Vol. 244 Wednesday, No. 6 9 December 2015. DÍOSPÓIREACHTAÍ PARLAIMINTE PARLIAMENTARY DEBATES SEANAD ÉIREANN TUAIRISC OIFIGIÚIL—Neamhcheartaithe (OFFICIAL REPORT—Unrevised) Insert Date Here 09/12/2015A00100Business of Seanad 447 09/12/2015A00300Commencement Matters 448 09/12/2015A00400Medical Card Eligibility 448 09/12/2015B00400Harbours and Piers Maintenance 450 09/12/2015C00450Pension Provisions 452 09/12/2015D00500Special Educational Needs Staff 455 09/12/2015G00100Order of Business 456 09/12/2015R00100Finance Bill 2015 [Certified Money Bill]: Committee Stage 477 09/12/2015AA00100Flood Risk Assessments: Statements 496 09/12/2015CC00100Gradam an Uachtaráin Bill 2015: Second Stage ��������������������������������������������������������������������������������������������������501 09/12/2015PP00100Assisted Decision-Making (Capacity) Bill 2013: Committee Stage 515 SEANAD ÉIREANN Dé Céadaoin, 9 Nollaig 2015 Wednesday, 9 December 2015 Chuaigh an Cathaoirleach i gceannas ar 1030 am Machnamh agus Paidir. Reflection and Prayer. 09/12/2015A00100Business of Seanad 09/12/2015A00200An Cathaoirleach: I have received notice from Senator Mary Moran that, on the motion for the Commencement of the House today, she proposes to raise the following matter: The need for the Minister for Health to explain why an individual (details supplied) di- agnosed with cancer has been refused a medical card I have also received notice from Senator Averil Power of the following matter: The need for the Minister for Agriculture, Food and the Marine to ensure Howth Har- bour is dredged in order to ensure its long-term viability as a commercial fishing port, lei- sure harbour and tourist destination I have also received notice from Senator Gerard P. Craughwell of the following matter: The need for the Minister for Justice and Equality to review the preservation of pension benefits for a group of former gardaí who left the force for various reasons before 1 October 1976 having had the five years required service. I have also received notice from Senator Catherine Noone of the following matter: The need for the Minister for Education and Skills to outline the position on the provi- sion of a special needs assistant for Scoil Oilibhéir, Coolmine, Clonsilla, Dublin 15 I have also received notice from Senator Lorraine Higgins of the following matter: The need for the Minister for Jobs, Enterprise and Innovation to introduce a salary scale for workers in the child care industry to ensure that, in the interests of quality, qualifications are reflected in the salary achieved for workers. I have also received notice from Senator Colm Burke of the following matter: 447 Seanad Éireann The need for the Minister for the Environment, Community and Local Government to provide the necessary funding for Cuan Mhuire to enable it to provide accommodation for 35 homeless persons in its premises which it purchased in 2007 on Western Road, Cork city and in Farnanes, County Cork and which have remained vacant since owing to the lack of funding I regard the matters raised by Senators Mary Moran, Averil Power, Gerard P Craughwell, Catherine Noone and Lorraine Higgins as suitable for discussion I have selected the matters raised by Senators Mary Moran, Averil Power, Gerard P Craughwell and Catherine Noone and they will be taken now Senator Lorraine Higgins may give notice on another day of the mat- ter she wishes to raise I regret that I have had to rule out of order the matter raised by Senator Colm Burke on the grounds that the Minister has no official responsibility in the matter. 09/12/2015A00300Commencement Matters 09/12/2015A00400Medical Card Eligibility 09/12/2015A00500An Cathaoirleach: I welcome the Minister of State, Deputy Kathleen Lynch 09/12/2015A00600Senator Mary Moran: I thank the Minister of State for coming to the House to take this Commencement matter Once again I am raising the issue of medical cards I understand the task force has stated eligibility must be assessed on the basis of financial means, but I deal with the issue of discretionary medical cards every week People who have been diagnosed with ter- minal or very serious illnesses are coming to me They have never claimed from the State, have always paid their taxes and have children in college without a grant or any form of assistance from the State, yet when they are extremely ill, having been diagnosed with cancer, and look for support to cover their medical expenses, their applications are refused I have raised the case of one family in my area The person concerned has been diagnosed with stage 3 cancer This person applied for a medical card earlier this year and the application was refused Additional and pertinent information was submitted and the application was again refused The person concerned applied for a medical card as an individual The application was not on behalf of an additional member of the family, a spouse or anyone else, yet when the response came back, the whole family was ruled ineligible The point being made was that the applica- tion was not in respect of the family but rather the individual and that, please God, when the person recovered, that would be it The medical card was wanted for the duration of the illness alone We should be examining the issue There was a time when things were examined at a local level, when people knew the genuine cases and when they were looked at favourably It is an additional source of stress for people who have been diagnosed with terminal or very serious illnesses that a medical card is not afforded to them The circumstances as such do not matter, but it is particularly stressful for people who have worked all their lives, paid all their taxes and done everything for the State They have never claimed anything Several of the families con- cerned have pointed out to me that if they had never worked and spent their lives on the dole, they would automatically be entitled to a medical card 448 9 December 2015 Will the Minister of State re-examine the matter? Also, when medical cards are being ap- plied for, what exactly is being applied for should be examined This case did not involve an application for a family medical card The application was made on behalf of an individual, yet every time that was pointed out, a letter was received stating it was family related 09/12/2015B00100Minister of State at the Department of Health (Deputy Kathleen Lynch): I thank the Senator for raising this issue We have the details of the particular case to which she refers, but it would be inappropriate to discuss an individual’s circumstances in public in the Seanad I know that the Senator agrees with this However, I understand from the HSE that this applica- tion was unsuccessful as the means were in excess of the qualifying threshold for a medical card or GP visit card I have been advised by the HSE that additional information has been provided and that the case has been referred for a discretionary review The Senator will be aware that, in accordance with the Health Act 1970, as amended, full eligibility and a medical card are awarded to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants That is the reason the letters received by the individual refer to dependants In accordance with the Act, 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 Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines but faces difficult financial cir- cumstances such as extra costs arising from an illness The Senator is aware of the Keane report, to which she has referred on several occasions, on the expert panel on medical need for medical card eligibility, published in November 2014 A key recommendation made in the report was that a person’s means should remain the main qualifier for a medical card. That was the main issue of contention. It has been repeatedly stated one cannot issue medical cards or GP visit cards for condition-specific reasons alone. It also recommended that it is neither feasible nor desirable to list conditions in priority order for medical card eligibility The rationale behind the recommendation will be clear to the Sena- tor On foot of the report, my Department and the HSE are undertaking a suite of measures to improve the operation and administration of the medical card scheme A number of those are already in place and are having a positive impact on how the scheme operates A key element of the programme is the work of the clinical advisory group on medical card eligibility which was established by the director general of the HSE The group has been tasked with developing a framework for assessment and measurement of the burden of disease and ap- propriate operational guidelines for the medical card scheme The clinical advisory group made an interim