More than two weeks ago, I again raised with the Taoiseach the policy of consistent withdrawal of discretionary medical cards from adults and children with chronic and lifelong conditions. The Taoiseach denied this policy was in place and stated the opposite was the case. This week, my party tabled a Private Members' motion specifically on the policy of cutting back and withdrawing discretionary medical cards. Since 2011, the number of such medical cards in the system has declined from more than 80,000 to 54,000. With more than 1,000 discretionary medical cards being withdrawn per month, the number of these cards will have declined to 50,000 by the end of the year if the Government's policy continues.

Last evening, Deputies raised various cases. I received a letter at the weekend outlining the case of an eight year old child with Down's syndrome, chronic asthma, two severe skin conditions, sight difficulties and bilateral hearing loss who also needs a wide range of therapies, orthotics and so forth. This gives rise to extraordinary costs, including a significant number of medical prescriptions and, at a minimum, 15 general practitioner visits each year. The young child's discretionary medical card has been withdrawn, despite the fact that the family's means have reduced since the card was first issued in 2005. The only reason I raise this case among many others is to illustrate that there has been a consistent policy of withdrawing discretionary medical cards from people who are chronically ill.

Last evening, Deputy Kelleher raised a case involving a young child of six years with highly complex medical issues, including hospital stays and so forth, whose medical card was, incredibly, withdrawn. People do not understand how the Taoiseach and Ministers can state in the House that this is not happening. Will the Taoiseach change heart and stop this policy?

The position is that when this Government was elected discretionary medical card applications were not routinely assessed by medical personnel. On the instructions of the Minister for Health, Deputy James Reilly, a clinical panel was established to assess the processing of applications for discretionary medical cards. This allows medical professionals to have an input into granting a medical card to persons who exceed the income guidelines but face particular personal circumstances, such as an illness of one sort or another. Discretionary medical cards are awarded to people who are unable, without undue hardship, to arrange general practitioner services for themselves and their families. The number of these cards has fallen by more than 22,000 because this number of discretionary medical card holders now qualify for an ordinary medical card on the basis that they meet the income eligibility criteria. That is a fact.

It is not a fact.

Some 22,000 people who had discretionary medical cards now qualify for ordinary medical cards as they meet the income guidelines.

That is not true.

Since 2011, some 22,584 individuals who were previously recorded on the medical card register as having been eligible for a discretionary medical card are now registered as medical card holders in their own right as they meet the eligibility criteria.

The Health Service Executive can only award medical cards in accordance with the Health Act, which requires that applicants be assessed. This is the subject of the discussion on a motion tabled by Deputy Martin's party in Private Members' time. There has been no change in the manner in which discretionary medical cards are awarded.

That is unbelievable. The Taoiseach should consider what he has just said.

There is no target set in the Health Service Executive national plan to reduce the number of discretionary medical cards. I have provided the figure on the number of holders of discretionary medical cards who now have full ordinary medical cards.

The HSE produced a national assessment guideline to give a clear framework for assessing eligibility for discretionary medical cards for persons who have a particular illness or hardship because of their circumstances. These guidelines facilitate the application of discretion by decision makers in responding to the individual needs of particular applications for discretionary medical cards. The Health Act of 1970 provides that persons who are unable, without undue hardship, to arrange general practitioner services for themselves and their family qualify for a medical card.

I do not accept Deputy Martin's assertion that there has been a change in the way in which discretionary medical cards are granted. In fact, as I have pointed out, 22,584 people no longer have these cards because they now have full medical cards, having qualified in the ordinary way.

I beg the Taoiseach to listen for once to what is being said by Deputies in this Chamber and members of the public outside it. His answer is incredible and does not tally with reality.

As I stated, I received a letter at the weekend from a woman who wrote to the Taoiseach on 23 September. I will not name the person who wrote it but if the Taoiseach reads it, he will see that what I have said is the truth. He should ask Deputies where the issue of discretionary medical cards rates as a percentage of the cases they receive. This is, by any yardstick, the most common issue raised with every Deputy.

The Government continues to argue that the practice I described is not happening. The Taoiseach should read the letter dated 23 September and instruct the authorities to stop using the term "undue hardship". The woman who wrote the letter states she received a letter from the authorities indicating the withdrawal of the discretionary medical card would not cause her family "any undue hardship". "I beg to differ", she writes. Her family is now being assessed on this basis rather than on need, which was the basis on which her child was originally granted a discretionary medical card.

I have a list of similar cases, including one involving a 12 year old with Ehlers-Danlos syndrome whose appeal against a decision to refuse a medical card has been ongoing since July. In another case, a 50 year old woman with multiple sclerosis has just lodged an appeal against a decision not to renew a discretionary medical card.

Another person with multiple sclerosis, who is 39 years old, was refused and has appealed. I earlier mentioned the child with complex medical disorders. A 70 year old with very complex ongoing medical issues had a card for ten years and that person also has huge difficulties.

I thank the Deputy.

A 69 year old with a very complex life-threatening condition as per a doctor's letter to the authorities had their card revoked having had one since 2005. A 67 year old in end-stage renal failure lost the card following a review. Another woman aged 48 lost the card in a review. Again, it was a very complex case.

The Deputy is over time.

Last evening in the House many other cases were itemised. The bottom line is that this is happening and is real. It is not good enough to come in here and deny the reality experienced by many people throughout the country. I appeal to the Taoiseach to listen to what is going on and stop this disconnect between what is said in here and the reality as experienced by people throughout the country.

I thank the Deputy.

There is a fundamental need to change what is going on. People with serious conditions are being denied medical cards.

Deputy-----

The Taoiseach claims they are all getting medical cards. Why are we having so many appeals? The only reason is that cards are being taken from people. It is not that thousands-----

Deputy Martin-----

-----are getting the cards in lieu of the discretionary card. The discretionary medical card is being taken from them.

Deputy Martin-----

We need a change of policy.

Deputy Martin-----

I ask the Taoiseach to-----

I ask the Deputy to resume his seat.

----- acknowledge what is going on and bring about that change.

I have listened to the Deputy. There has been no change in the method-----

Even the Labour Party does not believe that.

We are on Leaders' Questions, please.

There has been no change in the allocation of discretionary medical cards. I am not saying that every case gets a medical card. I am saying that 22,584 people, who had discretionary medical cards, have moved from discretionary medical cards to full medical cards. That is a fact.

Why are there so many appeals? Why are we inundated with appeals?

Allow the Taoiseach to reply, please.

He is taking cover.

May I proceed? Thank you, a Leas-Cheann Comhairle. The number of individuals who had eligibility to a medical card or a GP visit card on a discretionary basis on 1 January in 2009 was 93,000 and 78,000 in 2013. As I said, 22,584 have moved on to full medical cards. In cases of emergency situations, the HSE has a system in place for the provision of emergency medical cards for patients who are seriously ill and in urgent need of medical care they cannot afford. I think that is clear. The HSE issues emergency cards to such people within 24 hours of receipt of the required patient details and a letter of confirmation of their condition from a doctor or medical consultant. I think that is pretty clear. With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card because of his or her circumstances and the application is followed up with a full application by that person in due course.

Where a person is terminally ill, a slightly different category is applied. Once the terminal illness is verified, patients are given an emergency medical card on a six monthly rolling basis, as would be right and proper. Given the nature of the issues involved with terminal illness, the HSE has the capacity to ensure the person gets that card as quickly as possible.

If there is no change to the policy, why are there so many appeals? More people have medical cards than ever before.

That is because of changes in their circumstances.

There has been no change in the policy or methodology. The first test-----

They have had these cards for years and they have been taken from them. That is the point.

The Taoiseach to conclude, please.

Who is listening now?

The question has been asked and the Taoiseach is replying.

He is not replying to the core point.

The Taoiseach to conclude on this.

It is all gobbledegook.

The Deputy never wants to hear the truth because he is afraid of it. The first test in the assessment process is whether, following the medical card and GP visit card national assessment guidelines, the applicant is within the income limit. If the applicant is above the financial threshold and there is evidence of medical circumstances or social circumstances applicable to the applicant which might result in great difficulties for this person or family in arranging GP, medical or surgical services, granting of eligibility to a medical card or a GP visit card on a discretionary basis remains a routine aspect of the eligibility assessment process. I confirm to the Deputy that there is no change in the policy or method of assessment. I invite the Deputy to give me the document with the list of people he mentioned.

The Taoiseach has it. He has a letter already from the person.

We will just check and see whether what I am saying here applies.

It is policy I want changed.

The Deputy will not listen and never listens. I do not know the details of the cases the Deputy has mentioned, but against this background I will have them assessed to see whether they comply with the situation that applies here.

I can bring in a bundle of them tomorrow.

For years a person who needed a medical card always got a medical card. There are guidelines.

That has changed.

All I am saying is that more people have medical cards than ever before. Some 22,500 of those who had discretionary medical cards have moved on to that full medical card list.

There is now 14% unemployment; we accept that.

I invite the Deputy to give me the list of those cases after this and I will have it checked out in order that we can all see-----

Can we all bring them in for the Taoiseach? We will have a clinic with him this evening.

-----how they measure up in terms of these criteria.

I call Deputy Adams.

The Taoiseach's pigeonhole will be full.

Can we have order, please?