The cull of discretionary medical cards continues unabated. This involves taking cards from very sick and terminally ill people. Such people are still being asked to document and prove they have incurable conditions. Many of these cases are well known to the health authorities. Letters continue to issue in pursuit of a policy change this Government has decided upon, which is essentially to get rid of discretionary medical cards. It continues, as revealed in today's edition of the Irish Mirror where a terrible headline reads "Prove you're dying". It relates to a very high-profile case known to everyone in this House and the entire country. It is the case of Marie Fleming who is pursuing legislation for assisted suicide. Her condition is well known. She is terminally ill, yet she did not get her medical card automatically renewed. She was asked to provide documentary evidence to prove her condition is incurable. Her partner, Tom Curran, has spoken about the indignity of that.

It illustrates what thousands of families comprising many people with significant medical conditions are experiencing because of a fundamental change in policy in respect of discretionary medical cards. These are people who had cards for many years because of their conditions.

Last week, I raised the cases of Katie Connolly, a child with Down's syndrome, and Ronan Woodhouse. I also raised the case of a 11 and a half year old child with a very rare syndrome. Thousands more are anxious and fearful of what the health service plan has in store for people with medical cards.

Will the Taoiseach once and for all accept there has been a change of policy in respect of discretionary medical cards? The revelation in today's Irish Mirror pertaining to Marie Fleming is a further illustration of that reality. The Taoiseach spoke last week about the information flowing around as an unreality, but the reality is there for Marie Fleming, Katie Connolly and Ronan Woodhouse.

And thousands of others.

I am asking the Taoiseach to change the policy.

I do not have the details of the case that is so high profile-----

The country knows them.

Deputies, please.

It is about a renewal.

-----but let me say this. I am not sure-----

We have been listening to this for the past two months.

Settle down.

Can I reply to Deputy-----

She is critically ill. Everybody knows that.

I have it on my laptop here.

Be quiet, please.

-----Martin's question, please?

This is outrageous.

Will the Deputy stay quiet, please?

It is inhuman.

Would you mind staying quiet? This is Deputy Martin's question, not yours.

Deputy Martin asked a legitimate question-----

Yes, exactly.

The Taoiseach knows the details.

-----about a sensitive issue. May I reply to it?

Please, allow for a reply.

He knows the details of the case.

Deputy Martin's question is about a change of policy in so far as discretionary medical cards are concerned. My understanding is that, in this particular case, this is not a discretionary medical card. This is a medical card on entitlement, both on income grounds and on medical grounds. It is a case of renewal of an ordinary medical card. Deputy Martin is well aware that, in the case of-----

The Taoiseach does know the case.

-----a no change policy here, people start off not being entitled to a medical card, an application is lodged and people are entitled to a medical card either on income grounds or medical grounds. Depending on the nature of those circumstances, a discretion is applied. Twenty thousand medical cards have been issued on discretionary grounds this year.

My understanding, and I do not know whether Deputy Martin can confirm this, is that this is a normal full medical card granted on eligibility grounds both on income and on medical grounds, and it is a normal renewal of a medical card. If I listened correctly to Marie's partner saying that he was not objecting to the renewal process, the fact is that it appears as if there was contact on a number of occasions from the HSE about verification of the woman's medical position.

The HSE knows it. That is outrageous. She is critically ill.

Deputy Martin knows and I know-----

Was it not granted based on means?

-----that a person-----

She is terminally ill.

Listen, please.

The woman is dying. This is outrageous.

This is an issue-----

Will the Deputies please allow the reply without interruption?

That is not correct. My office is dealing with it.

This is an issue-----

That is not correct. The HSE knows about it. It is asking for the woman's details. She is critically ill. It is outrageous.

Deputy, please.

It is outrageous.

Please, through the Chair.

I am dealing with the issue and I know about it.

Through the Chair.

This is the situation as it stands.

This is an issue that concerns a terminally ill person. As I understand it, the circumstances are that this is a normal, full medical card for renewal. A person does not become unterminally ill once this is verified. There are significant numbers of people who are terminally ill. That position does not reverse itself. I accept that, in the process of centralising the processing of all medical cards in the country, there has to be a lesson learned in this case-----

Irish Water here we come.

-----that when a person is terminally ill and has a full medical card that is not withdrawn - it was not withdrawn in this case - it is about having an effective, simple way of saying we understand this position, the medical condition of the person has not changed, and so the card continues. As I said genuinely, I do not have all the details of this, but my understanding is that it is an ordinary renewal process for a full medical card-----

The Taoiseach is well briefed on some of the details.

He has only half the information.

-----as distinct from a discretionary card. There is a lesson to be learned in there by the HSE in the sense that here is a terminally ill person. That, unfortunately, is not going to change. Therefore, there has to be an effective and compassionate and understanding process for the continuation of the card.

There is no compassion.

That is something that, unfortunately, this case points out where a change must occur in the process of renewal in order that people do not have to deal with verification of an illness that is terminal.

The case of Marie Fleming is known to everybody. Deputy Halligan is correct in that, above all, it is known to the health authorities, who are acutely aware of her condition. Why should somebody who is ordinarily entitled on income grounds to a medical card have to provide documentary evidence about medical conditions?

Hear, hear.

The person concerned was asked to provide documentary evidence about an incurable condition. The HSE had it all anyway. The real problem is that the 2013 service plan provided for the elimination of approximately 40,000 medical cards. This is what is happening. Does the Taoiseach not get it? This is why thousands of letters are going out-----

He knows it.

-----to children with multiple conditions. I raised the case of the 11 and a half year old child last week. That child has asthma, is non-verbal and legally blind and has a profound mental disability and a very rare syndrome. The card was taken from that child.

The Minister of State, Deputy White, confirmed in a written reply to a parliamentary question that 10,000 discretionary medical cards were taken out of the system last year. This has never happened before.

A question, please.

It is happening because the Taoiseach endorsed the HSE service plan last year which has allowed the HSE to use income eligibility guidelines to review every one of those cards. This comes from the Comptroller and Auditor General's report and the review. The basic rule of thumb is that anyone with a card who is above income guidelines gets a letter to the effect that if they can prove it, the person can get the card back. This is what is happening. This is the change in policy.

Full stop.

The Taoiseach keeps saying there has been no change. He knows that children who avail of the services of the Jack and Jill Children's Foundation are, in many instances-----

Thank you, Deputy.

-----living in life-limiting and difficult conditions. Their parents are aghast and flabbergasted at the response of the Taoiseach and the Minister to the reality of their experience in trying to keep their medical cards. Children with the sickest and toughest of conditions are having their cards taken from them. Please, accept the bona fides of what I am saying.

Thank you.

There needs to be a change of policy. These kinds of situations should not be happening. We can change it. Will the Taoiseach accept that what is happening is wrong and change it?

The Deputy started off with the first part of his question by asking about discretionary medical cards. He named a particularly high-profile case of a woman who is terminally ill.

We all heard about it on the radio.

My understanding is that that is not a discretionary medical card. It is a full medical card granted on full eligibility.

Which makes it worse.

The process is about the normal renewal of that medical card.

Why take it off the person if that is the case?

In the case of somebody who is terminally ill, where there is an application for a discretionary card, the system is that an emergency card is issued for six months and then renewed and verified after that, but that is in the case of a discretionary card for a person who is terminally ill. As I understand this, there is no income coming into the household except a disability allowance-----

Why should the Taoiseach refer to a normal renewal for a person who is terminally ill?

-----and a carer's allowance, which qualify Marie-----

It should be automatic.

That is outrageous. It is inhuman.

No. These qualify Marie Fleming for a full medical card.

To even go down that road is to be inhuman.

Deputy, please.

As I understand it, the conversation was about the process-----

It is inhuman the way the woman is being treated. She is terminally ill.

We cannot hear the reply.

We are not getting any reply.

-----of the normal renewal of that medical card. There has been no change in the eligibility limits for medical cards.

Come off it. Who is the Taoiseach codding?

There has been.

I am talking about a woman who is terminally ill.

The Minister of State, Deputy White, confirmed that 10,000 cards had been taken out.

We know what happened.

If Deputy Mattie McGrath chooses to make smart comments-----

I have the details here. Does the Taoiseach want to see them?

-----about that, that is fair enough.

Hear, hear.

I have them here. The Taoiseach does not have a clue. He has them as well.

She has been asked to submit a medical report again even though the HSE already has it. This is terrible liaising.

Deputy Martin asked me a legitimate question.

Our time has concluded.

What I can say to him is that-----

The Minister of State, Deputy White, said 10,000 last year.

-----when he says thousands of cards have been withdrawn-----

They have been.

-----100,000 new medical cards issued this year-----

The Minister of State, Deputy White, said it. It is on the record.

Disgraceful.

-----and there were 20,000 discretionary cards. We have to have a conversation about this. I am saying to Deputy Martin that, in the process of renewal in a case of a person who is terminally ill, there is a lesson to be learned by the HSE. A person who is deemed and verified to be terminally ill-----

That is what we are telling the Taoiseach. We have been telling him it for a while.

The Government abolished the governance of the HSE and took control of it.

-----is not suddenly going to have his or her medical condition changed.

Stop blaming the HSE.

Help the Minister, Deputy Reilly.

There needs to be compassion and an effective understanding of how that card is to be renewed if it is a full medical card. In the case of a discretionary card, clearly, that is where discretion kicks in, but this is not that case as I understand it. I do not know whether Deputy Martin has better information than I have, but my understanding is that Ms Fleming-----

The card was not renewed.

-----is entitled to a full medical card and what is involved is the process. I do not blame her partner for being annoyed if it is a case that there were calls from the HSE about verification of the illness.

Once it is verified that a person has a terminal illness, whatever that illness is, we have to have an understanding how to put in place an effective renewal process which takes that pressure off the person.

Ar dtús, ba mhaith liom comhbhrón a dhéanamh le teaghlach an tAthair Alex Reid, go háirithe a dheirfiúracha Maura agus Margaret, a Aintín Ita, agus na Redemptorists. Fear iontach cróga ab ea an tAthair Reid agus gan an obair chrua a rinne sé, ní bheadh síocháin againn inniu.

Tuigim go bhfuil plean an HSE ag an Aire Sláinte i láthair na huaire. Is plean é seo faoina bhfuil daoine ar fud an Stáit an-bhuartha. An réasún go bhfuil daoine an-bhuartha is that the quality or state of any health service is a good indicator of how society treats the sick, including children, the elderly and citizens with disabilities. This is particularly so in a State which describes itself as a republic. Yesterday, the Health Service Executive delivered its 2014 national service plan to the Minister for Health, Deputy Reilly. It includes almost €700 million in cuts and there is speculation that the figure could be closer to €1 billion. Austerity rules. There is widespread concern about the effect this will have. Clearly, this is the worst small country in the western world in which to be sick. We were told at the weekend that in the period 2006-11, patients with breast, bowel and cervical cancer fared worse here than in the vast majority of industrialised states.

As the Taoiseach knows, last Friday the HSE confirmed that 24 health agencies - including some hospitals - are paying top-ups to their managers. In a republic, or indeed in any decent society, citizens have a right to a first-class health service on the basis of need. How the Taoiseach deals with this matter will be a mark of his Government's tenure. He clearly has no faith in the Minister for Health. The Department of the Taoiseach has assumed responsibility for health spending, along with the Department of Public Expenditure and Reform. Therefore, the Taoiseach will not be able to blame the Minister, Deputy Reilly, when his Government takes up to €1 billion out of the people's health service.

Can the Taoiseach confirm the scale of cuts contained in the health service plan? Can he tell us when the Government intends to publish this plan?

Aontaím leis an Teachta maidir lena ndúirt sé faoin Athair Reid. Chas mé leis cúpla uair agus tá a fhios agam go ndearna sé obair dhian iontach i leith phróiseas na síochána, ní hamháin sa Tuaisceart, ach i dtír na mBascach sa Spáinn freisin. Níor chas mé go pearsanta leis ach cúpla uair, ach bhí díospóireacht agam leis. Go ndéanfaidh Dia trócaire ar a anam dílis.

The Health Service Executive has an obligation to produce its health service plan for acceptance and approval by the Minister for Health, based on the budgetary allocation to the Department of Health and the ancillary services. The plan was delivered by the Health Service Executive to the Minister yesterday, as is the HSE's obligation, with accompanying correspondence. The Minister for Health now has three weeks to reflect upon and consider that plan and give his comments on acceptance or amendment of the plan, as the case might be. That work is already under way, so I do not want to comment any further on it except to confirm that it has been delivered. I can also confirm that the Minister and his officials are now working on the presentation of the plan to see whether it is acceptable to him or whether he considers that it should be amended in one fashion or another.

The Taoiseach says the plan has been prepared and given to the Minister for Health, which is right. However, the Taoiseach avoided commenting on the new situation whereby his Department and the Department of Public Expenditure and Reform, along with the Minister for Health, have assumed responsibility for health spending. On top of all the other cuts we worry about, the Taoiseach has targeted €113 million of cuts to medical cards in 2014. That will result in thousands losing medical cards.

Kate McShane is a two year old with Down's syndrome, requiring heart surgery and long-term GP and hospital care. She has been denied a full medical card. When I brought this matter to the Taoiseach's attention he invited me to send details of this case and others to him, which I did. I did not get a reply from the Taoiseach but got one from the HSE. Most of the people were denied medical cards and only one had the decision reversed.

A question, please.

Kate McShane was denied her medical card. This is Kate. Amharc ar seo.

I am sorry Deputy but that is not authorised in the Chamber.

She is less than two years old.

The Deputy cannot display photographs in the Chamber.

She is a child but she is paying the penalty for the Taoiseach's austerity policies.

Can the Deputy put a question, please?

Can the Taoiseach tell us how he expects the health service to survive with cuts of up to €1 billion in 2014, on top of all the other cuts taken out of health by him and those who preceded him in government?

There is a process to be followed here. The process is that the Government decides on the budget and puts it through the Oireachtas. The HSE responds to the Minister for Health in respect of providing a health service plan to implement the effective running of health services based on the figures given to the Department in the budget. The Minister for Health has three weeks to reflect upon and consider that plan and give his approval for it.

What about Kate?

As I have already pointed out to the Deputy, the Department of the Taoiseach, the Department of Public Expenditure and Reform, and the Department of Health are currently examining the plan. The Minister for Health has a statutory requirement to respond to the plan and he will do so. The Minister's job is either to approve the plan or approve it subject to amendments. That process is already under way.

If Deputy Adams wants to present the face of a young child in the House, I cannot stop him.

It is contrary to Standing Orders.

If the Deputy wants to ensure that I get something myself, he should give it to me before I leave the Chamber. I will be happy to respond.

I have already done so. I sent it to you, Taoiseach.

A veritable river of material comes into the Department of the Taoiseach every week. I cannot, and do not, see every single item. Therefore, if the Deputy wants to give me something again, he should make sure that I get it myself personally.

This evening, Dáil Éireann will debate a motion asking the Government to lobby the ECB and the European Commission to destroy the promissory note bonds of €28 billion. The Taoiseach does not normally speak on Private Members' business, so I wanted to take this opportunity to gather his thoughts. In February, the €28 billion IOU from the Irish people to Anglo Irish Bank was converted into a €28 billion IOU from the Irish people to the Cental Bank of Ireland. This reduced the borrowing costs, which is to be welcomed, but we should be absolutely clear that the Irish people still owe that €28 billion.

We raised this directly with the troika recently and asked what would happen if the Irish State simply refused to pay the Central Bank of Ireland this money. The troika said it was against the rules of monetary financing, which it is. That is reasonable because in normal circumstances central banks cannot print money and hand it to governments for free. As the Taoiseach well knows, however, these are not normal circumstances. That is because the ECB, at best, facilitated and, in my opinion, coerced both this Government and the previous one into paying tens of billions of euro in public money to the creditors of private banks.

Essentially, this €28 billion is a debt incurred by the Irish people to ensure that private creditors of former Anglo Irish Bank and Irish Nationwide Building Society do not have to incur any losses as a result of their bad investment decisions.

The ECB had no problem changing the rules when it came to protecting the banks. In socialising private sector losses the ECB essentially tore up the rule book on Europe's market-based economy. When it comes to a workable solution to removing those losses from the shoulders of the people, the ECB hides behind that rule book.

A question, please.

The Private Members' motion before the House this evening calls on the Government to lobby the ECB and European Commission for a one-off change, an exemption, to the rules of monetary financing to allow for the Central Bank of Ireland to tear up those bonds.

I have listened during the past three years to the Government's stated position. I still do not know whether it is paying the money because it thinks it is the least bad option available to it or because it believes these are debts properly incurred by the Irish State and due. Does the Taoiseach believe that the Irish people should pay the €28 billion which was loaned to ensure that creditors of Anglo Irish Bank and Irish Nationwide Building Society did not have to incur any losses on their investments?

We always live up to our obligations. Week after week for a long time Members raised in this House the issue of the promissory note and the requirement to pay €3.1 billion per annum for ten years to Anglo Irish Bank. The Government in its negotiations through the Department of Finance and the Central Bank with the European Central Bank arrived at a position whereby this has been moved out to 2038. We do not now hear any comment about the €3.1 billion that was required to be borrowed and paid each year in respect of Anglo Irish Bank. The court handed down its 68-page judgment in this regard today, which is in favour of the State.

Acceptance by the ECB of Ireland's position has improved our position and has allowed for further assistance in respect of the reduction of the interest rates and the extension of the loan term. I am sure the Deputy is aware of the independently verified figures from the Central Statistics Office today which indicate that 58,000 jobs have been created in the past 12 months and that the unemployment rate has decreased to below 13%, which is significant and is a sign of confidence in different sectors of the economy. It is hoped this can be improved upon in 2014.

The Government will be opposing the Private Members' motion this evening. We propose to continue to grow our economy and to provide opportunities and jobs for the people. The Deputy knows as well as I that at the end of the day what the Irish people need are opportunities for employment. The Government will continue to meet its obligations in this regard.

The decision of 29 June last year in respect of the ESM stands. It is a matter that will be negotiated through banking union, supervision, the capital requirements directive and as part of the wider agenda.

For clarity, we have not avoided borrowing €3 billion per annum for the next ten years. What we did was borrow €28 billion this year. It just so happens that we borrowed the €28 billion this year at a lower interest rate than that at which we borrowed the €3 billion in previous years. Hence, the lower cost of funding. Let us be under no illusion, we issued a bond to the Central Bank of Ireland. This means we borrowed the money this year.

There appears to be a conspiracy of silence around the promissory note bonds. I asked the Minister for Finance, Deputy Noonan, to identify the bondholders or to take steps to identify them and he refused to do that. I also asked him to present to the House an estimate in respect of the savings for the promissory note bond restructure. His response was that that was too complicated to do. I recently asked him for an amount per bank that was already guaranteed on the night of the bank guarantee under the €100,000 guarantee and was told that information is commercially sensitive. The Irish parliament is not allowed to know how much money was guaranteed on the night of the bank guarantee. With respect, the Taoiseach has completely avoided the question.

Regardless of whether it can be achieved, we are asking that the Government requests an exemption so that the bonds can be destroyed. Before this can be done, it is important Members of Dáil Éireann know whether the Taoiseach believes that the Irish people, regardless of whether they end up paying the money, should have to pay that money to cover the bad investments for Anglo Irish Bank and Irish Nationwide Building Society.

Hear, hear.

Lest the Deputy thinks the previous Government would have done things differently a number of years ago had it had the opportunity to do so, that is not the case. Given the circumstances with which we were faced, the Government, including the Ministers for Finance and Public Expenditure and Reform and the Central Bank, put a cogent case to the European Central Bank in respect of the decision made, which was announced in the House some time ago. I am sure the borrowing requirements would have been produced with the accounts when the promissory note was first put forward by the late Brian Lenihan.

Discussion on the Finance Bill is currently under way. The Minister for Finance will be in the House tonight to deal with the Private Members' motion and to respond to any detailed questions which members may have in that regard.