Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

The point is that more than 80,000 people had such an entity for a number of years and had been granted a medical card on discretionary grounds based on their illness.

Deputies who have already spoken on this Sinn Féin motion have outlined some terrible examples and every Deputy in the House has come across it. Time and again people's discretionary medical cards are being withdrawn and people who are applying for one on a discretionary basis because of an illness are not being granted them. That is a fact of life and that is what is happening. My difficulty is that there seems to be this official wall that has decided to brazen this out and I cannot understand why.

The former Ombudsman, Ms Emily O'Reilly, stated clearly that while there was not substantial change to the policy, the issue of discretion was being shrunk to the point where medical cards were not being awarded. I have frequently quoted her report in the House with regard to the discretionary element.

What is most bizarre is that the Minister, Deputy Reilly, the Minister of State present, the HSE and others have decided to ring-fence €35 million for children aged under six. Although the Minister of State has not said it, he is ring-fencing €35 million away from people who genuinely need medical cards in terms of the illnesses, or physical or intellectual disabilities they have in order to fund this project.

As my party's spokesman I have said repeatedly in this House that of course universality is something to which most of us subscribe. However, when we have limited finances we must cut our cloth according to measure. Any measure of a decent society would suggest that we should give a medical card to a person who has an illness, disability or congenital disease before giving a GP-visit card to a child aged under six who may come from an affluent background and does not need it in the first place. That is a decision the Government has made. The Minister of State can dress it up whatever way he likes, but until such time as he can come into the House and convince me that the Government is not taking the medical cards that have been awarded on a discretionary basis to fund the GP-only medical cards for children aged under six, then I have a difficulty in supporting the Government's project for universality for GP-only medical cards for children aged under six because it is inherently and deeply unfair.

The Minister, Deputy Reilly, has told me that he is a republican and that he lives in a republic. We have seen that word abused many times, but in this context nobody could stand up in this Parliament and say it is right to apply universality to children aged under six when we are taking medical cards away from people while undertaking a review of their medical evidence, people with Down's syndrome, congenital heart disease and people who are 90 years of age and are incontinent and blind. Where are we going? Any fair rational assessment of what we stand for as a people would suggest at the very least that we should first look after those people. If resources are then available, of course we should spread it out to ensure that as many people as possible have access to GP services. However, it defies belief for the Minister of State to come in here and try to convince me that there is not a problem.

If the Minister of State does not want to believe me, he should believe the replies he gave to parliamentary questions which show that the number of medical cards awarded on a discretionary basis has reduced from roughly 90,000 at one stage down to fewer than 50,000, which indicates there must be a targeting and culling of medical cards.

People who were previously granted a discretionary medical card based on certain types of illnesses can no longer get them. Deputy Ó Caoláin referred to motor neuron disease. By and large people who contracted motor neuron disease in the past would have been awarded a discretionary medical card regardless of means. This is a disease for which there is no cure. They will die from it and yet we drag them through a system that is heartless, bureaucratic and is set up purposely to discourage people from applying for a medical card on a discretionary basis.

The word coming back from the PCRS appeals process is that they are outside the income guidelines. We all know they are outside the income guidelines, but people have genuine illnesses, some of them terminal and some very serious and they still cannot get a discretionary medical card. The Jack and Jill Children's Foundation has repeatedly stated that some of their clients have reached crisis point with regard to the application of the discretionary card.

We have had it with terminal illness, including cancer. I have highlighted these on numerous occasions. We have been raising the issue on this side of the House for two years. I have sent on details to the Taoiseach on numerous occasions. I do not expect the Taoiseach to be involved in every particular application for a medical card, but I wanted to highlight what is happening in our society. The Minister of State has told us we will have a universal health system but the difficulty is that those who need it most will have universal access to a GP if they are aged under six.

However, once they are over six years of age, they will lose the GP card because of age and will not qualify for a discretionary medical card because of their illness. I cannot reconcile that. If the Minister of State genuinely thinks he will get plaudits for giving a healthy, wealthy five year old a free GP card while taking a discretionary medical card from a child with Down's syndrome, I think we are living in a banana republic. It is unfair and unjust.

When the human papillomavirus vaccine for girls was not brought in one year, the Minister said the former Minister, Mary Harney, was criminally negligent. I would never go that far but the Government is morally bankrupt if it thinks this is a good idea. I have no difficulty looking at the broader issue of universality but we should prioritise according to the need of individuals as opposed to a cohort of people who may not need medical cards at all. I would like to think most people in society with a reasonable income and young children would willingly pay for their GP knowing that if a crisis hit the family, for example, if a child got very sick, contracted a very serious illness or had an accident, the State would support them then. In the meantime, while resources are limited, would they mind going to the GP the odd time and paying? I think most people are fair. The Government has made a decision which is entirely wrong, unjust and should be reversed immediately. We cannot ask the sickest, the oldest and some people who are dying to fund those under six years of age.

There has not been an increase in the budgetary allocation.

See this speech in context