Last year, the Taoiseach made an apology regarding discretionary medical cards. He apologised to the people and stated that the Government had to take remedial action to make up for the unintended consequences of the savage review that was in train at the time. He stated that the Government had announced a new plan that would bring flexibilities, local input and discretion. Certainly, there were improvements and many people had their discretionary medical cards restored. Nevertheless, I put it to the Taoiseach that there are still very serious issues with quite a number of children who have very serious conditions and illnesses.

I know of a case involving a nine year old girl with B-cell lymphoma, which is a very rare cancer. The story is in the public domain. She has had surgery and intensive chemotherapy but despite considerable submissions to the HSE, she has been denied a discretionary medical card. We pursued the issue when we heard about it. She is under the care of a medical team in Crumlin which has also made submissions to the HSE. The mother has had to give up work and the issue has caused immense strain and anxiety. I put it to the Taoiseach that parents should never be put in this position, particularly when children have such serious conditions. Last week, a family travelled from Mayo with their 18 month old son, Ryan, who has Down's syndrome and also has a significant cardiac condition, apnea, and so forth. They were accompanied by the Our Children's Health campaign. The Taoiseach wrote to Ryan's mother, Nichola, indicating that he trusted the issue would be resolved to her satisfaction as soon as possible.

This year, it is intended to roll out free GP care for children aged under six. That is fine. Many people cannot comprehend how two young people in this position, in one case the child is over six but in the other the child is 18 months old, can still be denied full medical cards despite all the talk of flexibility and applicability of local inputs. This is happening while perfectly healthy children aged under six are to receive free GP care towards the end of the year.

Will the Taoiseach ensure that what he stated last year will apply and there will be common sense and flexibility applied to very serious cases? I should not have to raise such cases on Leaders' Questions and I am only doing so because it is the last opportunity I have to achieve some realism and common sense in the two cases I mentioned. I have been working on the case of the nine year old child for some time now. Yesterday, officials indicated it would be another year before the discretionary card system would be in place. I do not think that is correct. Perhaps it was a reference to the new flexibility or the new medical panel. Children in these cases cannot wait. I ask the Taoiseach to intervene. How can he justify rolling out the programme for children aged under six while at the same time denying a medical card to children who are over six years?

Where is the Minister hiding?

I do not want to comment on the details of a particular case. In some cases, a card was refused on the basis of income. The Keane report commissioned by the Minister considered whether cards could be granted on the basis of an illness and it indicated that this was not morally, ethically or in any case justified. The application process goes back to the element of discretion. An application would be made and the case of a child or children would be considered by discretion. That process is much more flexible than it used to be. There has been an increase from approximately 52,000 discretionary cards issued in the middle of last year to over 77,000 at the end of December 2014. There is a far greater degree of common sense and sensitivity applied here. There is also the question of checks with local medical and health officials to see if there are local issues or changes in circumstances that apply.

I note the Deputy's comment in respect of the first case he mentioned, where one of the parents has given up work. That would lead to a change in income circumstances for the family. Access to facilities and treatment is important in these cases, including issues that might arise for the children involved. My understanding of the second case is that the child has access to the long-term illness and GP card, as well as the facilities that the child needs. I understand that whatever is the medical requirement of the child has been approved. If the child needs orthopaedic shoes, they will also be made available, depending on when the child would be fitted.

I do not have the details of individual cases around the country. The Minister has made it very clear that we need a degree of common sense and, where discretion has to be considered, it should apply. If the Deputy has different information, I will certainly make it available to the Minister for Health, who is very anxious about these issues. Nobody wants a case of a sick child not having access to medical facilities and treatment. As has been indicated, until one gets to a universal health scheme, there will always be people over the limit for a medical card application. This leads to the question of discretion for circumstances that arise.

Without detailing the individual circumstances of children or any individual here, I hope the point mentioned by the Deputy about a change of circumstances in the case is checked. I do not accept that there should be a wait of 12 months before a decision can be made about a discretionary card, as that is clearly not true if we have gone from 52,000 to 77,000 discretionary cards issued in the past six months.

With young Ryan's case, 50 pages of information has been sent to the HSE and the long-term illness card does not cover all the aids and facilities required by the child. The Taoiseach is claiming that by the end of the year, free GP care for children aged under six will be rolled out, so there is no justification for this kind of behaviour. In October, the Taoiseach indicated his hope that the case would be resolved to the satisfaction of Ryan's mother; it has not and 65,000 people have signed a petition in that regard.

I do not wish to mention the name of the little girl, although it is in the public domain. There was a submission from Dr. Aengus Ó Marcaigh, consultant haematologist, which outlined very clearly that the diagnosis and treatment has required the parents of the child to provide a level of care which is greatly in excess of that normally required by a child of her age. The mother wrote that her daughter has been diagnosed with B-cell lymphoma, a very rare cancer, which is being managed by a medical team consisting of a number of consultants. The medical condition is constantly evolving.

In such cases, parents want security and they do not need the stress and anxiety that the endless toing and froing with officialdom brings while they are dealing with a very sick child in hospital. It seems there is no acknowledgement or recognition of that when parents are in such very difficult circumstances.

What about the GP card?

There is a juxtaposition of very healthy children getting free access to GP care but very sick children aged over six still being denied the medical card, which could provide a significant degree of security and reduce worry and stress levels. It would also be of practical help because of the frequent visits to GPs and the need for medication arising from this condition.

The Taoiseach did not answer the core question of how we can justify this as a society and children like this can be left in such a position. The Taoiseach apologised and promised flexibility with respect to medical cards.

These cases do not illustrate any such flexibility or common sense being applied to genuine situations.

Nobody believes that parents should be stressed or put under pressure in respect of their children. That is one of the reasons the Government has the objective of introducing universal health insurance in the long term. In the short term, nobody wishes to see parents stressed by difficulties with their children. Clearly, a far greater degree of discretion has been applied because 22,000 extra discretionary cards were granted from mid-2014 to the end of 2014.

They were the cards that were taken in the first place. They are not new ones.

The important issue is whether there is an outstanding treatment, facility or product that either of the two children needs, because parents need to know that they are not blocked from access to the treatment and facilities. In the second case, my understanding is that everything the child requires is being made available. If Deputy Calleary has different information on outstanding facilities or products that are required by these children, he should make it available to the Minister for Health.

With regard to the analysis of the discretion, the Our Children's Health group was outside Government Buildings for a number of months and I met its members on many occasions. They are very reasonable people and they are now working with the clinical team in assessing discretion for treatment and facilities for children. There is local check-back every week. If 22,000 extra cards have been issued on a discretionary basis, I would hope that the HSE could see that common sense is applied to these cases. I do not have all the details of the individual cases because I do not work in the HSE, but is there a product, facility or access to a treatment that either of the two children is not receiving?

Just give the card.

We cannot have a situation where people are put under that pressure. The Keane report was commissioned to report on whether to give medical cards on the basis of an illness and it said that cannot be.

I have issues with that as well.

Therefore, one goes back to the income threshold and discretion after that. It is in the application of the discretion that the Deputy's question, which is a valid one, must be dealt with. As the Deputy has raised the matter, I hope the people dealing with this can tell us what is outstanding for either of the children in terms of treatment, facility or product.

The Taoiseach knows what a medical card provides. It gives one access to a GP and to a range of things which this young girl does not have.

The Deputy has put his question. He has had a good run and received five minutes more than his allocated time. I call Deputy Adams.

Clearly, what is outstanding is the Taoiseach's commitments that he made four years ago.