It has been one year since the tragic death of Private Seán Rooney, a member of the 27 Infantry Battalion in Dundalk. Today our thoughts and prayers are with his family and friends.

There seem to be more and more problems for cancer patients applying for a discretionary medical card. A discretionary medical card gives you the same services as a means-tested medical card. However, a few of my constituents have not qualified for a medical card based on the means test. If someone is self-employed, young, without private health insurance, ineligible for a medical card or does not have savings, he or she is left in the very vulnerable position of being unable to manage basic expenses such as heating and travel to hospital for treatment. We are hearing from an increasing number of these people. It is only right that a discretionary medical card be granted to people who are over the financial means test but would suffer "undue hardship". However, the issue is that the discretionary medical card application process is the same as that for a means-tested medical card whereby you also must provide information about your family's medical expenses.

My office regularly sees constituents coming in with long-term illnesses who are struggling to get the services or medicines they need. There are people coming to me whose lives have changed due to a cancer diagnosis and are concerned that they may find themselves out of work due to the need for treatment. Many of these people are faced with a financial burden they cannot afford. At a time of utmost need, I have a constituent who is a cancer patient with very ill health who knows they are over the means test yet is being sent around the houses to gather private pension information for a family member who has no interest in applying for a medical card.

Why are we making it significantly more difficult for cancer patients to be awarded discretionary medical cards on the grounds that their diagnosis causes undue financial hardship? This is not only causing undue stress for the person but is doubling the work of the medical card approval section. Where is the efficiency? It is ten years since the HSE looked at medical card eligibility on medical grounds and how effectively the system of assessment for a discretionary medical card is working. Will the Taoiseach consider a review of the medical card eligibility and assessment process, especially for those with a medical condition? It is crucial that we review the recommendations from the 2014 report of the expert panel on medical need for medical card eligibility to see if those recommendations have been implemented and if they are working and are fit for purpose in 2023 and 2024.

I thank the Deputy for raising this issue. It reflects the hardworking nature of the Deputy in terms of the cases that come to him via his constituency office and the people he meets on a regular basis and I respect that. More generally, I would make the point that there has been record investment in health since this Government came into office. This has focused a lot on reducing costs for patients generally. We have removed inpatient hospital charges and have had the biggest expansion of access to free GP care in the history of the State, including an expansion of free GP care to children aged under eight and people earning no more than the median household income. We have reduced the drugs payment scheme costs, funded diagnostic scans for patients and agreed a new consultant contract to which approximately 1,000 consultants have already signed up.

Regarding medical card eligibility, there are approximately 1.6 million medical card holders in the country and over 623,000 GP visit card holders. Some 185,000 have access to discretionary medical cards and in many cases these are people with illnesses who would not normally qualify because of the means test but they do qualify because of the nature of their conditions and illnesses. As the Deputy noted, people who cannot without undue hardship arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card on a discretionary basis. This is then determined by the HSE.

It has always been a long-standing position of both the Department of Health and the HSE that medical cards be allocated on the basis of a means test threshold as the fairest way, as opposed to condition-based mechanisms. As the Deputy said, we have introduced discretion, particularly since March 2021. Persons who have been certified by their treating consultant as having a prognosis of 24 months or less are now also awarded a medical card. That reflects a programme for Government commitment to extend eligibility for medical cards to persons with a terminal illness.

As regards the expert panel on medical needs and medical card eligibility to which the Deputy referred, and as to whether eligibility should be determined on the basis of a particular disease or illness, that group concluded in 2014 that it was not feasible, desirable or ethically justifiable to list medical conditions in priority order for medical card eligibility. It has stuck with the means test process. Where the HSE can operate its discretion, other costs, or the costs of the illness, can be taken into account in respect of enabling a person to be eligible for the medical card.

The Deputy might have a number of cases. I would be interested in getting examples of them in order that we could reflect that or, if there are gaps in the system or in the situation we have, that that could be remedied.

The word "cancer" puts fear into every household in the country. It changes people's lives. I guarantee the Tánaiste that not one person in this House does not have examples similar to those I will give him today. The bottom line is that if you are not working, you are not earning. I had a self-employed man come into my office this week whose wife was diagnosed with cancer. He is self-employed and he has to start working. The wife is in hospital getting treatment. I refer to the simple things of getting children up in the morning, taking them to school and cooking their meals. They are trying to remain a normal family.

It has been ten years since this system has been looked at. There is no better man than the Tánaiste, a former Minister for Health, to understand this situation. We can all talk about money being spent and everything else, but there is a lot of hardship and a lot of suffering among normal families at the moment, and it is not fair. When you see a husband come into your constituency office with his three children and his wife in hospital, it is wrong. When they have to chase around family members looking to fill in forms and everything else, it is absolutely dreadful. The last thing they want to be worrying about is who will pay the bills. Just because you are working today and may be earning good money does not mean that something will not happen that will stop you working and earning.

The doors opened by the medical card are unbelievable. It is ten years since this was looked into. I am asking the Tánaiste to give us a commitment today that he will try to help ease the hardship of these families who are suffering. One of them has a cancer condition.

I thank the Deputy for raising those issues. Since 2015, medical cards are awarded without the need for a financial assessment to children under 18 years of age with a diagnosis of cancer. More broadly, the Government took a position whereby if there was a terminal prognosis of 24 months, the Government would facilitate the granting of a medical card. In other words, eligibility does not relate to a specific illness. There is neurological disease, which can shorten a person's life significantly, heart disease, COPD, stroke - there is a whole range of conditions that essentially mean a person's prognosis is terminal. The Government has taken the view that, based on the diagnosis of any particular condition, if the prognosis is 24 months or less, a medical card will issue.

On a more general level, we have dramatically expanded medical card coverage to try to cover the situation the Deputy has outlined, particularly in terms of the median income, which has been a very significant expansion of the card. Again, I would be interested to hear the details of some of the cases the Deputy has identified.