Yesterday, the Government accepted that it could no longer stand over cases of people with acute medical conditions and multiple disabilities losing their medical cards. It accepted that discretionary cards should be restored to 15,000 people in that category who lost them, until at least July 2015. Those people, however, will get no refund even though the Government has accepted that it wrongly took the cards from them and has inflicted considerable costs on them.

The Carers Association yesterday estimated that losing the cards would have cost many families up to €1,200 a month. Young Katie Connolly’s condition would cost her family €7,000 a year but she lost her medical card. The Government caused that family considerable distress. This money should be refunded. Will the Taoiseach put in place a mechanism to facilitate that?

I asked the Taoiseach yesterday about the other 15,000 who had lost their medical cards. What is to happen to them? They will not get them back. Over 30,000 people lost their medical cards, according to the Government’s statistics. Only 15,000 are getting them back. Some were paralysed with fear and shock and were not in any position to respond to the infamous letters sent out over the past two and a half years.

Yesterday’s decision also creates further injustices. Thousands of people who since 2011 would have applied for discretionary medical cards, who have acute conditions and disabilities were governed by the same policy framework that governed the removal of the 30,000 cards. They have been refused and will get no medical card, although the Government accepts that the policy framework was wrong and is giving cards back to 15,000 people who lost them as a result. Anybody who receives a new diagnosis in coming weeks or months will be governed by the policy framework the Taoiseach said was wrong, an admission which occasioned his decision to restore the card to 15,000 people. The Taoiseach has to accept this is a shambles and is inconsistent and incoherent.

It is a disgrace.

Will a refund mechanism be put in place for the 15,000 people who lost their cards, which are now being restored to them? Will the policy framework change for those who applied for cards since 2011, with conditions similar to those of the 15,000, but who never got them? What policy framework will apply to people who are newly diagnosed with severe conditions and multiple disabilities who apply for a discretionary medical card?

The Deputy has asked a range of questions. The Government accepts, and the Minister for Health made quite clear, that it is completely unacceptable that families were put through the stress and strain that arose from the decision to centralise the assessment for medical cards. I pointed out to Deputy Martin yesterday that under the Health Act 1970 the cards are governed by the phrase “undue hardship” and circumstances that apply thereafter for access to medical facilities, as distinct from the particular kind of card.

Yesterday the Government made a clear decision to make €13 million available to deal with the return of cards to people who had lost them since July 2011 on a discretionary basis. When a person applies for a medical card and is turned down discretion is applied and in many cases extended, depending on the range of medical circumstances that apply, the general income of the household and so on. When the review was carried out people lost their cards. The Government’s decision yesterday was very clear. It will cost €13 million to return cards to those who lost them on the review which began when centralisation started in 2011.

One of the senior personnel at the Health Service Executive confirmed this morning that it is working flat out to ensure that within the next four weeks those cards will be returned to those 15,000 people, 13,000 of whom received a general practitioner card.

The Deputy mentioned people who applied or were unable to respond because of their particular challenge, difficulty or medical circumstance. The HSE will of course take those circumstances into account because it has to. People can be stressed or under pressure, or for various reasons may not be in a position to respond in the way that one might expect. I know for instance of a couple of cases in which people with motor neurone disease were asked by the computer to respond. They were unable to speak and move and therefore could not respond.

Blame the computer.

It was the computer's fault.

It was the computer's fault.

The decision yesterday was very clear. Those who lost cards granted on a discretionary basis as a result of the review system will have those cards restored.

Was the Taoiseach talking to the computer as well?

He should reboot it.

The circumstances of those who were unable to respond for whatever reason have to be taken into account. The Minister for Health was clear yesterday about the non-payment of compensation. In many of the individual cases long-term illness facilities covers the vast majority of the facilities, aids or appliances people - child or adult - might need.

The Taoiseach did not answer my questions. My fundamental point is that there is inconsistency and incoherence at the heart of the decisions he has taken, particularly yesterday’s decision. A child born today with a rare syndrome will be subject to the framework under which 15,000 lost cards which are now being given back. That child will not get a medical card irrespective of the rarity of the syndrome.

In 2013, the Taoiseach and the Minister for Health signed off on the HSE service plan which said there would be policy changes that would bring discretionary medical card numbers down to approximately 50,000. There were 63,000 discretionary medical cards at the beginning of 2013, and 50,000 at the end of the year, as a result of the Government’s policy decisions. Anybody with severe conditions who applied from 2011 on was refused. Those people did not have cards before 2011. How will the Taoiseach rectify the injustice to those people?

The Taoiseach mentioned motor neurone disease. How will somebody diagnosed with the condition in the next three or four months get a discretionary medical card? The same question arises for a child with multiple disabilities. There is a fundamental incoherence and inconsistency here and the Taoiseach needs to deal with that. What has been proposed to date is not satisfactory. Does the Taoiseach accept that his decision is inconsistent and incoherent?

No. I do not accept that at all. There is no inconsistency or incoherence in the decision the Government made yesterday. That decision was very clear.

There were no changes last year.

There were no policy changes.

What about the people who did not get them?

They will not get them.

The Government decided to make €13 million available for the return of discretionary cards that were taken away from people in the review system.

The Minister for Health has set up the clinical assessment panel to move to a situation in which the medical condition of a person applying for a new card today can be used to give that person access to medical facilities. Over 1,000 submissions have already been received.

Sometimes Deputy Martin avoids things that are important. The Minister made it clear yesterday that in the cases he mentioned, such as a child born today with exceptional circumstances-----

I am not talking about the exceptional. This is one of-----

The Deputy is talking about exceptional circumstances. There is no inconsistency in this.

The Taoiseach is not changing the policy framework. He is only doing this for those who lost the cards before 2011.

The right of the director of the HSE to have the discretion to allocate cards on the mercy principle applies.

Yes, but that is not happening.

Equally, a doctor can say that a person - a child or an adult - needs a emergency card to deal with his or her circumstances. There is no inconsistency and no incoherence.

There is total inconsistency.

The decision is clear. Some €13 million is being made available to restore the medical cards that were taken away following the review of cards allocated on a discretionary basis. The HSE has confirmed this morning that it is working flat out to make sure all of those people get their medical cards back inside the next four weeks.

They should not have been taken off them.

That is neither inconsistent nor incoherent.

It is inconsistent because nothing is being done to help the other people.

What about the cases from 2011?

This decision was made after listening to stories of the pressure that is on so many people. I admit that obviously these things should not have happened, with the pressure and the strain they put on many families.

We told the Government but it would not listen.

We are moving to a new system. That is all under way.

The consequences of the targeting of discretionary medical cards cannot be in doubt. The claim that these consequences were unintended absolutely does not stand up.

It was totally intentional.

This decision has been defended by the Government and by a whole series of voices. The Taoiseach's reference to the centralisation of the processing of medical card applications is merely a smokescreen to cover the Government's embarrassment and hide its shame. The Minister, Deputy Reilly, indicated yesterday that he has received categorical assurances from fellow Ministers - he did not say "all Ministers" - that the €13 million projected cost of reissuing these cards would be new money for the health budget and would not result in cuts elsewhere across the health services. Who are these Ministers? Has the Minister, Deputy Reilly, received a full Cabinet assurance that additional moneys will be provided? Is consideration being given to not utilising this year the moneys that were set aside for 2014 to facilitate the roll-out of free GP care for everyone up to the age of six? Is it possible that some of those moneys will be employed in this regard?

On "Morning Ireland" this morning, the director of primary care, John Hennessy, outlined three criteria that are being taken into account. The second of those criteria is a requirement for the person in question to have completed a review process during the relevant period. There is a huge discrepancy between the number of people in that category, which is 15,000, and the number of cards that have been removed, which is 30,000. There is no doubt in the minds of Deputies across this Chamber that many people who had their so-called discretionary medical cards taken from them looked at the situation and decided there was no point in proceeding with the review process because they could see nothing other than a rollercoaster of culling. Are people who validly held medical cards but did not proceed with the review process to be excluded from consideration now? If the criteria that have been laid down are used, their hurt will be compounded. The primary care reimbursement scheme, which is overseeing the reimbursement of medical cards-----

Sorry, Deputy, you are over time. Would you put your question please?

My question relates to the need to reimburse families, many of which have children with grave illnesses and disabilities, for the costs they incurred and could not afford over the period from 1 July 2011 to 31 May 2014. That also needs to happen.

I appreciate the way the Deputy has phrased his question. One of the issues that arose when the assessment system was centralised was the clear difference between what was being done at various locations throughout the country. People would say, "How come that person was able to get a card when I could not even though I am in the same circumstances?".

It was decided to take them all away.

Stick with your scrap metal Bill.

The backbenchers voted for it.

The evidence was that in some locations around the country, the allocations were much higher than in other locations. The centralisation of this process was not a smokescreen. It was designed to ensure the assessment would be fair for everybody. Clearly, there were enormous difficulties for some Members in that regard. It was not a smokescreen at all.

It was a cloud.

Deputy Ó Caoláin's second point related to the endorsement of an extra €13 million for the Minister for Health in respect of the return of 15,000 cards to people who lost them following the discretionary review.

Are we taking that off?

That is a Cabinet decision. It is a collective decision of all the Ministers of the Cabinet. It is endorsed and decided unanimously in that regard. I hope that deals with the Deputy's second point. The Minister has already dealt with the question of compensation.

He has not dealt with it.

The important thing is that the Government has made a clear decision to provide extra money to return 15,000 cards to people who held medical cards or GP cards on a discretionary basis and who completed the eligibility review between 1 July 2011 and 31 May 2014.

The ballot box is powerful.

As I pointed out in response to the earlier question, if people were not in a position to respond to the review or complete the range of questions for certain reasons-----

They might have been sick.

-----that matter has to be taken into account by the HSE, as confirmed this morning.

Only for the local elections, they would be getting no cards back.

On that last point, it is very important that the door is not closed on those who did not respond for a variety of reasons. Many people felt intimidated by the entire barrage that came from the Government, which insisted that this cull must take place in the interests of so-called probity. I hope the door has been left open for such people. Will there be a process of appeal or review for those who have had their cards cut over the relevant period, but who do not receive a letter in the coming weeks as Mr. Hennessy has indicated? Will there be an opportunity for them to present again? What about those who applied for cards on discretionary grounds over the relevant period and had their applications refused? Given that the same criteria of assessment were applied to such people between 2011 and 2014, surely they are equally entitled to have their positions taken into account now.

Those who were holding discretionary medical cards - many voices on the Government benches claimed that such cards never existed - were not the only people to be targeted. What about the over 70s who were targeted during the exact same period? I know of many cases of people over the age of 70 who have gone through undoubted anguish and suffering because they have lost their medical cards and have to depend on GP-only cards, which are very inadequate replacements for what they previously had great faith in.

All of the Deputies on the other side of the House voted for it.

The Deputy has raised a number of questions. The Minister for Health requested a detailed examination of the status on 1 March of this year of the holders of the 78,000 discretionary medical cards that were in circulation on 1 March 2011. I will give the House the relevant information that emerged from that process. On 1 March last, some 33% of them - or 25,398 individuals - still held medical cards on a discretionary basis; some 49% of them - or 37,906 individuals - held medical cards based on assessment of means; and some 19% of them - or 14,621 individuals - no longer held medical cards. Within the latter group, some 2,521 people, or 3% of the total figure, were deceased; some 5,145 people, or 7% of the total figure, did not respond to correspondence from the HSE; some 1,522 people, or 2% of the total figure, initially engaged with the HSE did not complete the review process by providing all the required documentation; and some 5,433 people, or 7% of the total figure, completed the review process only to be found to be ineligible for a medical card. That is the current status of the 78,000 people who held medical cards on a discretionary basis in 2011, based on what happened them between 2011 and March of this year. Those who had their cards granted as part of the discretionary allocation, but lost those cards on review or assessment, will have those cards restored. That will account for a portion of the €13 million cost that the Cabinet approved collectively and unanimously yesterday in order to deal with this matter.

I will not have time to deal with the other elements of Deputy Ó Caoláin's question.