I put it to the Tánaiste that the Government's policy on discretionary medical cards is hitting hardest people with disabilities and children with special needs. In a survey, Down Syndrome Ireland, estimated that up to 100 people children with Down's syndrome have lost their discretionary medical cards. Up to half of the children with that syndrome have heart defects, gastrointestinal conditions and many other conditions attached to the syndrome. It is hitting them very hard. Children with very rare syndromes and conditions ordinarily had a medical card and have lost the discretionary medical card as a result of the change in policy. The Disability Federation of Ireland has raised serious concerns about the Government's medical card policy, particularly its impact on those currently receiving discretionary medical cards who have disabilities and multiple conditions. The federation makes the point that, for many people with disabilities, the costs associated with their conditions, including general medical services, therapies, transport and expensive medical aids and appliances, compromise their capacity to meet other basic costs of living. It says that removing the medical card from these people will cause their families undue hardship and stress. The Jack and Jill Children's Foundation deals with chronically ill children and works hard with them and is at the end of its tether with the struggles of many of the parents of children who attend services provided by the Jack and Jill Children's Foundation to get medical cards they lost. The director of the HSE wrote a seven-page letter to the Minister for Health about the health service plan and the Government decision to take over €100 million out of medical card services next year as a result of the budget, saying that such cuts to medical card services are being taken "against the advice of the HSE and the Department of Health". Does the Tánaiste accept the medical card policy is hitting hardest the sickest children, children with multiple conditions, children with very rare medical syndromes and medical conditions of all in the changes to the discretionary medical card system? Will he publish the letter sent by the director of the HSE to the Minister for Health in respect of the health service plan 2014?

The number of people with medical cards and access to free GP care is the highest ever in the history of the State. Almost 2 million people have a medical card or access to free GP care. Since the beginning of this year, the HSE has awarded 100,000 medical cards, of which over 20,000 are on a discretionary basis. The Minister for Health wants people to be clear on their entitlements and to reassure anyone entitled to a medical card that the person will continue to hold the medical card. With regard to discretionary cards, when Deputy James Reilly became the Minister for Health he instructed the HSE to establish a clinical panel to assist in the processing of applications for discretionary medical cards. This was to ensure medical professionals with expertise and knowledge have an input into the granting of a medical card to people who exceed the income guidelines but face difficult financial circumstances. This ensures the specific circumstances of a person with a particular diagnosis can be considered on a case-by-case basis. The discretionary medical cards are granted on the basis of financial hardship, not on the basis of a particular condition.

The long-term illness scheme covers people with certain conditions regardless of income.

Down's syndrome is one of the conditions covered under the long-term illness scheme.

As Deputy Martin knows with regard to the health service plan, there is a procedure for its consideration. It is submitted by the HSE to the Minister for Health, and that was done on 25 November. He has 21 days within which to consider that plan, running to 16 December, and between now and then the Minister will bring the health service plan to the Government. It is with the Minister and he is considering it.

The Tánaiste has not really dealt with the core point of the question. Today is International Day of Persons with Disabilities, which is why I focused on the impact of the Government's policy for children and people in general with disabilities who have lost their discretionary medical cards. The general increase in the number of medical cards is related to the economic position, unemployment and so on, but a policy change has been implemented by the Government in respect of discretionary medical cards, with a devastating impact on many people with disabilities. These are the people who are most sick; they have multiple conditions or very rare syndromes. I mentioned in the House the case of Katie Connolly, a five-year-old girl with Down's syndrome who is asthmatic and who has juvenile arthritis and a heart condition. We have also raised the case of an 11-and-a-half year old child who is one of six in the world with a particular syndrome that brings very serious issues.

Can we have a question, please?

That child lost a medical card as a result of the Government's policy change. The Minister of State with responsibility for these matters, Deputy Alex White, acknowledged in a reply to a parliamentary question that 10,000 such people have lost their medical cards in 2013 to date. By definition, a discretionary medical card is for people with special needs, multiple conditions or a range of other issues. These are the people who by any yardstick need a medical card the most.

Put a question, please.

The Government's policy is hitting these people the hardest. Does the Tánaiste acknowledge and accept that specific point on this, the International Day for People with Disabilities? Will the Government change that policy and approach, intervening to reverse what has been happening in order to restore medical cards to people with chronic and life-threatening conditions who have lost them?

There has not been a change in policy. The Deputy has said that a number of times and it is part of the distortion which he has continued.

It is not a distortion. How dare you?

There are criteria for the issuing of medical cards. More medical cards have been issued by this Government than by any previous Government.

That is not answering the question.

It is. The Deputy has come in here and argued that there are fewer medical cards and that the numbers are being reduced because the policy is being changed. That is simply not true. Let us deal in facts. First, more medical cards are being issued now than at any other time. Since the beginning of this year, an additional 20,000 medical cards have been issued on a discretionary basis. That is the fact of the matter.

It is not the fact. The Tánaiste is bluffing. What about the 10,000 that have been lost?

Deputy Martin should stop shouting down the speaker.

I am seeking the truth.

He is not answering the question.

One euro out of every €8 of public expenditure in the State is now spent on disabilities. This Government is spending more on disability services now, in difficult times, than was spent in 2008, when Fianna Fáil was in Government at the height of the boom.

Hear, hear.

That is not true. The Tánaiste is being sneaky with the figures.

I have the figures here.

What about the mobility allowance?

Everybody in this House knows that there have been problems in some cases with regard to the issuing of discretionary medical cards. The Minister for Health has made it very clear that the issue is being addressed. Somebody with a need for a medical card ought to have one. There have clearly been some cases in which medical cards either have been withdrawn or have not been issued when the person concerned should have had one. The matter is being addressed. It does not follow that because there are individual cases in which the wrong decisions have been made in the issuing and administration of medical cards, there is an overall change in policy. The Deputy should not come in and slap that contention in front of a Government that has issued more medical cards than at any time in the history of the State.

The Tánaiste is wrong.