In recent months, thousands of people have received letters from the HSE initiating reviews of their medical card entitlements and, in many instances, removing their medical cards. This has caused huge anxiety, grief and concern throughout the country. Many of these people are elderly and in receipt of medical cards. Nowhere is this more cruelly felt than in the persistent underhand campaign to reduce the number of discretionary medical cards. In essence, a discretionary medical card is for people who are over the income limit but have a chronic long-term illness necessitating high medication costs and visits to doctors.

I will give the Taoiseach an example. Yesterday, a 68 year old gentleman called to see me. He had received such a letter taking the card off him. The card's expiry date was 2021. This person has a very complex medical history with multiple issues necessitating high medication and so on. He has been out of work since 1985 because of his medical condition but the card was taken off him, which shows the campaign that is under way.

The grief and concern felt by people was added to by the Minister for Health last week when he confirmed that cancer patients are no longer entitled to a discretionary medical card unless they are terminally ill. I read a response to the Minister in a blog from a cancer survivor yesterday.

Does the Deputy have a question?

The level of outrage and anger articulated in that blog is something he should read because the phrase "not such a bad diagnosis at all" was adding insult to injury and is something that people with or who have come through cancer cannot comprehend. The person talks about the financial hellhole that the condition entailed involving numerous medications and visits to doctors. Many survivors and many people with cancer are very angry. They see this medical card as the saving grace and lifeline during such a condition. Could the Taoiseach get the Minister to apologise and withdraw those remarks? More importantly, will he reverse the policy of not facilitating people with cancer with discretionary medical cards and stop the policy of reducing the number of discretionary medical cards held by people with long-term chronic illnesses? In recent years the number has been reduced by 21,000. A campaign is under way and I call on the Taoiseach to stop it and reverse it.

The medical card has always been an important element of this country's society. When they were operated by the various health boards through clinics throughout the country there was a more personal connection with those who applied for them and it was always possible to explain directly what an individual's circumstances might be. At present more medical cards are issued than ever before.

There is more need.

Deputy Martin raised an issue about discretionary medical cards which, according to newspaper reports, have been reduced by 20,000 in recent years. He called on the Minister to apologise in respect of a particular case. I do not have the details of this case and I invite the Deputy to send them to me and I will have the Minister examine it.

When a person gets the results of a series of tests which show a major complication or ailment it is always a huge shock. The discretionary medical card was available for particular purposes. I do not have the details of the case Deputy Martin mentioned-----

It is not a case; it is a policy change regarding cancer.

-----but if the person has been unemployed since 1985 and has multiple issues, with other complications as well as cancer, and a card issued to the person involved until 2021 has now been withdrawn, there is a reason for somebody making this decision and we need to find this out. I have no doubt about the veracity of the case mentioned by the Deputy, and if the person has been out of work since 1985 because of medical complications, and has cancer and multiple issues which make life very challenging, I do not see why a decision was made to suddenly alter a previous decision made in good faith to issue the person with a medical card until 2021 when it would be reviewed. Medical cards have always been reviewed on an annual or biannual basis. Sometimes people moved away or passed on, and sometimes an ailment cleared up or the complication was such a medical card might never be required again but discretionary cards are a particular type of card and are issued to people with particular problems.

The Minister, Deputy Reilly, is as concerned as anybody else that those who deserve cards should have them. I do not suggest the person mentioned by Deputy Martin should not have a card but we will investigate this case and I would like to see the results of the inquiry myself.

The Minister, Deputy Reilly, stated cancer can range from a desperate diagnosis to not such a bad diagnosis. He confirmed it is now Government policy not to issue medical cards to cancer patients unless they are terminally ill. This is the point I made. It is this statement which has caused such outrage and anger.

I read extracts from the blog I referred to yesterday. The person who wrote it stated her not such a bad diagnosis brought her to her knees in ways one could only know if one had been handed one. She stated the medical card was the one saving grace in her life and still is. She details the doctors, pills and antibiotics and describes how it was such a financial hell. She was not terminally ill and is 14 months clear of cancer.

The Minister and HSE have stated one will only receive a discretionary medical card if one is terminally ill with cancer and any other cancer diagnosis no longer qualifies. The discretionary medical card was available for people with cancer and other life-threatening illnesses and for those who did not have cancer but who had long-term chronic illnesses. The reason was the necessity for frequent visits to doctors and dependence on a significant amount of medication.

Will the Taoiseach reverse this policy on cancer and discretionary medical cards and stop the ongoing underhand campaign to reduce the number of discretionary medical cards being issued, which was signalled in the budget when the eligibility thresholds were raised and it was stated 20,000 cards would be taken out of the system this year? It was under the radar and buried in the detailed documentation of the budget. People are now beginning to see it with letters coming in the door taking medical cards from them. This is the reality of life on the ground in terms of discretionary medical cards and I ask the Taoiseach to reverse this policy.

There is not a household in the country which has not been affected by cancer, including mine, and everybody understands the gravity and shock which comes with the dreaded word being diagnosed, but it is true to say medical science has advanced to a great degree in the past 30 years and many of the initial diagnoses of cancer are treatable and are dealt with and people move on to live very normal lives for a very long time. In other words, their cancers get cured, although clearly not in all cases.

It is costly.

It has a financial dimension.

Professor Kerin and the researchers involved in breast cancer research in Galway do enormous work. I spoke to somebody whose wife went through this quite recently who told me he would never again question the necessity of having centres of excellence, because his wife received such wonderful treatment and is now deemed to be clear.

I accept the treatment is much better.

This is wonderful and is an advance of medical science.

A total of 43% of the population now have medical cards and last year the number of people covered was 1.854 million. This year we want the figure to reach 1.9 million people.

I am speaking about discretionary medical cards.

The number of medical cards is increasing-----

It is because of unemployment.

-----and so is the cost.

Nobody would disagree with the gravity of the situation which arises when cancer, leukaemia or motor neurone disease is diagnosed.

Will the Taoiseach re-examine it?

Most people in the House have friends and family involved. The principle which underscores medical cards, as the Deputy knows because he was in the Department previously-----

It has changed.

-----under the Health Act 1970 is to provide comprehensive free medical care to anybody who cannot without hardship afford it. The decision taken allows for a case-by-case analysis of whatever the consequence of diagnosis might be. I will see to it the Minister examines the case mentioned by the Deputy-----

I am not speaking about a case.

We all know such cases.

I am speaking about the policy on cancer patients and medical cards.

We are over time.

The policy is to cover 1.9 million people in the country with medical cards this year.

I asked about the policy regarding cancer patients and discretionary medical cards.

This number is rising-----

The Minister made a statement last week-----

Please stop interrupting.

All I want is an answer to the question I asked.

This is not Question Time.

It is not true, as I understand it, to state the Minister or the HSE stated one will not receive a medical card unless one has terminal cancer. The Minister disagrees with this and is clear he did not state this.

What did he say?

The Health Act 1970 sets out the general principle of which Deputy Martin is well aware-----

Will the Taoiseach confirm the policy is not what the Minister stated last week?

-----which is that a person is entitled to comprehensive free medical care in the medical card system in situations where, by virtue of hardship or financial difficulties, he or she cannot meet the costs.

I ask Deputies to respect the Chair. We are four minutes over time on this question.

It is not true that because somebody gets cancer suddenly the Minister states one will get a medical card only if it is terminal. I will have the case followed up.

I ask Members please to stick to the time limits or arrange through the Whips to extend them. Do not ask me to run the Chamber on the basis of limits when Members do not adhere to them.