A total of 31,000 discretionary medical cards have been taken from very sick children and from people with life-limiting, life-threatening and terminal conditions over the past three years. I have raised this issue on various occasions in the past 18 months at Leaders’ Questions, and the Taoiseach has consistently denied any change in policy or any move to limit and get rid of discretionary medical cards. The Government’s position became farcical when the Minister of State at the Department of Health, Deputy White, said on radio that there was no such entity as a discretionary medical card. That attempt to eliminate the truth and the facts would have done justice to any North Korean leader.

The health service plan set a target to reduce discretionary medical cards. Every Member of the House has been inundated with calls from worried parents and families who have lost medical cards. I have a list of ten people with very serious conditions that I can give to the Taoiseach. One is a 12 year old child, one of six in the world with a particular syndrome, which gives rise to appalling conditions, who is denied a medical card,. Another is a 65 year old woman with multiple myeloma, a terminal condition, who had the card for some years until it was removed. There are many other such cases. There was an incredible report in the Irish Independent about the mother of Ben Hughes who was asked to prove that her child still had Down's syndrome. This is extraordinary.

Shameful.

The chief executive officer of Down Syndrome Ireland says that half of children with Down's syndrome have either been affected by this cull of discretionary medical cards or have lost them.

The specialist nurses of the Jack and Jill Children's Foundation wrote to the Minister for Health. They care for children with life-limiting or life-threatening conditions who need 24 hour care. They say the situation has become particularly vicious over the past two years. It is critical. It is only a matter of time before somebody, most likely a stressed out parent, is pushed over the edge by this unjust system. They see the danger signs: parents worn out, reduced to tears, not sleeping, not coping and worried out of their minds about their child’s medical card. We have all met such parents.

Will the Taoiseach for God’s sake intervene in this scandal which has been going on for the past two years? It is utterly shameful. Most people we meet, irrespective of whether they have medical cards, are asking us in the interests of a decent society look after the sickest, those who need medical cards and make them our priority. Will the Taoiseach intervene, reverse engines and transform the situation?

The Taoiseach must justify that.

I thank Deputy Martin for his question. I recall in 2002-----

Deputy Kenny is the Taoiseach now.

Deputy Healy-Rae should know that I always like to remind Deputy Martin of the truth. It is a very important element in Irish life.

They do not want to hear.

The Taoiseach should set up a truth commission.

The Taoiseach supported it.

Deputy Martin has already answered for that.

In 2002, Deputy Martin promised the electorate 200,000 extra medical cards. By the time he left the Department of Health in 2004, it was estimated that 100,000 individuals on low incomes had lost eligibility. That is Deputy Martin’s record.

What about people with cancer or motor neurone disease?

The question of discretionary medical cards, long-term illness cards, or cards for children or people with particular difficulties or for emergency situations is very serious because it impacts on people’s quality of life and causes stress and anxiety.

The Taoiseach is in denial.

A great number of our people who have full medical cards have not used them for quite some time because, as the Deputy knows, the legislation governing medical cards is based on financial hardship, not on medical condition. Community welfare officers in different parts of the country used their judgment in different ways to grant medical cards or not.

Who told the Taoiseach that? Where did the Taoiseach hear that?

That was from Deputy O'Dea. Deputy Martin centralised this process and the same criteria applied to everybody. That is where the problem has arisen because the centralisation does not take into account the particular circumstances that might apply in any individual case.

When Deputy Reilly became Minister for Health-----

We remember that.

-----he requested a detailed examination of the 78,000 people who held medical cards on a discretionary basis, in March 2011. Of the 77,925 discretionary medical cards in circulation on 1 March 2011 their status on 1 March 2014 is that 25,398 people, 33%, still hold a medical card on a discretionary basis; 37,906 people, 49%, now have a full medical card based on an assessment of means-----

They had it already.

That is gobbledygook.

The Deputies opposite may laugh if they want. There are 37,906 people with a full medical card; 14,621 people, 19%, no longer hold a medical card, 3% of them were deceased, 7% did not respond to correspondence; 2% did not complete the review process and 7% completed the process but were found to be ineligible for a medical card.

One of the key goals of the reform of the health system is to ensure people who have challenges-----

They are all own goals in this Government.

-----can get an integrated package of services of care built around their particular needs. The Health Service Executive, on the basis of current legislation which states this is based on financial hardship, may allow discretion – I know families, good luck to them, who may well be very much in excess of the income limit, they might be very high earners - but no matter how far one extends the discretion, one will fall short of particular cases. Campaigners say we must allow a full medical card for persons with a particular need, who deserve to have it for life, but if one applies that logic, everybody who becomes a diabetic, or everyone who is asthmatic might be eligible for a card.

We need to have a discussion on this and I take into account the many cases Deputies have raised here. Nobody should be asked the question: "Is your child still Down's syndrome or not?"

They are being asked that and many other questions as well.

Nobody should be asked that question, Deputy McGrath.

They are being asked.

That is what is happening.

Stay quiet, please.

It is the Taoiseach and his Minister who are doing this.

What is the Taoiseach going to do about it?

I cannot defend somebody in whatever office-----

We are way over time.

-----sending out a reply to a person who suffers from motor neurone disease asking if the person is still suffering from the disease.

It is happening on the Minister, Deputy Reilly's watch.

This is what we have to get right.

It is happening on the Taoiseach's watch.

This is where the Minister, Deputy Reilly, and others are working to ensure that the package of services and facilities are made available to those people in their particular difficulties.

Does the Taoiseach want me to hold up a mirror for him?

I understand Deputies raising the question of discretionary cards. I have given them the figures three years on from 2011 but I want them to understand that there is not an attempt here to show lack of understanding, compassion or consideration for people who have these challenges.

The Taoiseach is failing then.

It is a question of getting a system that is fair for everybody. This issue has been raised with me over the years. I have been asked questions such as, "How come this person had got a medical card and I cannot have one?" and "How come this was allowed and it was not allowed in my case?"

I will let the Taoiseach back in.

If we are going to have a standard, we need to look at what we are doing here. If it is on the basis of financial hardship, we need to apply discretion as far as we can but we need to put the local integrated package around people who need it to see that they get that care and attention.

Clearly, they are not listening to the Taoiseach.

We are not talking about any old case. People who had discretionary medical cards had them under the legislation. I think most people watching and most people in society would expect a 12 year old child who has profound mental disability, is legally blind, has hearing loss in the left ear, is asthmatic, is non-verbal and is wheelchair bound to have a medical card. That is my point. I am not talking about systems or integration this or that. Most people in society would say, "What in the name of God is going on when a child like that does not have a medical card?"

Hear, hear.

Equally, in terms of a 65 year old woman who has multiple sclerosis, osteoarthritis, congenital abnormality of the eyes and other conditions, I think most people would say that person should have a medical card. In terms of an elderly women with multiple myeloma, she had a medical card since 2006-----

A question please, Deputy.

----she has a terminal condition but has had her card removed. The Taoiseach can see that this is a policy. Enormous stress is being caused. Last night I called to a door and I am not going to name the case because it is confidential.

Deputy, we are over time.

This is the case of a person who has motor neurone disease, who is on a ventilator and for whom incredible care is being shown by a loved one. The person's card has only been renewed for six months. This is out of control. It is a disgrace. The Taoiseach should hang his head in shame-----

A question please, Deputy.

-----over a policy that is focused on taking cards from people who need them.

He has been told about it often enough.

The legislation is there to allow it. The Taoiseach has been warned enough by many people on his own side, by Deputies on the backbenches and Deputies from every other party here. This calls for a genuine intervention.

The letter from the Jack & Jill Children's Foundation specialist nurses was sent to the Taoiseach and it made a very good point. It said that the Government should be rolling out the red card for parents who are prepared to look after their children in very serious conditions on a 24 hour basis, not rolling out red tape. That is what is happening right now. They are in dread of the next letter that will come their way advising them that their card is under review and will they please fill in all the forms. That is what is happening. For God's sake, will the Taoiseach do something about it? Intervene and stop it.

Let me assure Deputy Martin that he is not the arbiter of all things that are just and fair in the country.

Answer the question.

His own record speaks for itself - it was disgraceful. I called in the HSE, the Minister for Health and everybody else to discuss these questions-----

Deputies, will you stay quiet please until we hear the answer?

-----because Deputies on this side of the House were bringing to our attention very serious cases. I have not heard Deputy Martin say that the law should be changed from what it is at the moment where it is based on financial hardship.

The Taoiseach is wrong there.

I have a case here myself.

Please, Deputies, a time limit applies here.

Let us have a conversation about it. If the Deputies want to decide to change the legislation to base it on medical needs as distinct from income and financial hardship that flows form that, well then we are entering a very different sphere here.

The legislation provides for that.

What I am trying to do here is to ensure-----

The Taoiseach has the super majority so he can come up with the solution.

-----that the people who need care, attention, facilities and aids for their particular illness get them-----

What about terminal illness?

-----but of course there are differences of opinion and perception about the medical card, the long-term illness card, the discretionary card-----

And the joker.

-----given in exceptional circumstances,-----

The Taoiseach should forget about the card and think about the people.

-----the emergency card given and people who have particular difficulties.

These are incredibly severe cases.

I said here that in a case involving the HSE, I do not believe it should ask somebody six months further on have they still got motor neurone disease.

That is the policy.

That is not what we want.

That is what is happening.

What is the Taoiseach going to do about it?

Yes, I understand, and that is why we have intervened here to put a stop to that.

It is not working.

Just like other cases where centralised digital recording took place, these cases come to light all the time and each time they do we try to deal with them with a sense of compassion. The Minister, Deputy Reilly, is going to meet with the nurses from the Jack & Jill Children's Foundation to go through these cases so that the State can say of course we understand that people-----

There no compassion.

-----have particular difficulties, some of them for life. I have a case here of a person who has motor neurone disease, who is suctioned ten times a day but is very much over the limit in terms of eligibility. What are we to do? Are we to say that everybody gets a card here?

Of course a person who has motor neurone disease who is at the end stage should get a card. It is obvious. It is elementary.

That person needs 24-hour care and cannot speak, walk or do anything. In our nation's history-----

The Government has been trying to cut them - some 30,000 of them.

-----we would never want to see a situation where they are left without attention or without medical care. The Deputy refuses to focus on the fundamental issue that we are trying to deal with here.

The Taoiseach is refusing to focus.

The law has been there for many years. That is why probably back in 2002-----

More and more cases are coming to light.

-----Deputy Martin disgraced himself with another promise that he could not keep.

The Taoiseach is going back to the last century.

I am giving the Deputies the figures for discretionary cards from 2011 to 2014-----

And we are giving the Taoiseach the cases.

-----and we will continue to show compassion and understanding where that is possible in all these circumstances.

That will be a change.

I ask the Members to have an understanding of the position of the Chair. That question extended for seven and a half minutes over the time allocated.

It was a very important question.

If they want to extend the time allowable, please arrange to do so, but do not have me shouting at them to please finish. That is all. I only apply the rules. Will the Whips ever get together and look at this issue so that we can have some flexibility to ensure I can stop having to call on people to sit down?

Okay.

Well said.

I cannot just allow things to drift on and say nothing. I have to try to be fair to everybody. I call Deputy Adams and I will be depending on his generosity.