Micheál Martin (Cork South Central, Fianna Fail)
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It is fair to say that one of the issues that had caused the greatest offence to the people we met on the doorsteps in recent weeks, irrespective of whether they were affected by it, was the policy position of the withdrawal of discretionary medical cards from very sick people, children with multiple disabilities and people with life-limiting and life-threatening conditions. To be honest, every Deputy heard shocking stories on doorstep after doorstep that went to the heart of the Administration's insensitivity - for example, of people terminally ill with cancer and brain tumours who had their cards taken from them.

We have been raising these issues with the Taoiseach and the Minister for Health, Deputy Reilly, for more than two years. I have raised them on Leaders' Questions a number of times. We got denial after denial of a change in policy and a lot of bravado from the Taoiseach. We got a metaphorical smacking down, with claims that we were scaremongering and so on. Lo and behold, a week or two ago the Minister for Finance stated that change was on the way but that, because of the looming elections, he would not tell anyone about it lest he be accused of electioneering and that he would tell us all about it in the elections' aftermath.

This issue has offended people's sense of decency. Many who never held medical cards told us that, whatever we did, we should look after those who were sickest first. Will the Minister confirm that the policy of withdrawing discretionary medical cards will stop and that those that have been withdrawn from sick people will be restored? Will new legislation be published to underpin the granting of medical cards to very sick children, irrespective of age, as well as to people with life-limiting and life-threatening conditions?

Michael Noonan (Limerick City, Fine Gael)
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I thank Deputy Martin for his question. It is reasonable to accept that people want a system of medical cards that is sensitive to families' needs and can operate on a case-by-case basis. The Government will certainly examine this. Taking medical cards from very sick children is not acceptable. This cannot be changed overnight, but the Minister, Deputy Reilly, and Minister of State, Deputy White, will look at some of the issues that have arisen.

Michael Healy-Rae (Kerry South, Independent)
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They have been looking at them for a long time.

Michael Noonan (Limerick City, Fine Gael)
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The Government has made clear its commitment to delivering on the implementation of a GP service for the entire population as part of the move to universal health care.

Everybody understands, however, that a medical card system that costs over €2 billion a year and where 42% of the population holds a medical card needs to be reviewed periodically. In 2013 alone, the Health Service Executive awarded 100,000 medical cards of which over 23,000 are on a discretionary basis.

The Minister also did a review and an analysis of the medical cards removed from people and it might be interesting, now that the battle on the streets is over, to hear the actual facts.

Michael Noonan (Limerick City, Fine Gael)
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The position is that over 77,925 discretionary medical cards were in circulation on 1 March. Their status on 1 March 2014 was as follows: 33% still held the medical card on the discretionary basis, that is, 25,398 people; 49% of those who had a medical card have retained their medical card based on an assessment of means. They still have their card but now on different grounds. That is 37,906 people. Some 19%, or 14,621 people, no longer hold the medical card. That 19% is made up of 3% who, unfortunately, are deceased, that is, 2,521; 7% did not respond to the correspondence from the HSE, that is, 5,145; and 2% did not complete the review process after initially engaging with the HSE, for example, documentation was not provided, that is 1,522 people; and 7% completed the review process and were found to be ineligible for medical cards, that is 5,433. Of the 77,925, 7% lost their medical card on the review system.

Obviously, this is a serious issue. The Government is committed to examining the situation again. I repeat that the Government does not agree with a policy of taking medical cards from sick children. As I said, the responsible Ministers will examine this at the earliest possible date and announce the changes they will make subsequently.

Micheál Martin (Cork South Central, Fianna Fail)
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The Minister said the policy will not be changed overnight. It was changed overnight. Legislation was not introduced to take the discretionary medical cards from approximately 30,000 people over recent years. It got so bad the Minister of State, Deputy Alex White, said that there was no such thing as a discretionary medical card. He has said that on the record and now the Minister has come in here and faithfully outlined all the discretionary cards that are again in the system. We either have discretionary medical cards or we do not. The Minister is experienced enough and around here long enough to know that we always had discretionary medical cards, and it was covered under the Health Act 1970. There has been an attempt of late to try to muddy the waters regarding the legislative validity of all that and hence the need to do all these reviews. The Minister of State, Deputy Alex White, stated on the record of the House that there never was discretionary medical cards but of course there was. There is no question that someone took budgetary decisions to get savings in the Department of Health.

Michael Healy-Rae (Kerry South, Independent)
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And Government decisions.

Micheál Martin (Cork South Central, Fianna Fail)
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Pressure came on the medical card system and the ones that were focused on were the discretionary medical cards.

This issue was raised long before the elections. It was raised over two years ago. The Jack & Jill foundation is saying that in the past two years the policy became particularly vicious, and it deals with children with significant life-limiting and life-threatening conditions. It has been driven to the unprecedented step of writing very strong letters to the Taoiseach and to the Minister for Health. We got indications in recent weeks from the Taoiseach, the Minister, Deputy Noonan, and his colleague that changes would be made. Is the Minister now saying that has been long-fingered again and that that was only said in the past week or two to try to ease the pressure-----

Michael Healy-Rae (Kerry South, Independent)
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For the election.

Micheál Martin (Cork South Central, Fianna Fail)
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-----or will we definitely get change? Will there be a more definitive, clear policy in terms of both holding discretionary medical cards for those who desperately need them and restoring them to those very sick people who need them urgently?

Michael Noonan (Limerick City, Fine Gael)
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Eligibility for medical cards has been somewhat fraught over the years and it becomes a political issue periodically but despite the review carried out by the HSE with the Department of Health, of all that were reviewed since budget time, 96.4% of those assessed continue to be eligible for medical cards, therefore, 3.6% of those reviewed lost their medical cards.

One of the reasons the economy is growing and people are going back to work again is that the Government has controlled public expenditure. When there is a big block of expenditure, such as €2 billion, on medical cards it is reasonable that would be the subject of a review. The review was carried out and 3.6% of those reviewed lost their medical cards, but Deputy Martin should not be sanctimonious about this issue. He promised a review of eligibility in 2001. He did not do it. He promised it again in 2002 but did not do it. He promised it again in 2003 but did not do it.

Micheál Martin (Cork South Central, Fianna Fail)
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I did actually.

Barry Cowen (Laois-Offaly, Fianna Fail)
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The Minister did the review.

Michael Noonan (Limerick City, Fine Gael)
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Fianna Fáil had a commitment to review medical card eligibility in its 2007 manifesto-----

Barry Cowen (Laois-Offaly, Fianna Fail)
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Did they?

Michael Noonan (Limerick City, Fine Gael)
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-----an election it won, and it did not do it then either.

Robert Troy (Longford-Westmeath, Fianna Fail)
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They did not take them from sick children and sick and dying people.

Michael Noonan (Limerick City, Fine Gael)
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The Deputy does not have to be sanctimonious.

Barry Cowen (Laois-Offaly, Fianna Fail)
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That is getting you plenty of votes.

Michael Noonan (Limerick City, Fine Gael)
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When that is added to the financial mess his party left behind when it abandoned office, the Deputy should take part of the responsibility.

Gerry Adams (Louth, Sinn Fein)
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The Minister said that taking medical cards from very sick children is not acceptable but that this cannot be changed overnight. Why can it not be changed overnight? He also said that 93% of sick citizens had their cards restored but that was after an appeals system, and that very system has many families worn out.

It is very disappointing to come in here and listen to the Minister give the answer he has just given. Obviously, it is business as usual for the Government. Its members hear nothing. They do not pay heed to anybody. They have learned nothing from the election results. Just before the election there was an unprecedented wave of contriteness as opposed to contrariness from Ministers. We saw, on the back of a public warning from Fr. Peter McVerry, an acknowledgement that there was a housing problem despite the fact that members of my party and others had been raising it here for a very long time. The Minister said regarding the crisis over medical cards that the approach to the review of medical cards will have to be changed. Nothing has changed according to the Minister's answer today. We do not need a review. A review is not necessary. The policy must be ended. Our health spokesperson, Deputy Caoimhghín Ó Caoláin, has prepared legislation to restore discretionary medical cards to those who have had them removed but that should not be necessary. The Government should immediately do the decent thing and restore these medical cards. Mar a deir an seanfhocal, is fearr an tsláinte ná an táinte. Having had a chance to reflect for a moment, will the Minister state without equivocation that this Government will stop denying medical cards to citizens who need them?

Michael Noonan (Limerick City, Fine Gael)
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The Government has heard the concerns raised in recent months, and they were raised in a more magnified way in the past few weeks. The economic recovery we are working very hard to achieve is succeeding and we need to continue with stable conditions to ensure the economy grows and that we get our people back to work. In that context we must protect the most vulnerable in society but as I said, the Government does not stand over a situation where medical cards are taken from very sick children. I have also committed that the relevant Ministers, the Minister, Deputy Reilly, and the Minister of State, Deputy White, will address all the issues that have been raised and come up with proposals shortly.

Deputy Adams is addressing the situation as if it was Sinn Féin policy that everybody in the country, regardless of means or illness, should get a medical card. Forty-two per cent have medical cards already, but we do not agree with the Deputy that everybody should get a medical card because the country simply cannot afford that. There must be eligibility for medical cards both on a means basis and an assessment of medical need.

We are trying to move to that position. In 2013, 100,000 additional medical cards were granted. There are approximately 2 million medical cards in circulation, which means that there are now more in circulation than ever before. Some 42% of the population have a medical card. During the review of medical cards, 3.6% of 79,000 people lost their medical card. That is the position. I know there are hard cases and some dreadful ones have been pointed out to all of us. The HSE will be told that the withdrawal of medical cards from sick children is no longer an acceptable option.

Gerry Adams (Louth, Sinn Fein)
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The Minister states the Government does not stand over the withdrawal of medical cards from very sick children, but that is what it does every day. Today there are children who will be refused the help, attention and treatment that they deserve as citizens. The Minister says he disagrees with Sinn Féin. Thanks be to God that he does. I am an Irish republican and citizens have rights. Vulnerable citizens, including the sick, the aged, the young and those whom society needs to protect should be afforded these basic elementary rights. As I said, it is disappointing to come into the House following the recent elections which caused the resignation of the Tánaiste - I wish him and his family well and understand there is trauma in all of this for him and his family, but this is not about personalities, rather it is about policies - and to hear the Minister once again reinforce this policy and say the Government is to stand over it. He has said we cannot afford this, but we can afford to pay big bankers, ministerial salaries and so on. It is almost as if he has his head buried in the sand. On his reference to "hard cases," what does he mean by this? Why does Government not act intelligently and in a swift manner restore citizens' entitlements to medical treatment on the basis of medical need rather than personal wealth?

Michael Noonan (Limerick City, Fine Gael)
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I am not impressed by the Deputy's proclamation of the new republic because it appears that he is committed to unrestrained public expenditure on all fronts-----

Gerry Adams (Louth, Sinn Fein)
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It is about minding the sick.

Michael Noonan (Limerick City, Fine Gael)
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-----and the piling of taxation onto the shoulders of ordinary taxpayers, which will lead to people losing their jobs and, thus, increased unemployment. That is what will happen if we follow Sinn Féin's policies. I asked the Deputy a simple question.

Gerry Adams (Louth, Sinn Fein)
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The Minister should answer my question.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Please, Deputy.

Michael Noonan (Limerick City, Fine Gael)
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Currently, 42% of people in Ireland have a medical card.

Peadar Tóibín (Meath West, Sinn Fein)
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Because of crushing poverty caused by the Government.

Sandra McLellan (Cork East, Sinn Fein)
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Because they are poor.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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They are poor. The Government has left them impoverished. It has not provided jobs for them.

Michael Noonan (Limerick City, Fine Gael)
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Is Deputy Gerry Adams saying the percentage should be 100%? If not, what eligibility criteria would he set? I am saying the most vulnerable children should retain their medical cards which should not be withdrawn in any review. Sick children should not be deprived of medical cards.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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They have been under the Government's watch.

Sandra McLellan (Cork East, Sinn Fein)
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It is happening every day.

Michael Noonan (Limerick City, Fine Gael)
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We have not yet heard Sinn Féin's eligibility criteria. To whom would it not award a medical card?

Seán Crowe (Dublin South West, Sinn Fein)
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The Government is providing for them to be given to those who do not need them.

Michael Noonan (Limerick City, Fine Gael)
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Would Sinn Féin give them to everyone?

Róisín Shortall (Dublin North West, Independent)
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That is what is done in most other countries.

Clare Daly (Dublin North, United Left)
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The big question on everybody's lips is, given that the Government no longer has a mandate, when does it propose to do the decent thing and resign? However, we all know the answer to that question. Rather than focus on that question, I propose to drag the Government back to the real world of families who are trying to raise their children and earn a living and who do not have the luxury of sitting around and wondering who the next Leader of the Labour Party will be or how the spoils of that party are to be divided. These families want to know what the Government proposes to do to improve their lives. The message to the Government following the recent elections is that what it has been dishing out to citizens can no longer continue.

The Taoiseach has told us that he will listen to people. I put it to him that the first test in this regard, with which the Government will be faced in the next two to three days, concerns the imminent strike action by Aer Lingus cabin crew. Some 1,000 cabin crew members have made a last ditch cry for help in their decision to take to the picket lines this bank holiday weekend, including at Shannon Airport, in a dispute over rosters, which dispute, contrary to the expensive and inaccurate propaganda by the company in blaming the IMPACT trade union and staff, is the sole responsibility of management. Management has, insultingly, sought to portray the strike as staff seeking an additional 32 days off, despite that it knows full well that no proposal would result in any staff member working fewer hours or gaining additional time off. All the staff are asking is that time off be given in a planned and family-friendly manner, as is the case in respect of pilots and across all other Irish and EU airlines. Why has this matter not been resolved? The only conclusion one can draw is that this is not about rosters, rather it is a declaration of war against the workforce. Normally, Fine Gael would love this; it is usually right up its street, and one wonders whether the recent election results have caused it to rethink its position. Perhaps its friends in the Labour Party will jolt it. Given that the Government holds a 25% shareholding in the company, which, when taken with the staff shareholding, equates to a majority shareholding, does the Minister believe it is acceptable in a modern economy that workers should be shackled to rosters that can change with two, three or four hours notice? Does he believe it is acceptable for a company with a Government shareholding to refuse to negotiate or engage with the Labour Court and that it can spend company money on advertisements against its staff and on a legal action? If he does, the Government is more out of touch than we thought. If not, what does the Government propose to do about it? It only has two or three days in which to do something.

Michael Noonan (Limerick City, Fine Gael)
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Deputies on all sides will be pleased to hear that we are not planning an election.

A Deputy:

The people are.

Mattie McGrath (Tipperary South, Independent)
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We want one.

Sandra McLellan (Cork East, Sinn Fein)
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These things are never planned.

Michael Noonan (Limerick City, Fine Gael)
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Members opposite should not pretend; most of them would run a mile.

Mattie McGrath (Tipperary South, Independent)
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Any time.

Michael Healy-Rae (Kerry South, Independent)
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Government backbenchers are afraid of an election.

Michael Noonan (Limerick City, Fine Gael)
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Arising from Deputy Clare Daly's remarks, I pay tribute to the Tánaiste, Deputy Eamon Gilmore. I believe history will be very kind to him. He stood by the people and the country in the worst crisis since the Famine.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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He stood by the Fine Gael Party.

Michael Noonan (Limerick City, Fine Gael)
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I am proud to have served with him.

Mattie McGrath (Tipperary South, Independent)
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He abandoned the people.

Patrick O'Donovan (Limerick, Fine Gael)
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Deputy Mattie McGrath should remember who he backed, former Taoiseach Bertie Ahern.

Michael Healy-Rae (Kerry South, Independent)
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The Government might get its answer soon enough.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This is Leaders' Questions. I ask Members on both sides to stay quiet and listen to the answers.

Michael Noonan (Limerick City, Fine Gael)
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The matter raised by Deputy Clare Daly is an important one. It is a great pity that there is an impending strike at Aer Lingus to be held over the June bank holiday weekend. An awful lot of ordinary working people like to take a break over the June bank holiday weekend and many families want to see their children return home and their relatives come to visit. The proposed strike is a big imposition to place on the ordinary people of Ireland. There are differing views on the merits of it. I argue that both sides should use the mediation machinery of the State to try to resolve the issue. We are all aware of how the people have suffered. Are they to be made suffer again over the June bank holiday weekend? It is unfair and a lesser initiative should be taken. I appeal to both sides to come together and use the mediation machinery of the State to resolve the matter.

Clare Daly (Dublin North, United Left)
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On the election, the Minister's words might come back to haunt him. On the strike and the Minister's remark that it is a pity, those for whom it is the greatest pity are the workers who have sought over a period of three years to have an acceptable rostering arrangement put in place to allow them to have a family life.

It is the biggest step for them to have to take. It is only as a last resort. The Minister's answer actually displays an appalling lack of knowledge of the situation on the ground. For three years now, the management of the company, in which the State holds a 25% shareholding, has refused to engage with the cabin crew committee. It is a fact that in recent times it has failed on six successive occasions to attend the Labour Court. Management has issued an instruction to its cabin crew that it will refuse to implement a Labour Court recommendation in that regard.

The Government has the shareholding. Combined with the staff, the Minister has an influence greater than anyone else. Will his answer to this and every other matter be to shrug his shoulders and let somebody else deal with it? Alternatively, will he use his influence to call management to account and allow the workers to work in a decent job that allows them to rear their families and earn a living without being treated as a commodity as part of a race to the bottom, and without being driven out of their jobs because of a lack of family-friendly rosters only to be replaced by casual labour? The Minister probably likes this prospect because it seems to be pretty much akin to Fine Gael policy.

Michael Noonan (Limerick City, Fine Gael)
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With regard to industrial relations problems, while everybody respects the rights of workers, those rights have to be exercised in a proportionate way. I am simply pointing out that many other workers who were looking forward to a break this weekend will have their plans totally demolished by the action. I appeal to both sides. I am sure there are faults on both sides, although Deputy Daly sees only one side of the spectrum. I would like the conciliation machinery of the State, of which there is a lot, to be used to bring the two sides together to determine whether the strike can be averted-----

John Halligan (Waterford, Independent)
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Can the Minister intervene then?

Michael Noonan (Limerick City, Fine Gael)
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-----and whether the issue can be resolved in due course.