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Other Questions - Medical Cards

Tuesday, 27 March 2012

Dáil Éireann Debate
Vol. 760 No. 3

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 8.  Deputy Barry Cowen Information on Barry Cowen Zoom on Barry Cowen  asked the Minister for Health Information on James Reilly Zoom on James Reilly  the average waiting time for medical cards in January 2012; the average waiting time in January 2011; and if he will make a statement on the matter. [16467/12]

 11.  Deputy Bernard J. Durkan Information on Bernard Durkan Zoom on Bernard Durkan  asked the Minister for Health Information on James Reilly Zoom on James Reilly  when it is likely that provisions can be put in place to address the difficulty and hardship being caused by delays in the issue of medical cards; if any evaluation has been carried out as to the main factors causing such delays; the number of applications in the system currently pending and in respect of which repeated submissions of information have been made by the applicant which in turn has resulted in further requests for more information; if as a matter of urgency he will put in place a reliable and universal system for the determination of eligibility and a reduction in the administrative procedures now causing serious delays; and if he will make a statement on the matter. [16249/12]

Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall I propose to take Questions Nos. 8 and 11 together.

A number of difficulties arose with the processing of medical cards in the final quarter of last year. These difficulties gave rise to a very large backlog and long delays for both new applicants and medical card renewals. A separate significant backlog also arose in respect of medical card appeals.

Reviews of the problems have identified a number of factors as to how these problems arose, including the decision by the HSE to fully centralise the processing of medical cards before the centralised service was fully resourced, a significant backlog that already existed prior to centralisation, poor communication with medical card applicants and the public, limited support from local health offices and poor communication between local offices and the centralised service and poor administrative and customer service practices and procedures in the handling, filing and processing of medical card documentation.

These issues are a matter of serious concern to me and I have had a number of meetings with the HSE over the past number of months to raise my concerns. The HSE has introduced a number of changes in recent months to the administration of the medical card application system.

These include increased staffing levels in the centralised processing service and in respect of medical card appeals, improvements to how medical card renewals are assessed and the frequency with which they are assessed, increased flexibility for GPs to add certain categories of patients to their GMS lists, and the fast-tracking of backlogged cases and cases where documentation has been misfiled. A number of additional changes will be implemented by the HSE in the coming months. I am particularly keen to see changes to how medical card renewals in respect of people with permanent disability are assessed. I am in discussions with the HSE on this and other matters and expect changes to be implemented soon.

[607]While a number of customer service and communication issues remain to be addressed, the HSE has nevertheless been making good progress in eliminating the backlog and preventing further backlogs occurring. The HSE has reported to me that 96% of completed applications received in late February and early March have been processed within 15 days, compared to a turnaround target of 90% in its service plan for this year. The HSE has also reported to me that the backlog in processing applications from last year has been reduced by 77% since January. As of yesterday evening, the backlog in respect of medical card applications and renewals had been further reduced to 10,770, down from 58,000 in January, and in the vast majority of these cases, additional information is awaited from the applicant. The backlog in respect of medical card appeals has been reduced to 569, or less than half of what it was in January. The HSE is on course to clear both backlogs by the end of the month.

Average waiting times are not collated because the performance metric used by the HSE is the 15-day turnaround time for complete applications. I have reported the latest information for that measure. For January 2012, more than 47,000 new and renewal applications were received. As of 21 March, 3,700 applications were incomplete and the HSE is assisting people with their applications. Some 42,600 applications have been completed, and 1,000 other applications are in the process of being completed by the PCRS.

Additional information not given on the floor of the House.

Figures for January 2011 are not available to PCRS as the centralisation programme was only completed on 1 July 2011. Prior to that date local health offices were responsible for processing medical card applications. Finally, a review of medical card processing has been undertaken by PricewaterhouseCoopers on behalf of the HSE and contains a number of recommendations that the HSE is considering.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher Can the Minister of State assure the House that some of the delays were not intentional in terms of trying to address budgetary problems in place in the HSE? Many people are of the belief that medical card renewals were being delayed for a long time to ensure they could come in within budget. When we consider how fast they have been able to address the backlog in January and February of this year it would lead one to believe there was a deliberate winding down of assessment, processing and renewal of medical cards. We have had several cases where people waiting for a renewal of their medical card had to fund their own medical needs in the intervening period. Will those people be fully recompensed for the cost incurred while they were waiting for the renewal in 2011?

In terms of communications, every Deputy in the House has been raising this issue for a long time and I acknowledge the efforts being made by the Department and the HSE but when Deputies raise these issues on a continual basis the HSE should respond with haste in trying to address them because there are still terrible cases across the country, not just those I have raised.

With regard to the 15 day turnaround for completed forms, the main problem is that it takes too long for the applicants to be informed that their application is not complete. That area must be addressed. The form should be assessed and the applicant informed quickly of the required information needed to make the application form complete.

Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall I assure the Deputy that under no circumstances was any direction given or intentional decision taken to slow down the issuing of medical cards. I want to rule that out because allegations were made at the end of last year that somehow this was an intentional policy to reduce the number of medical cards. I refute that.

[608]In terms of what I stated in my reply, it would seem at this point that there is an acceptance that the HSE bit off more than it could chew in the overnight centralisation of medical cards in the middle of last year without the system being geared up to cope with that. That all came to a head at the end of last year and resulted in a situation which I have said on a number of occasions in this House was unacceptable as a public service. People were treated very badly during that period when this backlog had built up and the level of service being provided to people was unacceptable. A great deal of effort has been made in recent months to get on top of this problem and I am hopeful that all the backlogs will be cleared by the end of April and that this situation will not recur. I take the opportunity to state there was no intentional decision taken in this regard and the situation is being addressed rapidly.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin I welcome the indication that there is improved processing in terms of the Finglas operation. I welcome once again, as was advised to us on our recent visit to Finglas when we met Mr. Patrick Burke and his staff, that the powers have now been given to general practitioners to extend medical cards beyond the expiry date where, for whatever reason, the person concerned was unable to respond to the review process because of a medical condition or social circumstances and where there was a clear error that the doctor can confirm. Are there any statistics on the take-up of that? I know that correspondence only issued a few days before our recent visit to Finglas at the end of last month but is there any indication even at this point in time of the take-up by general practitioners of this option? Has the Minister any feedback from the profession?

May I use the opportunity to ask if serious consideration is being given to extend that power to general practitioners in the cases of people who are terminally ill and those suffering from lifelong, non-recoverable illnesses because this continual review process is very frustrating when somebody is sadly trapped in a situation that will not change for whatever life expectancy they may have. It can be very upsetting, and we have all had experiences of that. It would be a huge advance if that, too, could be granted to general practitioners and the need for a review every so often for people in end of life situations and those suffering from lifelong illnesses.

Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall The agreement recently reached with GPs in terms of the processing of medical cards is a very welcome one and it enables a number of actions to be done. The first is to extend a person’s eligibility in the case of vulnerable patients where they may not be in a position to do that themselves. The second is in regard to patients who are deceased. Their names are being removed from the panel from the date of date. The names of newborn babies are being added now by GPs from the date of birth. That is real progress. It is a new functionality for GPs and is very much to be welcomed.

Regarding terminally ill patients, there is a new arrangement that has been clarified. In the case of a person with a terminal illness, where that terminal illness is validated by a GP or a consultant, there is a nominated person in the local health office who has a direct line to the primary care reimbursement service, PCRS, and where that person is contacted an emergency medical card can be provided within a 24 hour period. I am in the process of producing an information sheet to go out to Members of this House to inform them of that new arrangement and I am waiting for confirmation that all of the staff concerned are aware of these arrangements but I can confirm that all GPs and all social workers are aware of that new arrangement. I hope that will work smoothly from now on.

Regarding incomplete forms, most of the current backlog relates to incomplete forms and to get those on the move staff in the PCRS are contacting people directly by telephone to fill in [609]those blanks and get their hands on the missing documents required to process that. I am very hopeful that all of the backlog will be cleared by the end of April.

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