asked the Minister for Health if he is satisfied with the present income limit for qualification for medical cards; and if it is expected that the limit will be increased.
36.
Ceisteanna—Questions. Oral Answers. - Medical Card Liability.
35.
asked the Minister for Health if he intends to revise the guidelines of eligibility for medical cards in view of the steep rise in the cost of living.
With the permission of the Ceann Comhairle, I propose to take Questions Nos. 35 and 36 together.
The income limits which are used by health boards in dealing with applications for medical cards have now been adopted by the chief executive officers as guidelines to assist them in deciding on eligibility in a uniform way. These guidelines are reviewed annually. The guidelines which are now used were brought into effect from 1st January last.
Would the Minister state when it is expected that they might be reviewed?
On 1st January, 1975.
Is the Minister aware that certain health boards have given interim increases of 10 per cent in the last few weeks because of the hardship caused to people placed outside the existing limit?
I am not so aware. I take the Deputy's word for it but, as I indicated to the House, the Deputy knows that where there is unusual hardship, even though the guidelines are exceeded, the CEO has power to issue a card to a particular person, for instance, a particular person in a family.
Surely the Minister must be aware of cases, even in his own constituency, which have been barred from medical cards as a result of having received perhaps 50p or £1 weekly increase in wages and that this is something which should be taken into account? I would urge him to ask the CEOs and health boards to do so.
This is so in respect of medical cards. It is so in respect of other types of medical assistance as well, particularly in social welfare. It might be that some person would have means which would exceed the limit by even 10p. Might I point out to the Deputy that if a case is regarded as a hardship case, even though the guidelines or means test is exceeded—the CEO has power—and, as far as I know, he uses it; I do not know to what extent—to grant a medical card permanently or temporarily to somebody who would suffer hardship if he or she had to pay doctor's expenses.
Is the Minister satisfied with the limit?
The Chair is seeking to allow in another Deputy. Deputy Power.
I would never be satisfied with the limit.
Would the Minister ensure that when laying down the guidelines for eligibility for medical services a married man who is a farm labourer and trying to live on a farm labourer's basic salary will always qualify in any part of Ireland for a GMS card?
I could not honestly give that undertaking because the Deputy is as aware as I am that the CEOs lay down the guidelines.
Therefore the Minister does not agree that a farm labourer should automatically qualify for a GMS card?
Is the Minister satisfied that the guidelines at present laid down are adequate?
I would not say so. There will be a review on 1st January next.
Is the Minister satisfied that the guidelines laid down for the last year were adequate?
It is not for me to say whether or not they were adequate. They were laid down by the CEOs. Whether or not they are adequate, the fact is that over the last 12 months—from June, 1973, to June, 1974—the number of persons covered by medical cards was 1,061,239 as against a figure in June, 1973, of 965,029. Therefore, it would not appear to me in any case that people are——
(Interruptions.)
I am seeking to bring in Deputies who have legitimate questions. We cannot have a debate. Deputy Molloy.
Bearing in mind that the Minister said these guidelines are laid down by the CEOs, could I ask him if there are consultations held between the CEOs and officials of his Department—persons reporting to him—and whether he in any way, through his officials or direct intervention, influences the guidelines finally adopted by the CEOs? Or is he saying that this is a matter solely within the sphere of authority of the CEOs and that he, as Minister, can in no way interfere and that he has not in fact interfered or been advised on the question of guidelines?
The CEOs take decisions unilaterally in respect of their own health boards. They met last January and revised the guidelines. The same thing will happen on 1st January next. They will meet and decide on guidelines which will be uniform throughout the whole country.
The question I put to the Minister has not been answered. Will the Minister tell us whether consultations take place between officials of the Department of Health, acting on his behalf, and the CEOs before the guidelines are finally adopted?
I assume that consultations take place in view of the fact that the Department of Health pay most of the bill for the health services.
(Interruptions.)
Deputy Molloy, a number of Deputies behind you are seeking to get in. The Chair is anxious to facilitate all within reason but the Deputy may not usurp time. I am calling Deputy Callanan.
I fail to understand this sudden attack on me.
Please, Deputy.
I am trying to extract information from the Minister in a reasonable manner.
I am trying to facilitate Deputies behind you.
I think the Chair is most unreasonable. He is carrying on the same pattern established last year.
Time is limited and I am seeking to get in as many Deputies as possible. Deputy Callanan.
The Chair is certainly not seeking answers to questions. He is doing his damnedest to keep the Minister off the hook.
(Interruptions.)
Is the Minister aware that the figures he has just given are not realistic because of the number of students who now have medical cards. We are experiencing that in the Western Health Board, where there has been an increase in the number of medical cards, the reason being that every student has a medical card now who did not have one two or three years ago? Is the Minister also aware that the guidelines laid down for medical cards eligibility are not keeping in line with inflation? If a person receives a £1 rise a medical card may be taken from him even though he might have had it for, say, 30 years. Would the Minister also recommend to the health boards that these guidelines be increased substantially on 1st January?
Since we are coming up to the time limit perhaps Deputies Dr. O'Connell, Coughlan, C. Murphy and G. Fitzgerald would get in their questions to the Minister who might have an opportunity of replying.
May I ask the Minister is it not true that his sanction must be obtained before any increase in the limit of eligibility for medical cards takes place nationally?
Not that I am aware of.
Would the Minister consider some form af escalator clause written into a scheme of guidelines which would ensure that the people Deputy Callanan has just mentioned would retain their medical cards instead of being cut off by a £1 rise?
With regard to the renewal on 1st January, would the Minister not agree at this stage that, in view of the present abnormal cost of living increase, January to January is a very long time to await a review of the medical card guidelines? Would he recommend to the CEOs, on the change of guidelines in January next, that they would build in a cost of living increase, so that these guidelines could be revised, say, half way through the year, on 1st July or some such date, in order to relieve hardship created in the current year due to the cost of living increase and the huge escalation of poverty within the country?
Is it not true that CEOs of the health boards are at present discussing the guidelines to apply to the issue of medical cards and that they are taking into account in very great detail the cost of living?
The time for Questions has expired.