. There is even an onus on them to return medication for safety reasons. One can understand why there might be a difficulty between Departments. A well known comedy show springs to mind in this context where a girl sits opposite the person asking a question and the response is “Computer says no.” In this case we are talking about one Department that has all of the information at its disposal. One organisation, namely, the HSE, issues death certificates and medical cards. Surely to goodness we need some joined-up thinking in this regard.

I thank the Senator for raising this issue. Medical card processing was centralised at the Primary Care Reimbursement Service, PCRS, office from July 2011. This central processing is single national governance, with a central office location to replace the 100 locations used in the past. This national project provides for an enhanced service delivery to clients and a consistent and equitable national assessment process. The system now facilitates standardised, homogeneous and equitable assessment of all applications, irrespective of the origin or nature of the application.

Since centralisation, the HSE has in place a system for the processing of death information based on the death event publication service, DEPS, operated by the General Register Office. Under the systems applying, the HSE obtains a file of deaths each week which is uploaded to the medical card database. While there may be a delay in recording a death with the General Register Office, amounts paid to GPs after the date of death are recouped from them.

It is important to note that the HSE does not rely solely on the death event publication service. One of the enhancements to the processes introduced by the HSE was an agreement with GPs that allows them to manage their medical card panel more proactively. In this regard, they can confirm that their medical card panels are, to the best of their knowledge, correct on a quarterly basis. In addition, they can remove a medical card holder from their panel where they are satisfied that the individual has passed away or is no longer resident in Ireland. Individuals can also contact the HSE directly to notify it of the death of a family member and the HSE's own staff monitor these matters.

Legislation which came into effect in March 2013 - the Health (Alteration of Criteria for Eligibility) Act 2013 - allows the sharing of data between the Revenue Commissioners, the Department of Social Protection and the HSE. The introduction of these additional controls will strengthen the risk management framework for schemes and provide additional support. Overall, the centralisation of the medical card system and the new measures, involving verification by GPs of their medical card lists every three months and the removal of deceased individuals from panels, ensures payments are not being made to GPs for people who are deceased or no longer eligible due to their having emigrated.

It seems that when the information is available in-house, it is unnecessary to put the onus on doctors to be responsible for making sure their own lists are in order when we have the information available when a death certificate is issued. I am not convinced on the issue, but there is no point in pressing it.

I thank the Senator. The opportunity GPs have to update the system is just one of the methods used to update the system. As I indicated, the HSE has the DEPS system in place and it should work. The involvement of GPs should be an additional safety net. The Senator is correct that the system should ensure updating occurs and that we should rely on GPs and others involved in the system to ensure everything is done properly.

Carer's Benefit Payments

I thank the Minister of State, Deputy John Perry, for coming to the House to address this issue. Although it is not within his remit, I am sure he has been well briefed. I know he will have a good answer for me.

I have a number of clients who are in receipt of carer’s benefit. However, payment of the benefit stopped after one year. When the persons concerned contacted the Department of Social Protection, they were told they needed to fill in a new form and provide updated documents, in particular one from their employer indicating how many hours they had worked during the year. That is fine, but I urge the Department to notify recipients of carer’s benefit four weeks in advance of the review of the documents required to ensure continuation of payment.

The Minister of State will appreciate that carers have enough to do without running around trying to find out why their payment was stopped or why no money is going into their bank account. They visit me, their local social welfare office or call the carers section of the Department only to be told they need to fill in a form. Just as one is sent a letter saying one's illness benefit will terminate in two months, for example, the carer's benefit section should adopt the same procedure, write to recipients stating the information required and that there is a deadline in four weeks. Sometimes, the benefit is the only income carers have. It is sometimes coupled with a small income from 15 hours work or less. Carers are, therefore, left high and dry without money for a number of weeks until the payment is reinstated. I welcome the response of the Minister of State on this issue.

I thank the Senator for raising this issue. On behalf of the Minister for Social Protection, Deputy Joan Burton, I welcome the opportunity to outline to the Seanad the range of entitlements available to carers from the Department of Social Protection. One would imagine, based on the issue raised, that the intelligent approach would be to give the notification such that one would not have to reapply. I will raise that issue with the Minister.

The existing entitlements include carer's benefit, carer's allowance and the half-rate carer's allowance, which is payable in addition to most other social welfare entitlements. In addition, the Department pays an annual respite care grant in respect of each care recipient, and carer's allowance recipients may be entitled to the household benefit package. In 2012, the Department spent in excess of €670 million on payments to carers, appreciating the key role they play in society.

One of the schemes entails the carer's benefit, a payment made to insured people who leave the workforce to care for a person or persons in need of full-time care and attention. Carer's benefit is available for a total period of 104 weeks for each person being cared for. This may be claimed as a single continuous period or in any number of separate periods up to a total of 104 weeks.

If one is caring for more than one person, one may receive carer's benefit for each care recipient for 104 weeks, whether consecutively or concurrently. In common with all social welfare schemes, reviews are carried out of carer's benefit claims as appropriate to ensure recipients remain eligible for the payment. That is related to the Senator's point although it still does not answer her question. It is not the case that carer's benefit claims are routinely reviewed after 12 months. However, carer's benefit will expire after a period of 104 weeks spent caring. Carer's benefit recipients whose benefit is due to expire are written to well in advance of expiry and advised of their options. The personal rate of payment for carer's benefit is €205 a week, plus €29.50 for each qualified child. There is an increase of 50% of the personal rate for those who care for more than one care recipient at the same time. The value of the annual respite care grant is €1,375 in respect of each care recipient. These rates of payments have been maintained in budget 2014.

Carer's leave complements the carer's benefit scheme. The relevant employment legislation ensures that those who are entitled to carer's leave will have their jobs kept open for them for the duration of the leave. Carer's leave from employment may be taken, irrespective of whether a person qualifies for a carer's payment from the Department once the person being cared for is in need of full-time care and attention.

We spent two hours today speaking about reform of the Seanad, the Dáil and Oireachtas procedures. The first step we could take is reformation of the replies to questions raised on the Adjournment. I did not ask for the information given in the reply provided by the Minister of State. All I heard was what carers were entitled to. I know well what they are entitled to, as do the Minister of State and all my colleagues. I asked why the Department could not send a reminder. There is one line in the reply that refers to this: “It is not the case that carer's benefit claims are routinely reviewed after 12 months.” Why are my clients having their payments stopped? The Minister of State may not be able to answer as he is not in the Department of Social Protection. Why are payments stopped because individuals need to send in further documentation? A form needs to be filled out. It is sent to the individuals, who must take it to their employer. The reply, presumably prepared by an official in the Department, is saying it is not the case that carer's benefit claims are routinely reviewed after 12 months, but I contend they are because my clients' payments continue to be stopped because of the form not being filled in. Somebody is getting the message wrong. I did not need to be told about carer's leave or the respite care grant, the half rate and the full rate. I know all about them. We could start by reforming the way in which Ministers answer questions during Adjournment debates. To be honest, this reply is a load of rubbish. I am not getting at the Minister of State-----

I am just telling him that there is but one line in the whole reply that refers to my question and it is not even right.

I fully appreciate the Senator's view and respect the integrity of her case. In fairness to the Minister for Social Protection, Deputy Joan Burton, she is very much a reforming Minister and has made many changes regarding the automation-----

I am sure she did not prepare the reply and that it was her Department that did so.

Perhaps the Senator might be hitting on a bad-file case. Fundamentally, the Department states it is not the case that carer's benefit claims are routinely reviewed. They may be in some cases. I suggest the Senator contact the Minister's office regarding the cases in question. I have no doubt the problem will be rectified. I will raise the point with the Minister. It would make no sense and involve a massive workload for the Department if all the information had to be refurnished after 12 months. It is really about cutting back on the paper trail. The objective of the Government is to remove the red tape associated with obtaining entitlements. I will pass on the Senator's view to the Minister and seek clarification on the particular question asked.

Banking Sector Regulation

I thank the Minister of State for taking this matter on the Adjournment. It is important that we establish whether any staff in senior management in all the State-owned banks, including AIB, Permanent TSB, Bank of Ireland, the EBS and Irish Nationwide Building Society, converted any of their variable mortgages to tracker mortgages in the six-month period before the date of the Government-funded bank guarantee or immediately thereafter. This, as we all know, was a very important time in Ireland's economic history. It was a time at which Irish banking debt was tied to the ordinary taxpayer, a decision that my party, the Labour Party, was rightly opposed to. The reality is that, at the time, the people of Ireland bailed out the bankrupt banks of the country and were left with numerous austerity budgets as a result. I commend the Minister of State and all his colleagues in government for the work they have done in trying to strike a difficult balance and to ease the burden on the people. Did the management or employees of the banks now owned by the State try to seek a benefit for themselves by converting their mortgages from variable-rate mortgages to tracker mortgages, which have transpired to be a cheaper option? I look forward to the Minister of State's response.

I thank the Senator for raising this matter. I am deputising for the Minister for Finance who is abroad and consequently unavailable.

In the period before the bank guarantee of 2008, the then Minister had no involvement in the oversight of the banks. The current Minister is not aware of any instances of senior management in the banks converting from variable rate mortgages to tracker mortgages in that period. It is important to realise the mortgage market at that time was very different from that of today in that the variation between variable and tracker rates was small. In some instances, moving from the standard variable rate to the tracker rate would have resulted in a higher interest rate, but it was possible to switch from a variable rate to a tracker rate should a customer so request. However, regardless of what rates individual mortgage holders are on, the Minister, even if he wanted to, would have no access to the details of individual personal accounts.

I refer the Senator to two parliamentary questions on this topic that were answered in the Dáil on 15 October. Responses were provided from the two State-owned banks, Allied Irish Banks and Permanent TSB.

AIB advised the Minister at the time that for confidentiality reasons it is precluded from discussing or divulging details of individual customer accounts. AIB has informed the Minister for Finance this applies to staff who are bank customers.

Tracker rate mortgages operate by fixing a set margin over the European Central Bank, ECB, rate for the period of the mortgage. With a tracker rate mortgage, a customer's repayments rise or fall in line with ECB interest rate movements. Until 2008, it was possible to switch to a tracker rate should a customer so request. However, from October that year, AIB and the EBS, separate entities at the time, had withdrawn the product both for new business and conversion from existing non-tracker customers.

AIB withdrew its tracker mortgage product on 10 October 2008, shortly after the Government bank guarantee of 28 September. The EBS withdrew its tracker mortgage product on 13 October. Prior to that date, all customers, be they bank staff or otherwise, were entitled to convert their mortgages from variable to tracker. No customers converted their existing mortgage to a tracker product after 10 October in the case of AIB or 13 October in the case of the EBS, unless entitled to under the terms of a contract completed prior to date of tracker withdrawal.

The Minister is not aware of any instance of senior management in Irish Nationwide Building Society converting from variable rate mortgages to trackers in this period. However, the Minister does not have access to the details of individual customer accounts in the Irish Nationwide Building Society, including those of former senior management in the bank. It is important to note, in general, the Irish Nationwide Building Society did not provide tracker mortgage products. At the end of June 2012 less than 0.1% of its book were tracker mortgages linked to the ECB base rate.

Bank of Ireland is not a State-owned bank. We own 15% of its share capital, which makes us a minority shareholder in it. Bank of Ireland has also informed the Minister that owing to customer confidentiality obligations, it is not in a position to discuss details of the individual circumstances of any customer or transaction, including those of bank staff.

The Minister has been informed by Permanent TSB that no such action occurred in respect of senior management of Permanent TSB and that the bank stopped selling tracker mortgages in July 2008.

I thank the Minister for his response, but I am disappointed with it. I find it does not deal specifically with the question I asked. I feel the response was drafted in such a way that we are talking around it rather than getting to the crux of the issue. Terms such as “not aware” and “in general” have been used throughout the response which is most disappointing.

The reality is the State and the taxpayer bailed out these banks. The Minister claims customer details are confidential, but we own the majority of Irish banks, with a stake of 15% in Bank of Ireland. The taxpayer should be given the information I sought. It is regrettable that this has not happened. Will the Minister of State pass on a request for an independent investigation into this matter to the Department of Finance and the Minister? It is the State and taxpayer that will lose out as variable mortgages attract higher payments than tracker mortgages. Obviously, it will be the State that will be at a loss in terms of profits.

I will convey the Senator’s request to the Minister for Finance. However, the Minister will never have access to the details of personal accounts of bank customers.

It is not the bank customers' details but those of banks' management. I am concerned there were activities carried on that may be akin to insider dealings. I just want to get to the bottom of that to ensure no one in bank management benefited from the bank bailout for which the taxpayer paid.

Under the relationship framework agreement which is in place between the Department of Finance and the banks, the Minister has no statutory function in banking decisions made by individual lending institutions. The Minister must ensure the banks are run on a commercial, cost-effective and independent basis to ensure their value asset to the State as per the memorandum on economic and financial policies agreed with the European Commission, the ECB and the International Monetary Fund. I will convey the Senator’s concerns to the Minister.

The Seanad adjourned at 8.05 p.m. until 10.30 a.m. on Thursday, 24 October 2013.