Centralisation of Medical Card Services: Motion.

The committee is meeting today to consider a motion regarding the centralisation of medical card services. The committee has before it a motion and an amendment to the motion. Copies of both are provided to the members of the committee. In accordance with Standing Orders, if the motion is agreed, the committee must make a report on the matter to the Houses.

I move:

That no further centralisation of the processing of medical card applications should take place until a full review has been carried out into the preparations undertaken in advance of centralisation, the staffing of the centralised unit, the current problems in its operation and the affect of centralisation on those whose income and-or ill health may entitle them to a medical card; that the Joint Oireachtas Committee on Health and Children would consider carrying out such a review and any such review would be public.

I thank the Chairman. Everybody present knows there is a serious problem with the processing of medical cards and the centralisation of the processing of medical cards. Most of us have only experienced the move to the centralised unit of the processing of medical cards for those over-70, but having listened to Deputy Róisín Shortall who spoke at a previous meeting, the Dublin constituencies where the centralisation has taken place are having severe problems in terms of accessing information, documents being lost and the general failure of the unit to be able to deal with the public. Those of us in constituencies outside Dublin have the same issue, perhaps to a lesser extent.

There is a great deal of confusion around this issue. People, including public representatives, cannot get information. I will refer to some cases with which I have dealt. One concerns a couple, both of whom have diabetes. The man had a stroke. Their cards have expired and they sent them back last October. They are now running out of medication and cannot get information. I rang my office before the meeting to try to get information and could not get it. These are real people who have real illnesses and are faced with this problem.

I am getting confused information. I have been told by some people that one does not have to apply if one's card is coming up for renewal because it will be automatically renewed. Other people have said to me that their cards were cancelled and not automatically renewed and they are now left without a card. I received a document from general practitioners, which was circulated to us, which stated there is a difference between national and local lists, and that payments were only being made to people on the national list.

The local offices do not have the information they need to inform the public. They do not have access to the information in the central office so they cannot tell people what is happening. There is a fundamental underlying issue, namely, that the issues regarding medical cards concern in the main very vulnerable people. We need a front-line service for such people. People should be able to talk to a real person when they are in a borderline situation regarding medical cards. I have in mind people who have illnesses and are just above the income guidelines. These are guidelines and not hard and fast limits such as those pertaining to social welfare payments. The humanity is being taken out of the system.

Yesterday the committee heard a presentation from the Irish Motor Neurone Disease Association whose representatives told us that two of its members had their medical cards withdrawn. We all know what kind of an illness motor neurone disease is. If people do not have access to people at a local level to discuss medical cards, we will see increasing numbers of people in such categories having their medical cards withdrawn. The system will comprise a paper exercise in a back office somewhere in Finglas, as I understand it. There will be no access whatsoever to any kind of pleading of a case or giving the human side of the reason people need a medical card. Members from all parties around the table know I am talking about genuinely vulnerable people who need a medical card.

The HSE should rethink the whole issue of the centralisation of the medical card service. Centralisation of the service is not working and will become even more chaotic when other parts of the country come under the centralised system. As I understand it those who are working in the service are still working in the local offices. Presumably they will do other work after the centralisation takes place. Their expertise will be diluted and put into other activities. Given that they will still have to be paid, I cannot see how there will be a saving. I understand that many of those in the central offices do not have experience of dealing with the medical card issue and, in effect, will not have the expertise that people have built up around the country. That is the reason I put forward the motion. The committee or somebody else needs to review the issue before it is too late, before the transformation happens. As happens with many issues within the HSE, it probably looks fine on paper but the reality will be very different. We have an opportunity to intervene and we should before it happens in April.

I have no problem with the HSE appearing before the committee and giving us its side of the story. In fact, it needs to come in. However, we also need to invite in representatives of the GPs who have written to us. We need to facilitate a few people who have experienced difficulties with the centralised unit and representatives of the people who have been doing the job in the HSE offices. I have no problem with the suggestion to invite in the HSE but we need to invite in other people who have something to say about this issue.

I move amendment No. 1:

To delete all words after "That", in line 1, down to and including "out" in line 2, and substitute the following:

"the Joint Oireachtas Committee on Health and Children hear a detailed presentation from the HSE on the matter of centralised processing of medial cards prior to consideration of any full review".

This is a major issue. Of course, I agree with most of what Deputy O'Sullivan had to say about the cause and effect. All services should be delivered as close as possible to the client and medical cards should be processed at local level provided there is not some good reason it should be done otherwise and it is in the interests of the patients that we have to provide all these services. For that reason I want to hear the HSE's rationale for introducing the new centralisation office. Before making a decision on the motion before the committee I would want to hear the reason the HSE proposes to do this. I do not think it is necessary to call in anybody else at this stage. When we hear the HSE, we will either agree or disagree with it. At that stage we can decide how, as a committee, we will proceed. I am in favour of inviting in the HSE as a matter of urgency to hear the rationale behind what it proposes to do and how it will guarantee that the issues raised by Deputy O'Sullivan will not arise.

Most of what needs to be said has been said. There is no public representative present who has not experienced problems with the centralisation of the medical card service. The problem affects only those over 70 years of age when they have to renew their medical card. Two constituents over 70 years of age, whose cards were due for renewal at the beginning of December, came to my office. They submitted all their details to the office but heard nothing more. When they telephoned the office, the officials did not know what they were talking about. I then tried to contact the office. Sometimes people have a difficulty using the phone and as one gets older the difficulty becomes more apparent. I telephoned the office and had to waited 25 minutes for an answer. That is okay for me. I was determined that I would get somebody to answer the telephone. If one is elderly one may be worried about the telephone bill. When the answering machine comes on to say "the office is grateful for the call, it will be dealt with in rota, please hold on", most elderly people think that is an answer and begin talking again and they miss half the message. We all know that and are aware it happens.

The medical card and how it was processed locally was an example of how health matters should be dealt with. One made application and if the answer was no, one could appeal locally. If the answer was positive, the doctor was informed and the card issued in due course. It was a fairly smooth operation and it was processed by people who also did other work. It was not a stand-alone operation, yet it was done very effectively. If the application was refused, the applicant knew who to approach, the community welfare officer, and did not necessarily have to approach his or her public representatives. The new service has been a disaster. Whether there are not enough staff employed in the office or whether, as those in the office told me, it was a unilateral decision and they were not consulted beforehand, or whatever the reason, it is not working. We had a system that worked and there was no need to change it, and now we have a system that does not work. It is not good enough to tell elderly people who are entitled to a medical card not to worry about it and that it will be dealt with in six months' time. They do not understand that. That causes confusion and worry. That is not what we should do.

The system as it exists in various regions should remain in place until we learn what went so badly wrong. The notion that all medical card applications would be transferred to a central repository is a form of madness and should not be done.

I second the amendment moved by Deputy O'Hanlon. To say that the old system was a good system could not be further from the truth from a number of points of view. First and foremost, there has always been problems with providing medical cards. If I applied today for a medical card in Dublin I could be refused. If I moved residence to another part of the country, say, Donegal and made application there I could possibly get a medical card there. The big problem area in regard to medial cards is interpretation of regulations which must be complied with. There are also guidelines. The problem is that there is a different interpretation of the guidelines right across the country so they are not all pulling together.

There is the idea that the old system was a good one but I do not believe it. There was also a belief in certain quarters that the old type politics worked best and that if somebody did not get a medical card the local politician would give the local HSE worker a grilling and get a medical card for the individual. That is a belief held by some politicians and it is a factor.

Before we knock such ideas it is important to establish the facts with the HSE. There may be far more people employed throughout the country dealing with medical cards than are employed in our passport office. That office provides a very good service and it deals with many more applications than all the staff dealing with medical cards. We must ask ourselves if we want to retain the system in the local offices that provide, in some ways, a half-hearted service to the general public or do we want to have a service that will guarantee delivery on decisions on medical cards? I would like a set-up under which politicians have access to system. Progress can be made in many areas, including in this area. Rather than knocking the HSE's ideas about the delivery of this service, we should invite its representatives to come before the committee and establish what those ideas are. If we cannot secure improvements that we consider suitable, then we could consider knocking them.

I disagree in principle with what Deputy Blaney said. I have no idea how the system works in County Donegal, but I have a good idea of how it works in County Galway. I am not saying I was the first person to raise this matter but I raised it during the second or third meeting we had with the Minister for Health and with Professor Drumm and they ruled me out of order on that occasion. They thought I was ratcheting up the issue, but this is an issue that is exercising minds throughout the country. I do not mind whether a medical card is issued from the office in Newscastle in Galway or from the office in Finglas in Dublin, provided it is issued on time and that if a problem arises the applicant can interface with the staff member who made the decision. That is the bottom line.

I agree fully with everything that has been about this issue. I deal with it every day of my life. Deputy Lynch was lucky to get an answer to her telephone query in 25 minutes. I and my secretary spent 11 days trying to get through on the telephone to the office in Finglas on behalf of a constituent. The Minister for Health and Children was good enough to circulate to Deputies and Senators a list of the people to contact in the office in Finglas. It took me five days to get through on the telephone to the person concerned in that office. I decided I would spend a day dealing with the matter until I got to the bottom of it. I had to contact people at various levels in the HSE and had to e-mail the document I received from the Minister to a certain person in a very high position in the HSE who was not aware that the Minister had circulated that document to Members. I have all this on file. I received a telephone call about the matter the following day.

I do not have anything against the staff working in the Finglas office. They handle matters as well as they can. Applicants are over 70 years of age and they may omit some small detail when completing their application forms. This is not a political matter, the HSE is handling this service and, as such, it is a procedural matter. There is no possibility that the elderly person in question can have a direct link to the person who made a decision on his or her application. That is what is wrong.

Given that systems are in place in local offices in all counties, why can applications not be processed through those systems and then forwarded to the Finglas office, if the HSE wants to have an overarching system in place, as Deputy Blaney mentioned, where at least the same ground rules will apply, if that is what was wrong with the old system? There would be no trouble in doing that, but the people for whom this service is intended should not be penalised. With this system, the people we are trying to help are being overly penalised. A system is in place in every country, people have been trained to do this work and should a problem arise, the pressure in resolving it should revert to the staff in the local area office and the staff in the office in Dublin. They can suffer the drudgery of the long telephone calls, but it should not be borne by the people for whom we had hoped this system would work.

The position is bad enough with the processing of applications for the numbers involved who are over the age of 70, but Professor Drumm told me at a recent meeting that it is intended that this system will be applied to applications for those under the age of 70 in April. Matters will turn upside down if that is allowed to happen. It is obvious that the staff in the office in Finglas are not ready for this change.

I cannot understand why the local offices cannot have a more specific role in dealing with these applicants. The local offices are used to dealing with the applicants in their area and if a problem arises the staff in the local office can deal with the staff in the Dublin office if that is what is required. I have no problem with a national register of medical card holders, if that is what the HSE wants to set up. I want the relationship between the applicant and the supplier of the service, that is, the community welfare officer and the staff in the local centres that has been built up over the years to be maintained. If that was done, we would overcome the problems. If the HSE goes down the road that it is now talking about, this issue will be raised at every meeting. It will also be raised on the floor of the Dáil and the Seanad every sitting day for the next 12 months because it will create havoc.

On the role of TDs, a speaker questioned whether they should telephone the HSE about such applications. Many years ago a person telephoned me to thank me for getting them a medical card. I told the person I did not get their medical card but persuaded the system that they were entitled to one. That is a different matter. That is what we do. I have a great deal of sympathy with what my Labour Party colleague said and I will not disagree with what she said, but the Fianna Fáil motion is a good compromise at this point. We raised this issue with the Minister and Professor Drumm on the last occasion and I have no hesitation in saying that I strongly believe the system in the office in Finglas does not work. I do not know about the systems in place in the offices in Donegal and in Galway, but I found it easier to deal with my local office.

I live in an major urban area and this service was delivered from a modern health centre in Jobstown for the local community. That system worked, of that there is no question. Problems will always arise, but at least that system worked. The staff knew the situation, one could call to the office or telephone the staff there. I have nothing against the nice people in the office in Finglas and I do not know whether I know them, but like other colleagues I have not been able to get through to them.

I, like Deputy O'Hanlon, have been a long time supporter of local services. I was a member of the Devolution Commission set up by the Taoiseach, Mr. John Bruton in 1996. That commission, on which I was a lone Fianna Fáil member, adopted an all-party approach and it took on board strong views. Members should not ask why the Taoiseach, Mr. John Bruton, asked me to be a member of that commission, but it did good work.

The idea of having local services, as Deputy O'Hanlon has said, is the way forward. I remain unconvinced that what is now being done by the HSE is the way forward. I suggest to my colleagues that we should genuinely consider inviting representatives of HSE management to appear before the committee. I am not talking about having a Mickey Mouse approach to this issue but about bringing in members of senior management and asking them to convince us about this system. The jury is out about why we should tolerate this system. We only get involved in these and other issues where there is a need for us to do so. My colleague, Deputy Rabbitte, made the point that in the Dáil this morning that we cannot get answers to parliamentary questions from any Department. I had tabled a parliamentary question yesterday and it was not answered. Certainly, where medical cards are concerned, we are dealing with vulnerable people who want answers and they are entitled to get them through us. The senior HSE management should be brought before the committee to inform members why the HSE is doing this, why it is persisting with it and why this is a good system, because I am not convinced.

I support the motion proposed by Deputy Jan O'Sullivan and seconded by Deputy Kathleen Lynch. I would not have a problem with the amendment if it were more inclusive. In other words, it does not make sense to hear just one side of the story. If we are going to hear the HSE, we should also hear the IMO, patient representative groups and IMPACT. Primarily, I wish to hear from the patients.

I will not spend long on this because everybody has said what needs to be said. Like many things in the HSE, it sounds like a great idea to centralise everything, generate efficiencies and have a standard across the country. Why are so many medical cards issued in places such as Donegal as opposed to Dublin? The last time I looked, the percentage of the population in Donegal that was covered was 49%, so there are issues. However, the problem is that the implementation has become something of a disaster, and everybody in this room acknowledges that. Patients are having tremendous difficulty. One would imagine that people in Dublin would suffer the least but I know that many patients went to Finglas to have it out with the HSE as to why their card stated they were entitled to treatment but when they visited their general practitioner, they found out they were not. Such was the volume of people going there that the nice people in the PCRS or whatever they call themselves put a security man on the door to stop the nice ladies getting in.

They are over 70 now, beyond being ladies.

There are some nice ladies over 70.

Yes, but I am just making the point.

Perhaps they met them on Kildare Street a year or so ago.

We will have no talk of a seditious nature. The point is that people are extremely frustrated. Even those who are within striking distance geographically of where the problem is in Finglas cannot get in to sort out their problems. Every politician knows this is a mess. Again, it is the way it was implemented. It clearly must stop until such time as whatever went wrong is fixed. I do not have a problem with the concept of centralisation and more efficiency, although I subscribe to Deputy Connaughton's comment that one can have local information and a local person who understands people's situations. It is nonsensical. As Deputy Jan O'Sullivan said, people believe that if they have their medical card, they keep it and do not need to do anything after a review. However, the contrary is the case. If the HSE writes to a person and does not get a response, it considers that person as passed on and strikes them off.

I will not labour the point, but if the system worked properly, politicians would not require any access or have to get involved. They should not have to get involved. It only drives this idea in life that it is not what one knows but who one knows. There would not be any of that if there was a transparent, centralised system that worked as opposed to what is being provided at present. We have a wonderful opportunity if we accept this motion or the Fianna Fáil motion if it is more inclusive. We must include the other people. It does not make sense to hear only one side of the story. We can then make up our minds about it.

I subscribe to the Fianna Fáil motion but I was not an originator of the motion. I would have no difficulty in embracing what has been suggested.

When the idea of centralising medical card provision was first suggested, I did not support it. The local system has worked very well in terms of access for the clients as well as access to me as a public representative. I had a very effective arrangement whereby I could contact the local health office and get access to information. When Professor Drumm answered a question on this at the last meeting, he highlighted the fact that there was a backlog of 6,000 medical cards in the local offices when centralisation took over. That might be the case but it is a couple of hundred in every county. However, while there was a backlog and improvements needed to be made in the local office, at least one could get access to information on the medical cards that were tied up. Even if it was a case that dealing with them could take up to four weeks, I could communicate with the office and, more importantly, I could report back to the constituent who was waiting on the card.

The other aspect of the system was the involvement of the community welfare officer. I accept that it did not work in every county but it did in County Mayo. Under the system in County Mayo the community welfare officer would make a recommendation with the application that went to the health office. That did not apply in some counties. When I discussed it with the Minister, Deputy Mary Harney, I discovered it was not uniform practice throughout the country. However, in Mayo it was fantastic. Somebody who was familiar with the income of the individuals and had already carried out the assessment was in a position to make that recommendation. It streamlined the process. It was also another avenue for me, as a public representative, to represent my clients by contacting the community welfare officer in connection with it.

The third aspect was the discretionary card. We talk about a transparent system. If it is a straightforward matter of the income guidelines being in place, one can get a robot to do the job. One puts a formula into a machine, clicks a button and somebody either does or does not qualify. However, I considered the option of a discretionary card to be very beneficial, be it on severe medical grounds, very large families or a number of children with medical conditions.

There is also the case of somebody who falls sick half way through a year.

Correct. Whatever the scenario, there was an element of discretion. I do not believe it is possible to operate a discretionary card system through a centralised system.

Deputy Connaughton made a very good point. It is nice to be able to agree with members of the Opposition. I have no problem with issuing the card centrally as long as the decision is made locally. If the local office staff do all the leg work and put the information into a computer ordering that a card be issued, I have no difficulty with that.

I thought the Deputy and I would never agree on anything.

One never knows. That issue is very important. I support the Fianna Fáil motion and feel very strongly about this. I have spoken to the employees of the local health office; I am their representative. I have also spoken to huge numbers of patients and I raised the matter with Professor Drumm on the previous occasion. I am the patients' representative. Equally, I represent the general practitioners in my constituency. To be honest, I do not believe any body or organisation is more equipped to represent the views on medical card issues than a Deputy because we are very much part and parcel of the mechanism in that regard within our constituencies. It was obvious when we met Professor Drumm on the previous occasion. A member of the Opposition articulated very strongly the points relating to her constituents.

This is not a political issue but an operational issue. We can nail that very strongly with the representatives of the HSE. We do not need to invite the general practitioners, IMPACT or individual patients. Where does one draw the line with that? We can do that job extremely well and it was done very well at the previous meeting. I therefore endorse the Fianna Fáil motion.

Deputy Flynn has said most of what I wished to say. I believe very strongly that the granting of a medical card should be based on medical need at the time, especially in the case of discretionary cards. Yesterday, we heard from representatives of the Irish Motor Neurone Disease Association. When one hears their stories, knows what is facing them and yet they do not qualify for or are refused a medical card, there is something wrong. It is also totally unacceptable that anybody, be they a politician, public or private citizen, would be expected to wait at the other end of a telephone line for 25 minutes. It is an absolute disgrace. If one takes the time to make a call, the least one should expect is that there is somebody at the other end of the line to answer the call.

I also take issue on the matter of parliamentary questions. Members have sent in questions about medical cards, social welfare issues and so forth, although that is a matter for another day. If it is one's job to answer the telephone, speak to the person at the other end, find out the difficulty and try to help the person but one is not doing that as a result of an industrial dispute, one is not doing one's job. I have a huge issue with that because we are getting it right, left and centre from everybody, especially on medical cards. There must be a system to track and trace whereby when people make a telephone call, they will get an answer and find out where their medical card application is in the system. We have always had such a system locally. As Deputy Flynn explained, we could telephone and get the information. It might not be as immediate as one would like but at least——

It might not be positive either.

Indeed, but at least one could report back to the constituent. However, this business of ringing people to report that one has tried the office three times in one day and spent 20 minutes each time trying to get an answer is not satisfactory. I agree we must invite representatives of the HSE to appear before the committee. We have all said what the general practitioners, the workers and the patients will say. We do not need to reinvent the wheel on this. We just need answers. We need a system that will work to ensure patients get the service they deserve.

I do not want to repeat anything that has already been said. The worst scenario we come across is when a problem arises but it is not sorted out. The person may not get a medical card and thinks he or she is being refused. There are people who do not understand the system and feel they have been refused a medical card when they are perfectly entitled to it. The people who come to us are doing something about it. I worry about the ones who either do not contact Finglas or do not even know where Finglas is. They do not know what is happening and do not relate to a public representative helping them out. Those people constitute the biggest worry and have the biggest loss.

Community welfare officers know what it is like on the ground; they know families who are in difficulty for reasons other than lacking a medical card. People approach community welfare officers for other things and those officers can make a decision based on more facts than just an application form. They have much more information in their heads — and have feelings concerning the families and individuals with whom they have to deal — than one would get on an application form going in to Finglas. It is a serious issue and I fully support the motion.

I apologise for being late, but I was tied up with something else. It seems to me that we are all singing from the one hymn sheet. When one boils it down and listens to the various speakers, we are all saying the same thing. As a Senator, I have been contacted by umpteen people in this regard. It is the one area in which I feel I am targeted as much as Deputies are because it is such a sensitive matter. Would this committee not be in a much stronger position if we had a consensus motion and were not divided on a vote? We could then meet the HSE with all guns blazing. The HSE is engaged in bringing in the operational part of it, as Deputy Flynn said, but ultimately we represent the public. I agree with Deputy Reilly on very little, but I agree with him that we should perhaps broaden this. I hear colleagues from my party saying they know the general practitioners and patients involved. Nonetheless, perhaps we should broaden it a little and have a small group of users in to let the HSE hear them at first hand. Sometimes I feel that we are only half believed when it comes to the HSE. While I will endorse the Fianna Fáil motion, we would be much stronger if we could have a consensus from today's meeting in our follow-up with the HSE.

I will not hold up the meeting because everything has been said and I agree with everything that has been said. We are looking for a service that will work. It is desirable to have a suitable wording to get that progress in place. I agree with Deputy Flynn that the decisions should be made locally. I was a local councillor before becoming a Member of the Dáil. It was better to have decisions made locally by community welfare officers and health boards. As Deputy Neville said, they knew what was happening within individual families; they were closer to them and they understood the system. It is a red-tape job in Dublin involving someone who may not know anything that is happening in Galway, Kilkenny or anywhere else.

We need to get the HSE representatives here and get a better system in place. It is ridiculous to be held up for 20 minutes on a phone, while if one rings in the afternoon there is no answer because they are on a go-slow. We need to do something about this because patients require their medical cards. We must make the system work for them by whatever way we can.

I regret that if this is to come to a vote, I will not have the opportunity to participate as I am not a full member of this committee, so I understand that I am precluded.

I cannot give a dispensation.

I appreciate that the Chairman cannot do so. That said, I take it from the original motion presented in the names of Deputies Jan O'Sullivan and Kathleen Lynch, that they are seeking a hold on further centralisation until a full review has been carried out. One would expect that such a review would include engagement with the HSE and all the other interested bodies as articulated by Deputy Reilly. I note that most Deputies have experienced significant difficulties in their dealings with Finglas or with the arrangement currently in place. Yet, if there is to be further centralisation it could add to the current difficulties. The substantive motion seeking to put a hold on further centralisation until a full review has been carried out has merit.

Deputy O'Hanlon moved the amendment and I agree with the broad thrust of everything he said. It strikes me as strange that there is any difference of opinion here at all. What Deputy O'Hanlon said broadly reflects not only my views and experience, but those of many others who have spoken. There was undoubtedly a difference between the proposer and seconder of the amendment in their respective views of the community welfare officer system heretofore. That aside, however, the substantive motion achieves the result that most Deputies wished — agreement that engagement with the HSE, Impact, the IMO, and the service-user representative groups is all part and parcel of a review pending which there should be no further centralisation. That is an eminently sensible position to take. I agree with Senator Feeney that it is preferable to have a consensus on this matter to give it greater weight. The substantive motion incorporates that and reflects much of what almost all the Deputies have stated.

If the centralisation approach is to include decision-making as well as the issuance, it is really flawed. The absence of local knowledge, engagement and accessibility will result in even more demands on us as Deputies and Senators from people seeking intervention and representation on their medical card entitlements. Where there is local access, knowledge and awareness by community welfare officers of the reality of different individuals' and families' circumstances there is less need for all of that. However vexatious these continuing requests are, if the centralisation project is to proceed, with assessment, decision and issuance being centralised — the first being the most important — we will be plagued. It will be a huge additional burden on each and every one of us because that is the logical outworking of what is involved. I strongly support the proposition put forward in the names of Deputies Jan O'Sullivan and Kathleen Lynch. If I were in a position to vote, I would support it. I strongly urge everyone to examine both these proposals because the amendment's objective is also reflected in the substantive motion. I agree that it would be preferable to arrive at a consensus, given the opportunity.

I thank everyone who participated in the discussion. I agree with Senator Feeney that if we can reach consensus, that is the appropriate way to go. Everybody understands the problem and deals with people caught up in this system on a daily basis. Senator Feeney and Deputy O'Connor indicated they would be willing to extend this beyond inviting the HSE. It was interesting that Deputies Connaughton and Flynn were in agreement that there is no problem with centralising the decision-making as long as there is a local input in terms of dealing with the public. We can all buy into that as long as it is possible to deal with the issue locally and humanely.

A medical card is very different from a passport. One is either entitled to a passport or one is not but with a medical card, there are issues in regard to one's health. One can be given a medical card on health grounds despite being above the income guidelines. That is the crux of the issue — it is not the routine ones that automatically qualify but the ones that are borderline and need a human response. That is what we are all trying to achieve. I am reluctant to push this to a vote because I would like consensus and also because we will lose the vote. That is the reality of life here.

I do not have a problem with inviting the HSE. However, I suggest we have the opportunity to give it some information in advance of the questions we want answered. If that does not happen, we will not get much of the nitty-gritty information we want from it. I also suggest we need to invite a representative of the public. If not individuals, I suggest we invite Age Action Ireland, the Senior Citizen's Parliament or a representative group of the over 70s who have already had their cards centralised. If members do not want to invite the trade unions or the IMO, we could get written submissions from them. I am trying to be as accommodating as possible but I would prefer if we invited them.

Written submissions are not a bad idea.

I strongly believe we need a group other than the HSE sitting across the table from us. We should hear the points of view of the person directly affected — the person applying for the medical card and who needs it. The HSE will listen to everything we say and it will leave this room and do exactly what it planned to do before it came in. That is no use to the people we are here to represent. It will be a disaster or an absolute shambles if we move the medical card system from the different parts of the country.

This committee will be most effective if it is united in the approach it adopts.

I agree with that.

We will stand by the amendment. The issue here is with the HSE. The IMO or Age Action Ireland cannot resolve it. The most important thing in meeting the HSE is to establish the facts, and I outlined earlier. The fact that the assessment for medical cards is dealt with differently in each area is a major concern. The fact that there is a backlog of 6,000 applications, whether 200 or 300 in every area, is a major concern. Perhaps we will be able to quickly establish where the HSE is going with this. Probably the main reason problems exist is that it must get rid of the backlog before it can set up a proper system. We need to hear its issues before we can establish whether we will meet other people. That is why we stand by the amendment.

What Deputy Jan O'Sullivan proposed is a very reasonable compromise. The HSE will come in, tell us everything is fine and dandy, that there were a few teething problems and that everything is being dealt with in the 15 days as was promised. We all know that is not true. We are not fools. What is proposed by Deputy Jan O'Sullivan is a very good compromise. The committee should not divide on this. We want to meet the administrators and the people affected. One cannot ask for more than that.

There is almost nothing between us. Could we ask the IMO or whoever else to send in written submissions? On the day the HSE comes in, we could ask Age Action Ireland to be present on the basis that it is directly involved and so that it hears what is going on.

Age Action Ireland is probably one of the most reasonable groups. It researches well and does not make claims which do not stand up. It would be a good representative group to speak on behalf of the over 70s.

That point has been made.

I caution that part of the objective was to put on hold any further centralisation. It is important not to lose sight of that. Age Action Ireland has a sector specific focus. The medical card issue is much wider than the older citizens and different criteria apply. There is automatic qualification for the over 70s. Many of those currently adding to the number seeking medical cards are young families. Age Action Ireland with all its experience, which I acknowledge and appreciate, will not be able to give a holistic representation of societal needs in this regard at this time.

The reason we suggested Age Action Ireland is that cards for the over 70s have been centralised and they have experience of how the system is working. We should welcome any written submissions from any organisation.

We have no problem with submissions but as has been said, if we invite one group, there are many others we should invite. I do not believe that is a good road to go down. First and foremost, we should establish the facts with the HSE and then decide to where we need to go. Perhaps we will not need to go anywhere. Let us establish the facts before we start to jump to conclusions. We agree with written submissions.

I am in the committee's hands.

We suggested a compromise and if it is not acceptable, I will call a vote.

Everyone is entitled to his or her opinion.


I have no problem with written submissions. I do not know what the party will decide to do. I have no problem with Age Action Ireland——

Deputy Aylward is the party.

We have not been making the decisions.

Is one person making the decision here?

I am on Deputy Aylward's side. I have no problem with Age Action Ireland being invited. I have made that very clear.

Could we suspend for three minutes so that we can have a chat among ourselves?

I am happy to suspend for two minutes.

If it gets us somewhere, that is fine.

Sitting suspended at 2.08 p.m. and resumed at 2.11 p.m.

Are we in a position to resume?

Are there any concluding remarks on these matters before we decide how to proceed?

There are. I consider we are going down a road that is coming close to a review and we have to be very strong. If we are to invite in one group, it should be one group alone, Age Action Ireland, with the HSE. I would agree to that but nothing more.

And written submissions from anyone who wants to make one.

Do we have agreement——

May I ask about the written submission clause? How is that going to operate? I would be anxious that it embrace all the users, including staff and anybody who has contacted us. I need to know how we are going to do that.

I understand the IMO has already supplied a written submission on this particular matter. I believe IMPACT has also written. I assume, from the publicity that will arise in respect of today’s meeting, it can go forward into the public arena that anybody else who wishes to make a written submission may do so.

Will we be allowed see those submissions?

I will ask the clerk to send all those submissions to the members of the committee.

It should not exclude individuals.

It does not exclude individuals.

Will this meeting be held as soon as possible?

Yes, absolutely.

Just to be clear, my motion provides that no further centralisation of the processing of medical card applications should take place until a full review has been carried out. Are we to take it that this is the actual review that we are carrying out?

No. My understanding is that we are agreeing to hear from everybody prior——

And then we will look——

——and then we will decide on whether we will conduct a review.

Was there not an understanding that the HSE, acknowledging as it did that there was a problem, would not be pressing forward? That is what I understood.

The HSE has said that all medical card applications will be centralised by the end of April.

That is just——

Considering the fact that it is unable to process the ones it has, it is unlikely that it would be able to centralise by the end of April.

Will our meeting be held as soon as possible?

Just to finalise the matter, I thank the Fianna Fáil group for reconsidering its original position. What we are supposed to do in this committee is to try to reach agreement where we can. Our position is that the centralisation should not proceed until such time as we have had a good look at this issue. I have used the term "review" in the motion. We will see how far we get with the groups who appear before the committee. I put down a marker that if we are not satisfied with what we learn at that meeting and from the written submissions that we will still propose that the centralisation should not go ahead.

As far as we are concerned the meeting with the HSE and Age Action Ireland — with the benefit of the written submissions — and Oireachtas Members is not a review, but a fact finding exercise to find the problems, the logjams and how the service can be improved for the patients. Following on from that meeting we will consider what steps we need to take.

That is fair enough. We are not going——

Which may or may not be a review.

We do not mind what it is called. We just want to get the facts.

I will deal with the formalities and then come back to Deputy O'Connor. Can I take it, therefore, that neither the amendment nor the motion is being pressed and that we are proceeding as we have agreed?

I want to make an obvious point. I would hope serious players from the HSE will appear before the committee.

Yes. We want to see the senior executives responsible for these initiatives. The clerk is advising me.

Can we have a date for the meeting?

Our formal position is that we are not proceeding with either the motion or the amendment but simply convening the meeting.

It should be stated that both the motion and the amendment were agreed.

Were both not withdrawn?

No, not withdrawn.

They have not been agreed. One has to say both are withdrawn.

I propose that these items remain on the agenda until we have had the meeting to which we have agreed and we will consider those motions then.

May I clarify that members of the committee can bring to the attention of the HSE in advance some of the issues we would like it address.

Please do.

I would certainly like to give it advance notice

The minutes or a synopsis of today's meeting would suffice. Can we consider a date for the meeting?

Just to be clear. The motions will remain on the agenda. They are withdrawn so far as today is concerned. We will return to them following the hearing we propose to have with Age Action Ireland and the HSE.

That is compromise.

May we consider a possible date?

We have a free date on 23 March. We will try for that date or earlier if at all possible, preferably earlier. St. Patrick's Day falls in the week prior to that.

It should be as soon as possible.

Can I make a suggestion?

Tuesday, 9 March will be a very busy day. If there was to be no meeting on 23 March I suggest we slot in a second meeting that week and given the importance of this issue, I do not think members would be averse to that.

Is that instead of 23 March?

If we were to have two meetings that week——

The meeting should be held as soon as possible.

Tuesday, 9 March will be a very busy day. Is there any possibility of holding the meeting on the morning of 9 March? We will be here in any event and it will be a very busy day.

The clerk will consult on the time but we will try for 9 or 10 March.

We will have no meeting on 23 March.

Okay, fine.

Will we try for a meeting on the morning of 10 March given that some people will be travelling on the Tuesday morning?

If we could get that in, it will take no longer than an hour and a half.

HSE and Age Action Ireland. Is Deputy Lynch joking?

It is possible there will be many more people here.

That will take a long time.

I think we have general agreement. Unless there is any other business to discuss the meeting will adjourn.

The joint committee adjourned at 2.20 p.m. until 2.30 p.m. on Tuesday, 9 March 2010.