Dublin: 30,000 People Lost Medical Cards Due To An 'Unintended Consequence Of Centralisation' ?

By Mary Regan, Political Editor ( Irish Examiner)

AN "unintended consequence" was the phrase used repeatedly yesterday to explain why thousands of terminally ill patients or children with profound disabilities have been losing their discretionary medical cards at an accelerating pace over the past few years.

It was, we are told, completely unplanned, an accidental result and unforeseen outcome of a decision to centralise the medical card processing system into one single office for the whole country

And, once the Government realised what was happening, with horrific cases of seriously sick and vulnerable children appearing in this and other newspapers, it acted to stop it.

Announcing that cards would be returned to 15,000 people who had lost them since July 2011, Health Minister James Reilly said: “The unforeseen consequence of the implementation of the centralisation has caused such difficulties for people that we wanted to correct that in an urgent fashion and that’s why we have taken this course of action.”

The Taoiseach told the Dáil: “The decision to centralise the system and to have quality of examination, resulted in many families being severely inconvenienced.”

He said: “I am very sorry that many of the cases that were brought to light on foot of the examination of discretion caused a great deal of stress to people.”

The Government is right that it recognised a problem and went about fixing it, and that is a good result for people who have suffered for months of worry.

But the problem with the narrative it presented yesterday is that it ignores the reality that they were extremely slow to act, and that the removal of cards was, based on the evidence, a policy decision rather than an accident.

It also fails to address why the coalition, despite being made aware of the “unforeseen consequences” being suffered by families throughout last summer and autumn, proceeded to include €113m in medical card cuts through a “probity” exercise in last October’s budget.

The centralisation process that resulted in reviews over the past few years was introduced by the Fianna Fáil government in July 2011.

At that time, there were around 80,000 discretionary medical cards in circulation. Now there are about 50,000. So, were the 30,000 or so that have been lost in that period merely an unintended consequence of centralisation?

The HSE service plan for 2013 — signed off on by Health Minister James Reilly at the start of that year — said “policy changes” would result in a reduction of 40,000 cards, suggesting a clampdown was an agreed policy.

About 20,000 people aged over 70 were to lose their cards last year through eligibility changes, leaving a further 20,000 card holders in the younger age groups who would lose the benefit.

In May 2013, Alex White, the junior health minister, told the Dáil “the rules on a person’s expenses that are taken into account in calculating their net income for medical card purposes would be tightened”.

He said the changes meant that “payments on a home improvement loan and a €50 per week allowance for a car are excluded from the standard means test assessment”.

At the start of 2013 there were 63,126 discretionary medical cards in circulation. The HSE’s monthly management report for August 2013 described a “target year-to-date” to have 55,000 discretionary medical cards in circulation — a target that was being met.

At the end of 2013, there were around 50,000 discretionary cards in circulation, as planned in the HSE service plan for that year.

The number rose for the first time in April 2014, leading to suggestions that there was some political interference in the process in the month before the local and European elections.

A question now for the Government is why it took so long to act on the issue, and why the coalition was in such denial about the problem which was allowed to develop into one of its biggest crises in office.

Dr Reilly said yesterday the coalition had taken steps to “address the unintended consequence as speedily as possible”.

It is hard to see how they acted quickly when a range of cases highlighted on the front page of this newspaper in October were not addressed.

The Government said yesterday it could not “stand over” cases of people with acute medical conditions or disabilities losing this vital assistance. But that is precisely what they did for at least a year when patient groups and individuals highlighted the many unintended consequences.

And that is what the Taoiseach did throughout his continued insistence in the Dáil that there was no policy of removing cards.

In one contribution last October he accused opposition politicians of “scare-mongering” over the issue. On another, he accepted there were some “exceptional cases where, because of a lack of information or whatever, they have been refused”.

The Government has also failed to address why and on what basis it proceeded with a probity exercise in October’s budget. If it is truthful in saying it was “unintended” that people who needed their cards would lose them, then what precisely was intended in the €113m in savings pencilled into the budget arithmetic?

Minister Alex White said on Monday that it was a mistake to include this measure in the budget. On the controversy this was to cause, he said the Government “didn’t pick up on it”.

That appears to be what was at the heart of the medical card crisis: A year-long detachment by the Government from the consequences of its actions.

And unless it can now be truthful about its own policy decisions and face up to its own inaction and consistent denial, then its hard to see what lessons can be learnt.