Last June, in the aftermath of the local elections, the Irish Cancer Society and other advocacy groups were invited to a meeting with then Health Minister James Reilly and senior officials, to be told of the Government’s new approach to medical cards.
Our concern in particular was for the cancer patients who were being denied a discretionary medical card, who were in the late stages of their illness and whose cards were being “reviewed”, and those who simply could not get a medical card.
For these patients, it was inexcusable that they would have to suffer the stress of worrying if they could pay for vital cancer treatment, as well as the many extra costs that go with being treated for cancer.
We were given a reassurance that those who had had their discretionary cards removed would get them back and that the “review” of cards which had caused so much difficulty, was now over.
That was all positive news. But what I remember particularly about that day was being told that there had been a “quantum leap in policy terms” on medical cards, and that medical and clinical need would now be included alongside financial need as a basis on which a medical card, including a discretionary card, would be awarded.
One senior official said “we want to focus on need rather than bank accounts”.
Hence the establishment of an expert panel, appointed to advise the Government on the list of medical conditions which would qualify an person for a medical card. We made a strong case for cancer to be included on that list.
But the Expert Panel have come back and said it cannot be done, or, rather, should not be done.
“It would not be feasible, desirable nor ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility,” they concluded.
Instead, Minister for Health Leo Varadkar (left) has now announced that the HSE is taking ten actions to improve the operation of the medical card system, particularly for people with medical needs.
One of the actions, however, will be the appointment of a clinical advisory group “to develop guidance on assessing applications involving significant medical conditions”.
What is the difference between this “guidance” and compiling a list of conditions serious enough to qualify for a medical card if a patient is over the income limit?
In practice, we suspect, very little.
Some of the ten actions are welcome, such as the decision not to review cards when a person has a terminal illness and a simplified application process, but taken together they do not change the fundamental basis on which a medical card is awarded.
Unfortunately this basis remains the bank account rather than medical or clinical need.
The only way to change this is by amending the Health Act of 1970 to give medical need the same priority as a person’s financial means.
Our concern now is for those cancer patients we heard from back in May and June who, having lost their medical card, were not sure if they could afford the prescription drugs which were part of their treatment.
Or a cancer patient on her fourth round of treatment who has given up applying for a discretionary card because it just proved too much for her.
We are asking her to apply again. Her illness is certainly serious. She has secondary breast cancer. Her application will let us know if anything has really changed.
We agree that the long term solution to the problem is universal free primary care.
Ireland is an exception in Europe in not having this available but it looks like it will be a long time before all our citizens get this. So we will continue to campaign for an amendment to the Health Act.
In the meantime, we don’t believe the ten actions announced yesterday are the “quantum leap” we heard about in June.
This is more like putting a new dressing on a long-standing wound. It’s a nice fresh dressing, but clearly surgery is necessary.
Kathleen O’Meara is Head of Advocacy at the Irish Cancer Society