Written Answers Nos. 648-660
648. Deputy Ken O'Flynn asked the Minister for Health the number of discretionary medical cards granted to persons aged over 70 following a means assessment in each of the years 2020 to 2025, inclusive; and the number of applications in that age cohort refused following discretionary assessment in each year. [13800/26]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
649. Deputy Ken O'Flynn asked the Minister for Health whether her Department has conducted any review, audit, or policy assessment since 2020 of trends in the exercise of discretion in medical card eligibility decisions affecting persons aged over 70; and if she will provide details of any such review. [13801/26]
View answer651. Deputy Ken O'Flynn asked the Minister for Health whether her Department has assessed the financial impact on older persons who are refused discretionary medical card eligibility but granted a GP Visit Card; and if she will outline any policy considerations arising from such assessment. [13803/26]
View answerI propose to take Questions Nos. 649 and 651 together.
Medical Card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account. Detailed guidelines are available at: www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/
Persons aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, it should be noted that those aged over 70 can also be assessed under the general means tested scheme where there are particularly high medical costs.
Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. In such circumstances, the HSE may exercise discretion and grant a medical card, for example:
• Discretionary medical cards issued to patients with significant medical expenses, but who do not satisfy the means test.
• Emergency medical cards are issued to patients that are terminally ill, or are seriously ill, and in urgent need of medical care that they cannot afford.
Where a person's sole income is derived from a Social Protection payment, he/she will be awarded a medical card.
Information provided by the HSE indicates that there have been increases over recent years in the number of medical cards held by persons 70 years old and over, as outlined in the table below.
Separately, since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card.
|
Year |
Number of Discretionary Cards held by 70-year olds and over |
|
1st January 2021 |
21,306 |
|
1st January 2022 |
24,692 |
|
1st January 2023 |
28,702 |
|
1st January 2024 |
32,048 |
|
1st January 2025 |
35,566 |
|
1st January 2026 |
38,509 |
Furthermore, under the 2023 GP GMS Agreement, GP visit card eligibility was expanded in 2023 to all children under 8 years of age, and to all those who earn up to the median household income. Over 400,000 additional persons, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion.
It is important to acknowledge that the administration of the medical card exists within a wider eligibility framework, and that a range of other measures have also been implemented over recent years to help increase access to and the affordability of healthcare services, for example:
• under the Long-Term Illness Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
• under the Drugs Payment Scheme (DPS) no individual pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
• Public in-patient charges in public hospitals have been abolished.
• Individuals may also be entitled to claim tax relief on the cost of qualifying health expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
I can assure the Deputy that, in order to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.
650. Deputy Ken O'Flynn asked the Minister for Health whether national guidance or policy directives are issued by her Department to ensure consistency in the exercise of discretion under the medical card scheme; and if she will outline the governance arrangements in place to monitor consistency and equity of outcomes for older persons. [13802/26]
View answerUnder the Health Act 1970, eligibility for a medical card is based primarily on means. The Act obliges the HSE to assess whether a person is unable, without undue hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure. In doing this, the HSE assesses each medical card application on a qualifying financial threshold. However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.
Where a person's sole income is derived from a Social Protection payment, he/she will be awarded a medical card.
In response to the query raised by the Deputy, the HSE National Medical Card Unit process medical card applications, and my Department has not issued any recent specific guidance or circulars to the HSE regarding the exercise of discretion as part of the medical card assessment process.
As part of the question is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
652. Deputy David Cullinane asked the Minister for Health when she will consider and publish the review of the physician assistant or associate role in the health service; if she will sanction the grade and role; the steps she is taking to ensure robust governance; the steps she is taking to ensure that other professions which could or do perform some of the roles proposed for physician associates are supported to practice at the top of their licence in order to provide a clear niche for this role, if it is deemed necessary; the steps she is taking to engage with professional groups on the matter; and if she will make a statement on the matter. [13804/26]
View answer676. Deputy Pádraig Rice asked the Minister for Health further to Parliamentary Question No. 359 of 11 February 2026, to confirm that she has received the HSE’s report into the physician associate grade; if she will publish this report; the timeline for same; and if she will make a statement on the matter. [13939/26]
View answerI propose to take Questions Nos. 652 and 676 together.
Physician Assistants are dependent practitioners with generalist training through a medical model. They can support physicians and surgeons in the management of patients, with supervision and appropriate delegation.
As committed in the 2025 National Service Plan, the HSE commissioned an independent review of the Physician Assistant role with the aim of making recommendations regarding the governance of the role, scope of practice, and appropriate and safe deployment in Ireland. The HSE paused the recruitment of Physician Assistants pending the outcome of the review. The report is now complete and I have received it. On the basis of the report, I have requested the HSE to prepare an implementation plan for the end of February 2026. The HSE expects to be in a position to publish the report following submission of the implementation plan to the Department of Health. I expect that patient safety in service delivery be prioritised in relation to any HSE workforce roles, including Physician Assistant. My officials and I continue to engage with colleagues in the HSE on the Physician Assistant role in Ireland.
653. Deputy Ken O'Flynn asked the Minister for Health the total number of whole-time equivalent GPs practising in the State in each year from 2020 to 2025; the estimated population per GP ratio in each year; and whether demographic change, including inward migration, is factored into primary care workforce planning models. [13869/26]
View answerThe Government is committed to ensuring adequate staffing across our health service. A comprehensive approach to health and social care workforce planning is required to ensure that staffing levels keep pace with population and demographic changes, along with policy objectives.
Ireland’s Future Health and Social Care Workforce paper from December 2025 sets out an evidence-based strategic direction for the health and social care workforce for the next 15 years. It focuses on the long-term demand and supply of health and social care workers out to 2040. It covers the entire health and social care sector, including GPs. The demand modelling used considers demographic changes, including inward migration.
The ESRI report on future GP capacity requirements provided a welcome contribution to our general practice workforce planning. The report shows that as our population grows and ages over the next 15 years, and as we continue to provide more services in the community, we need to continue to increase our general practice workforce to meet the resulting additional demand for general practice consultations.
The recent Irish Government Economic and Evaluation Service (IGEES) technical note ‘Supply and Demand of General Practice in Ireland’, examined factors associated with the supply and demand of GPs with particular reference to the geographic dimensions of these issues. This includes how population growth in certain regions may impact on GP capacity constraints.
Regarding the number of GPs practising in the state and the estimated population per GP ratio for the years 2020-2025, as this is a service matter, I have asked the HSE to reply to the Deputy directly as soon as possible.
654. Deputy Ken O'Flynn asked the Minister for Health the total amount of funding allocated in 2025 and to date in 2026 to commission external private providers under Service Level Agreements or Grant Aid Agreements for the provision of primary care level child and adolescent psychological interventions in HSE South West; and the breakdown of that funding by provider and agreement type. [13870/26]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
655. Deputy Ken O'Flynn asked the Minister for Health the number of children and adolescents referred to external commissioned providers under Service Level Agreements or Grant Aid Agreements in HSE South West in 2025 and to date in 2026; the average cost per intervention episode; and the average number of sessions delivered per child. [13871/26]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
656. Deputy Ken O'Flynn asked the Minister for Health the impact of the commissioning of external psychological service providers in HSE South West on primary care child psychology waiting lists; the reduction achieved in average waiting time in months; and the performance metrics used by the HSE to evaluate value for money and clinical outcomes under these agreements. [13872/26]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
657. Deputy Ken O'Flynn asked the Minister for Health whether it is Government policy to continue the commissioning of external private providers for primary care level child and adolescent psychological interventions beyond 2025; and how this commissioning model aligns with national workforce planning for publicly employed psychologists. [13873/26]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
658. Deputy Ken O'Flynn asked the Minister for Health whether all Service Level Agreements and Grant Aid Agreements entered into in 2025 in HSE South West for the provision of primary care child psychology services are subject to formal clinical audit; and if so, the dates of audits conducted and whether any compliance or performance issues were identified. [13874/26]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy as soon as possible.
