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.