asked the Minister for Health the reason a personal medical card has not been issued by the Midland Health Board to a person (details supplied) in County Offaly as he applied last December and supplied documentation of income which was certified by the inspector of taxes for the year ended 5 April 1983 which confirmed that the gross income as certified by him was well under the limit set by the health board; if, in view of the circumstances, the card should also cover the father, mother and rest of the family; if he will now confirm the position in regard to certified income; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Offaly Medical Card Applicant.
4.
Following assessment of the means of the family concerned this application for a medical card was refused.
I do not know what income the Minister of State is talking about because he has not clarified the issues on this. The income agreed by the inspector of taxes qualifies a person for housing loans and various other things. What is the criterion laid down because the Department of Health recently issued guidelines in this respect? The income of the father in this case is within the guidelines and qualifies that child for a medical card.
The guidelines are laid down by the Government and they are operated by the health board in the particular geographical area the Deputy is referring to. The health board made inquiries into the means of the family in the case the Deputy is talking about. The family holding is 136 acres although the applicant described himself as a small farmer. At present the family home is being extended. The family comprises of the parents and three children, the youngest of whom, I presume is the person the question refers to more than anybody else. This is a three year old child who suffers from asthma.
I respect what the Minister has said because he would not know the location of this farm. I am not being derogatory when I say that.
It is a holding of 136 acres.
It is 136 acres in bogland in Clonsast, where Eamon de Valera cut the first sod many years ago. I cannot understand the guidelines in respect of this. The total amount in regard to tax liability brings this child's father within the guidelines. A P60 in regard to income is recognised for every other benefit provided by the State. I cannot understand what is happening in this case. What kind of guidelines are the Department going on? Where did the Department get their guidelines because on 5 April 1983, the eligibility year date on which all health boards go on in regard to the self-employed and employees——
The Deputy is making a statement.
I am not making a statement. I want clarification in respect of this. How are health boards coming to a decision in regard to this?
There are certain guidelines laid down by the Department of Health. They are passed on to the health boards who determine who is entitled and who is not entitled to a medical card. The health boards have responsibility for providing a medical card or not providing one. The guidelines are laid down and it is up to the health board to operate the scheme. In relation to the case the Deputy is talking about, it is possible in regard to the three year old child who suffers from asthma that if there is undue hardship on the family as a whole in paying their medical expenses the case will be reviewed. If they do not think there is undue hardship on the family as a whole the parents can make application for a medical card for the three year old child. If in the view of the health board there is undue hardship on the family in relation to that child a medical card will be provided and if in the eyes of the health board the individual in question is entitled to it.
Will the Minister of State tell the House——
This question is about a particular case.
It is a particular case and I have a few supplementaries to ask on it. Are the health board not prepared to accept the certificate from the Revenue Commissioners? Is the Minister satisfied that the health board's assessment is more accurate than that of the Revenue Commissioners? What appeal procedure is in operation for people who wish to appeal a decision of the community welfare officer in the administration of the medical card system? Who decides the appeal? Does it go back to the community welfare officer again?
This matter refers to a particular case.
My questions are particularly relevant to the question asked.
This may be information the Minister might not have with him.
There is certain machinery which the Deputy is possibly much more familiar with than I am, or possibly than most other Deputies in the House are, in relation to applications for medical cards because the Deputy is a doctor and I am sure that these are not unknown to him. If a person is dissatisfied with the decision of the community welfare officer he can appeal to the chief executive officer.
It goes back to the community welfare officer.
If a person feels that there has been an unfair decision I am sure the chief executive officer would have a look at it to decide the matter.
With regard to this and other cases would the Minister of State agree that there is quite a difference in relation to all health boards in the time it takes to process applications for medical cards for the self-employed compared with the PAYE workers?
I do not want to curtail the Deputy but he will appreciate that this question deals with the case of a named person and to extend the debate to the general practice prevailing all over the country is not reasonable.
We are dealing with a specific case but it relates to the general attitudes of health boards towards the self-employed vis-á-vis the PAYE workers.
We will have to confine ourselves to the Midland Health Board.
Will the Minister of State agree that Deputy Connolly has instanced the case of a man and family with an income of approximately £90 a week, and that income is agreed by the Revenue Commissioners, who should have been eligible for a medical card, this year, last year and the year before? In the light of the fact that the Revenue Commissioners have accepted this figure of £90 per week, would the Minister of State consider that he should contact the health boards and rectify the matter for the family?
The health board made their own inquiries into the means of the family and as a result they came down with the decision that they have made.
On a point of order, before Deputy Connolly asked his final supplementary, I asked the Minister if he was satisfied that the health board's estimation of this man's income——
That is not a point of order.
——was the more accurate——
It is a further question, Deputy.
I asked the Minister that question and I would like him to answer me as to whether he himself is satisfied.
I am satisfied that the health board made their own inquiries into it.
Is the Minister satisfied that they are accurate?
In the minds of the health board that is the case. It is not the Department of Health who make the decisions on medical cards. They lay down the guidelines and it is up to the health boards to look into the case and as a result make their own decision.
Deputy Connolly.
I do not wish to drag out this issue, but I find it hard to come to the reality of this situation. The assessment of the Inspector of Taxes as agreed by him is relevant in regard to other State benefits and is recognised. Does the Minister of State agree that the income for the year ending 5 April 1983 as agreed by the Inspector of Taxes does not qualify that person for a medical card? Also, will he take it up with the Midland Health Board in regard to income, and ask them if they will issue the medical card?
In this instance the only thing we can do is take it up with the health board and ask them to have it reinvestigated with a view, if possible, to providing a medical card for the family in question.
Will the Minister of State do that?
I will.
A Cheann Comhairle, I have one question.
I hope it is relevant.
This question proves an important point. If you are a PAYE earner income tax certificates are relevant and if you are not they are not relevant. It is different standards for different people.
Uimhir 5.
(Interruptions.)
I want this clarified. Will the Minister of State take it up with the Midland Health Board?
Yes.