asked the Minister for Health if he is aware of the severe hardship caused to medical card holders who do not now qualify for certain medicines and other benefits which have been withdrawn from the medical card list and if he will make a statement on the matter.

While items excluded from availability free of charge under the general medical service are cheap and may be purchased without hardship by the majority of medical card holders, the health boards will in special circumstances arrange for their supply free of charge.

I am not aware of any case in which a medical card holder is incurring hardship due to the withdrawal of these items.

May I take it that various health boards have a certain amount of latitude in regard to the dispensing of drugs in cases of long illness?

Yes, they have very definite individual responsibility and there are 502 cases in the Deputy's health board area. Under the Health Act the CEOs can exercise discretion without reference to the Department. Each CEO has statutory power to deal with cases of hardship.

Has that been restricted in the past two years?

No. For example, the Southern Health Board between 1 January 1983 and the end of August 1983 received 500 claims of that nature which cost them £9,915. In 1983 the North Eastern Health Board received 135 claims which cost them £6,500. In the Eastern Health Board area there were 2,200 claims which cost them £44,000. All the health boards meet individual cases of need.

Have the payments board carried out a comparative analysis of the various drugs used in substitution for those removed? Is the Minister satisfied that it is still cost effective to keep many of these drugs off the prescribing list and, in particular, that more potent and expensive drugs are not being used in lieu of the drugs not available?

I know they have a great deal of information and I hope that most of it has not been destroyed by the fire in Finglas. I will ask them to produce this information on a comparative basis and I will sent it on to the Deputy.

10.

asked the Minister for Health if receipt of the family income supplement will be taken into account when assessing eligibility for a medical card.

The operation of the family income supplement scheme should not bring the income of families above the medical card guidelines except in very exceptional circumstances. If such a situation were to arise the chief executive officer of the appropriate health board would still have discretion to issue a medical card or provide a specific service without charge if he considered that undue hardship existed.

In practical terms, therefore, the family income supplement is not a factor which will affect eligibility for medical cards.

My question arises from a situation in Limerick where a medical card was withdrawn as a result of receipt of a family income supplement. Could the Minister indicate the number of cases where medical cards have been withdrawn as a result of receiving family income supplement?

I do not have the exact number but I have heard of the case concerned. Only a handful of people are affected. The possibility of that happening has been discussed with the chief executive officers of the health boards who have agreed that if such a case should arise a family's eligibility for a medical card should not be lost solely because of the family income supplement.

11.

asked the Minister for Health if he will consider making medical cards available without means test to psoriasis sufferers due to the very expensive treatment needed to control the rash.

Medical cards are issued on the basis of individual financial and medical circumstances having regard to income guidelines as prescribed from time to time. The refund of drugs scheme is available to those who do not qualify for medical cards. Under the drugs refund scheme net expenditure on drugs will not exceed IR£28 per month after reimbursement by the health board.

General practitioner services and drugs prescribed for the treatment of psoriasis which are available under the general medical service are provided free of charge to medical card holders.

Where an individual medical card patient may require items not available free of charge, application may be made on hardship grounds for assistance towards their cost from the health boards.

Would the Minister not agree that the disease referred to should be on the list of long term illnesses and that a means test should not apply in such cases? I have an individual case in mind where because of the cost of the drugs involved it is not worth the man's while to work and he would be better off drawing the dole.

The case has probably already been examined by the Southern Health Board. However, medical cards are never issued on the basis of a particular condition such as psoriasis. Any expenditure he incurs in excess of £28 a month he would be fully reimbursed for by the health board. Anything over £7 a week is refundable. I do not know the individual case, but for a married couple the amount is £90.50 from 1 January. That assumes that he would not have any other allowance in excess for travelling or for rent.

Has the Minister any plans to review the list of long term illnesses with a view to adding such conditions as psoriasis mentioned here and bronchial asthma?

There are no proposals at the moment to add on additional illnesses although there is a great deal of pressure to add particular conditions such as psoriasis and asthma. It is very difficult ——

You had better keep to psoriasis.

—— to take a decision on those.

My client must get medical treatment and the drug required is on prescription, so would the Minister not agree that it should be classed as a long term illness and that the health authority should have discretionary power to make a medical card available to such clients?

I do not think it can be on an across-the-board basis. As I said, every penny that is spent over £7 a week is fully refunded. That is the position at the moment. I have been trying to keep to that £28, a month. I do not want to increase it.

12.

asked the Minister for Health if he will consider making medical cards available without a means test to all old age pensioners; and if he will make a statement on the matter.

13.

asked the Minister for Health if he will consider making medical cards available without a means test to old age pensioners and those on retirement pension.

I propose to take Questions Nos. 12 and 13 together.

Medical cards are issued to persons who, in the opinion of the chief executive officer of the appropriate board, are unable without undue hardship to provide general practitioner services for themselves and their dependants.

Income guidelines have been adopted to assist chief executive officers of health boards in determining applications for medical cards. Special provision has been included in these guidelines for persons over 66 years of age. All non-contributory old age pensioners should qualify for a medical card in accordance with the guidelines.

Contributory old age pensioners and retirement pensioners who have no income other than their pension should also qualify for a medical card in accordance with the guidelines.

Contributory old age pensioners and retirement pensioners who have income additional to their pension, for example, from an occupational pension scheme may qualify depending on the amount of their total income.

I consider that old age pensioners generally are adequately protected by the existing guidelines especially with the inclusion of the age allowance which I introduced last year. I do not, therefore, consider that medical cards should be issued automatically to all old age pensioners irrespective of their financial circumstances.

Many contributory pensioners have been deprived of the medical card as the result of having a retirement pension. Therefore, would the Minister reconsider the position of old age pensioners and raise the ceiling to qualify for a medical card by approximately 50 per cent?

For a pensioner couple, for example, over the age of 66 the income guideline is £100.50 a week. On top of that anything paid in excess of £10 for rent is allowable. If they are paying £15 a week they will be allowed another £5. That is the guideline. It is being kept in line with inflation and, generally speaking, with an increase of 7.5 per cent this year, it is above the rate of inflation. Several Governments including the former Government considered this matter and decided that it should be related to income. The former Government decided to give medical cards from July 1982 to all persons over 66 who were in receipt of social welfare pensions including contributory pensions. That decision was reversed in October 1982. I am operating this as it was since October 1982.

The Minister stated that this decision he talks about to remove medical cards from old age pensioners was taken in October 1982. I challenge him on that. I ask him to tell the House when that decision took effect. As the Minister knows, there was a change of Government in December 1982 and up to the time of the change of Government old age pensioners were still receiving medical cards. I ask the Minister to tell us the date on which that decision took effect. Also, will the Minister instruct the health boards to accept that a person who receives a full old age pension after investigation by a social welfare officer will not have to go through a second investigation by a community welfare officer at great expense to the health board in order to receive a medical card?

The decision was taken at a Government meeting in October 1982.

That is not the question I asked.

I can send the Deputy the information.

The Minister has given the information in the House here. It was February 1983.

I can send him the text of the Government decision and the date on which it was arrived at.

No, the date of the implementation of it.

On the basis of that decision——

It was since the Minister's party came into office.

——the Estimate figures for 1983 were decided. It was in the preparation of the Estimates that the decision was taken. A general election overtook the decision, but we assured this House, as did the Fianna Fáil Party, that the Estimates for 1982 would be the Estimates for the budget of 1983 and I took it over on that basis. The decision is there——

They were still being allocated in February 1983.

14.

asked the Minister for Health if he will consider making medical cards available to all those suffering from long term illness.

Medical cards are issued to those who, in the opinion of the chief executive officer of a health board are unable to provide general practitioner services for themselves and their dependants without undue hardship. In determining eligibility chief executive officers take into account the financial and other circumstances of applicants. Those suffering from long term illnesses which give rise to substantial medical and drugs expenditure would have such cost taken into account and, indeed, viewed sympathetically by health boards. Those suffering from one of a schedule list of long term illnesses have drugs and appliances prescribed for that condition supplied free of charge. As part of their continuing review of patients' circumstances, health boards may issue a medical card rather than a long term illness book to patients suffering from one of the scheduled conditions where their financial and other circumstances would warrant this.