Over the past 18 months, when the issue of discretionary medical cards was raised and the removal of discretionary medical cards from very sick people was being highlighted in this House and throughout the country, there was a denial in Government that there was any change in policy. Whether there has been a change in policy or in practice, there has been a change because people are having their discretionary medical cards removed on a continual basis. The figures and statistics are there and more than 30,000 discretionary medical cards have been removed over the past number of years.

The Joint Committee on Health and Children is in the medical card centre in Finglas today observing how discretionary medical cards and other medical cards are assessed.

Another stunt.

I have no doubt the staff there work exceptionally hard and diligently but the difficulty is that they are doing the Government's bidding in regard to the removal of discretionary medical cards. A Private Members' motion this week and one last year highlighted, and advocacy groups continually highlight, the fact discretionary medical cards are being removed and yet the Government denies there has been any change in policy. Even as late as last year, it was in the HSE service plan that there would be a removal of discretionary medical cards.

The reason I raise it today is that we have raised it with the Taoiseach and on Private Members' business and the Tánaiste is our last chance to get this Government to accept there has been a change and to reverse that change. Children with Down's syndrome have been asked whether their condition has improved, as have people with motor neurone disease. Let us be very clear - Down's syndrome is with one for life and motor neurone disease takes one's life and yet people are being asked these questions on a continual basis. In the House yesterday, in response to a question by Deputy Martin, the Taoiseach stated, "there is not an attempt here to show lack of understanding, compassion or consideration for people who have these challenges" and that it was a question of being fair. What is unfair is asking the oldest and the sickest to pay free GP care for those under the age of six which will, in many cases, be given to healthy and wealthy people.

I accept there is a problem with the way in which the review of discretionary medical cards is being carried out. The number of medical cards which is in circulation now is significantly higher than it was a number of years ago. There has been a 46% increase in the total number of medical cards. Almost 600,000 additional medical cards are available now than in 2008, for example. As I understand it, and I have spoken to the Minister about this, 96% of those reviewed to date have retained their medical card.

There are a number of problems, as I see it. The first problem is that when a letter comes in the door stating that the medical card will be reviewed, it causes worry and upset and a better way has to be found of conducting the actual review. The second problem arising is that people who are reviewed once are very often reviewed again a number of times. In particular for older people, it constitutes a degree of harassment where somebody receives letters again and again within a very short period of time essentially asking the same questions. There is no justification whatever for somebody getting a letter asking if his or her child still has Down's syndrome or somebody getting a letter asking if he or she still has motor neurone disease. That type of approach must be dealt with.

In terms of solutions, a number of things can be done. Where a review takes place, there should be a freeze on that person being reviewed again for a period of time. Where it is proposed to withdraw a medical card, a reasonable period of time should be given to that person to enable them to appeal the decision and to make a case, if there are exceptional circumstances in the household or exceptional medical circumstances, for example. Perhaps a small additional inquiry should be made. I know of a case, for example, where a medical card was withdrawn where the person had moved to a nursing home. Clearly, that could be established by a small additional inquiry.

Where the medical card is being withdrawn and where issues arise in regard to access to services, which is an issue for people, the Minister has committed himself to ensuring that access to services is made available. Again, a period of time should be allowed for that.

I am very glad the Joint Committee on Health and Children is in Finglas today talking with the staff dealing with the review of the medical cards. I hope that arising from that visit, it will be possible to progress a number of practical recommendations which can address the kind of problems we all see arise from the review.

The programme for Government guarantees access to medical care based on need and not on income. That is a central tenet of Government policy in regard to health delivery. Fairness should be at the heart of any policy. The Irish people are very fair when it comes to deciding whether free GP care for all those under six should be funded by taking discretionary medical cards from the oldest and the sickest society, which is stated in the HSE service plan and is stated Government policy, namely, that it will reduce the number of discretionary medical cards while announcing that €35 million will be ring-fenced for GP care for those under six. By ring-fencing that money for GP services, the Government is taking it from those who are the sickest and the oldest in our society who need it most.

Even at this late stage, would the Government not revisit that policy where it is taking cards from children with Down's syndrome, who are over six, elderly people who have life-limiting illnesses and conditions, people with motor neurone disease and people who have had double mastectomies? What is happening is criminal and yet the Government is saying that the under six policy is one for delivering health care. It is not, it is the opposite.

A question, please.

Clearly, what the Government is doing is ensuring that those who need the supports of the State most do not get it and that those who can afford them will be able to access their GPs for free. Would the Tánaiste not agree that if the Government is genuinely interested in social solidarity that it should revisit this and ensure there is funding in place for those who need it most? We can address the issue of universality when conditions improve but in the meantime, we should not ask the old and the sick to pay for this particular policy.

I know that Fianna Fáil is opposed to the Government plans to extend free GP care to children under six.

The populist thing would be to welcome it and to ask for more.

However, that does not justify distorting the facts. The facts are that the provision of free GP care for those under the age of six was additional funding which was provided for in the budget last year.

The Tánaiste should read the HSE service plan.

As the Deputy well knows, that policy is the start of the phased introduction of universal free GP care as part of our policy to transition the health service to one where there is universal health cover.

In regard to the general issue of medical cards, as I said earlier, there are now more medical cards in circulation than at any time.

Second, everybody in this House, and anyone reasonable, would accept that from time to time it is necessary to review who has a medical card. I do not think anyone would justify a situation where, for example, payment is made for medical cards that are either no longer in use or where a person has passed on. I acknowledge that the way in which the review of medical cards has been conducted has caused and is causing a lot of distress, in particular to elderly people. I have talked with the Minister about it and the approach I outlined about additional care being taken in terms of the way in which reviews are conducted, and additional time being made available to people where there is a proposal to withdraw a medical card, is the route to go.