Next Saturday there will be an event entitled Walk a Mile in Ronan and Katie's Shoes to lobby for the return of Ronan and Katie's discretionary medical cards. Katie is a five-year-old girl with Down's syndrome and many complications, including asthma and juvenile arthritis. Her medical card was granted based on her medical condition and although her condition has become a little worse since then, her card has been taken from her. Her mother, Jackie Connolly, has been campaigning on this case, which illustrates the appalling impact the change in policy on discretionary medical cards has had on very sick children. Ronan Woodhouse is a child with Down's syndrome and 13 associated illnesses. Last February he lost the medical card he has had since his birth in 2005. Why? Someone said no undue hardship was involved. His mother was outside the Fine Gael Ard-Fheis and the Taoiseach said he would meet her, but that has not happened and her son still has not got his medical card.

The denials go on. I have been raising this for months. The Taoiseach told me anybody who deserved a medical card would get it, but that is untrue. The Minister's statement that there has been no change in policy but only the application of probity is as skewed a statement as I have ever come across and is designed to hide the truth. The Minister of State at the Department of Health, Deputy White, stated in reply to a parliamentary question that from 1 January to October this year more than 10,000 discretionary medical cards had been taken from people. By definition, these are very sick children and adults with significant and rare conditions.

How long must the denials of any change go on? Will the Taoiseach accept that there has been a fundamental change in policy with regard to the allocation of discretionary medical cards and that this change has resulted in the visiting of extraordinary hardships on people and families who deserve much better? I have been talking about this for six months. Shame on the Taoiseach and the Government for refusing to accept what people from all sides of the House have been saying for so long and doing nothing about it but giving us empty, meaningless rhetoric that does not accord with the reality on the ground.

There has been no change in the medical card policy. Nobody is automatically entitled to a medical card. The problem we had in this country for so long was that different health areas allocated medical cards based on different criteria. Everybody is now treated equally, starting here. Nobody is automatically entitled to a medical card. If a parent, parents or whoever has an income in excess of the guidelines laid down, the discretionary element comes into play. Last week I had a case in which there was a claim for a medical card for someone whose income was €7,000 over the limit not just in the year but every week. I have dealt with a number of sensitive cases in the last month and I am glad that many of these were cleared due to the application of discretion because of the nature of the applicants' medical problems.

Deputy Martin mentioned Ronan and Katie and said that Ronan had 13 illnesses. The director of the HSE has met Ronan's mother on two occasions. I do not have the details of the child's illnesses, but I can understand the frustration. Deputy Martin asked me the question, as he is entitled to, of whether this child is entitled to a long-term illness card.

Children should not have to go through that when they are sick.

He asked if the child was entitled to appliances and aids and the provision of services on the basis of his needs, as distinct from an illness, via a determination based on discretion. To answer that I would need to have the facts in front of me.

It is a child, not a robot.

I can sympathise with the mothers of Ronan and Katie. Deputy Martin mentioned the Fine Gael political gathering in Limerick. Nobody told me the person involved wanted to meet me. I spoke to several people on the way in. That is not the issue. The issue is that Deputy Martin has a right to ask a question here about two children and a walk that is taking place regarding their discretionary medical cards.

We should not have to ask.

There is no change in the policy. Nobody is automatically entitled to medical card. Issues such as income and discretion apply after that. Because of all the cases that were brought to light here I called HSE to the Cabinet sub-committee. It put together a communications system for dealing with sensitive cases. Deputy Ó Fearghaíl may laugh.

He is laughing at the Taoiseach.

I was getting sick and tired of information floating around without reality. One sits down and deals with each individual case. I do not speak for the director of the HSE. He sat down with this mother on two occasions, whether to discuss the details of this case or little Ronan's circumstances I do not know. I do not have that information, but I will find out for Deputy Martin. There has been no change in the policy.

That is absolute rubbish.

I had a sick man from Castlebar talking to me-----

Will Deputy Boyd Barrett stop interfering with Leaders' Questions?

The Taoiseach is waffling again.

I can give Deputy Martin the number of discretionary medical cards that were allocated this year. Twenty thousand newcomers were allocated medical cards on that same discretionary basis. Deputy Martin is entitled to ask the question. In many of these cases, where a determination is made on discretion, the person involved might be entitled to a long-term illness card which gives them aids, appliances and facilities for their particular requirements. I am sorry I cannot give a more comprehensive answer because I did not have notice of this and I do not have the details of this particular child in front of me.

Does the Taoiseach want notice of Leaders' Questions now?

Anyway, it would be unfair to outline the circumstances that apply in an individual case in that detail.

The child was offered a long-term illness card but many of his conditions do not qualify under the long-term illness card. If somebody met the person they could sort it out. I use these cases to illustrate the problem. I dealt with approximately 12 cases two months ago, including people with varying ages and various conditions or disabilities, including motor neuron disease. Professor Hardiman of Beaumont Hospital said she had never written so many letters. Why? There has been a change in policy.

I cannot understand why the Taoiseach gets up here every day and says there has been no change in policy. Since the 1970 Health Act, undue hardship has been the reason in the legislative framework for giving people with particular conditions and illnesses medical cards. This represents only 0.3% of the entire medical card allocation. There has been a change in policy. The Taoiseach and the Minister for Health keep talking about narrowing the gap and financial thresholds. That is what it comes back to. For the last three years the move has been on to get rid of discretionary medical cards from the system, and it is dressed up in gobbledygook.

Only this morning my office was notified of another case-----

The Deputy is way over time. Will he, please, facilitate the Chair?

It concerns a young child with a very rare condition, which I will not name because in doing so I would nearly identify the child.

Please allow the Taoiseach to respond. This is a supplementary question.

Fewer than ten people in the world have this condition. In the name of God, what kind of system do we have when the Government takes a medical card from such a child? Can the Taoiseach answer that question? I do not think he can. This is a call to stop all of the meaningless rhetoric -----

Will the Deputy, please, co-operate?

We are talking about giving everybody under the age of five years a medical card. We could start by giving everybody in this category a medical card. That would introduce fair play. We could do this before we start giving out medical cards to anybody else.

This is Leaders' Questions.

Can sick children and people with multiple conditions be given medical cards? I am asking for a change in policy. Do not tell me it has not changed. It has and I want that change to be reversed and medical cards restored to these young children and adults.

The Deputy should have carried on like this when Brian Cowen was in charge.

Bravo, Deputy Martin - strong talk. The Deputy was the person who, as Minister for Health, signed the working time directive. He was the one who said he would have the problem sorted out by 2004. Ten years on, this is another mess which has been left to us to clear up. The European Commission decided to bring the country before the court as a result of the Deputy's gross incompetence and neglecting his business at the time. I refute his charge in regard to medical cards. I do not have the medical information available to me, but if I did, I probably would not understand all of the implications of the medical requirements involved. However, it is my understanding the long-term illness card granted to the child mentioned by the Deputy does cover the child's illnesses. That is my information, but the Deputy has different information. Neither of us is competent to make the judgment on medical grounds, although the Deputy might pretend that he is.

It is a probity exercise.

The Deputy makes the charge that there has been a change of policy, but let me assure him that since the start of the year some 100,000 new medical cards have been granted, of which 20,000 are discretionary medical cards. The Deputy left behind a most unholy mess of a structure that we now have to change.

It was the Minister of State who said in response to a parliamentary question that there had been a change of policy. Blame everybody else, except yourself.

Some 20,000 new discretionary medical cards have been granted this year alone. Under the system I have changed, with the communications element of the HSE, where something of this nature is required, the HSE deals with each individual case. The Deputy can wave all the paper he likes, but there has been no change in the policy on the issuing of medical cards. Nobody is entitled to a medical card automatically, but everybody is entitled to have his or her case properly and compassionately assessed. Either the case mentioned by the Deputy is not covered-----

It is not that case.

That is the case the Deputy raised.

We are way over time.

The Deputy is entitled to raise the case. Unlike his predecessor who said to me when I had raised an individual case that it was too facile, I will allow that the Deputy is perfectly entitled to raise a case. This is a House of Parliament. My understanding is that the long-term illness card in the case mentioned by the Deputy does cover the medical condition and requirements of the young child involved.