20 August 2009 Edition

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'Sinister' HSE plans to centralise medical card applications

IMPACT: Gerry Dolan

IMPACT: Gerry Dolan

Plans to centralise the processing of all applications for medical cards represent a “sinister HSE agenda” to save money by making it harder and slower for eligible people to obtain medical cards, according to IMPACT trade union. In a letter, which the union is sending to all local councillors and other elected representatives this week, the union also says the proposal will “cost jobs in virtually every county” as services are centralised in Dublin.
And it says local democracy would be seriously compromised by the proposal, which would increase the volume of calls to local representatives while reducing their ability to intervene to protect their constituents against mistakes or ill-informed assessments.
IMPACT, whose members recently voted to take industrial action if the HSE forces the issue, says it is taking the unprecedented step of writing to every elected public representative in the country asking them to pledge their opposition to the proposed replacement of local services with a centralised applications system, which it says will:
  • Make the application process harder, slower and less accessible to citizens
  • Dramatically reduce the system’s responsiveness to citizens, GPs and local representatives
  • Remove flexibility and safeguards from a system which now benefits from the local knowledge and assistance provided by health staff and others, and
  • Depersonalise the process, forcing vulnerable and elderly citizens to depend on email, recorded telephone messages and other ‘faceless’ technologies.

The union points to the recent centralisation of medical card applications for the over-70s, which resulted in long delays, mistakes and poor response times leaving patients and doctors frustrated and confused. “The HSE now plans to extend these arrangements to all medical card applicants. This will be a bigger and much more complex task, which is bound to cause chaos and confusion for medical card applicants,” according to IMPACT official Gerry Dolan.
He said IMPACT and the staff concerned had repeatedly offered to discuss the development of a more standardised approach to processing applications. But he claimed the HSE’s current plans would simply distance medical card eligibility decisions from local health professionals while removing local support to applicants. “IMPACT offered to participate in a genuinely inclusive examination of real improvements and better efficiencies in the current locally-based system. We believe the HSE refused this offer because it has a more sinister agenda of saving money by making it harder and slower to obtain a medical card at a time when thousands more people are becoming eligible because of the recession,” he said.
Members would resist if the HSE imposed its plan to replace the locally based service, in 32 offices across the country, with a centralised bureaucracy. “The proposed new system would remove the opportunity for input from medical card staff and other experts with local knowledge, like GPs, public health nurses and community welfare officers. Instead of dealing with a local health office, vulnerable and anxious citizens, who might need guidance on eligibility, access to services or completing forms, will have to deal with a central Dublin facility via email or telephone. This is a public service that is best rooted in the local community, with the benefit of local knowledge and expertise,” he said.
He said the earlier HSE decision to centralise new medical card applications for the over 70s, which account for just 5% of the total, had been a disaster for service users. “The service was overwhelmed with complaints about mistakes, delays and poor responses. For example, a 91 year old woman, who was entitled to a medical card, returned her card because of the threat of legal consequences on the application form, despite qualifying within the guidelines. Numerous cards have been cancelled and listed as ‘deceased’, even though the cardholders are still very much alive,” he said.

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