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

There is a reduction in the number of medical cards. We can assume this is because of two things - a drop in unemployment and a number of people emigrating. We are not quite sure but we hope that it is primarily due to a take-up in employment figures. What is disturbing is that we are now down to 50,501 discretionary medical cards. Over the past number of years, the Minister has consistently said that there has been no real change in policy. I must beg to differ. I raised this issue last week in the Dáil and I want to say it again, not only in front of the Minister but in front of the HSE officials who are supplying the Minister with the answers to these parliamentary questions, which are answered up-front by and large. There has been a change in policy. The Minister even tried to pretend that the word "discretion" had been removed from the lexicon of the HSE in terms of assessing medical cards. This word had been used for years in accounting in respect of the HSE budget. It has been used in the service plan for the previous number of years but all of a sudden, there was an effort to remove the word "discretion".

In response to a parliamentary question I tabled, I was told that there was no such thing as a discretionary medical card but that is not the case. At one stage, there were over 90,000 of them in the country and we are now down to 50,501. Week in, week out, organisations who consistently represent and advocate for individuals, families and cohorts of people with very profound disabilities and illnesses consistently say that their members are having their discretionary medical cards withdrawn. Regardless of whether one describes it as an entity or otherwise, it is still a fact that many families are encountering huge difficulties. Even in recent weeks, organisations representing people with Down's syndrome have said publicly that there has been a blatant attempt to reduce the number of discretionary medical cards issued to their members. That is something with which we must deal.

Mr. O'Brien referred to the National Ambulance Service, the NAS. We could talk indefinitely about this issue, which needs to be addressed. There is now a pretence from the Minister, officialdom and the NAS that no problem exists. People representing those working in the NAS appeared before us a couple of weeks ago. There was almost a pretence on the part of union representatives at the top that no problem exists. The "Prime Time" programme has exposed what we all knew was happening. Week in, week out, we are having major difficulties and are continually hearing about the lack of response times and the fact that we are now pretending we have a NAS that is in some way meeting the guidelines that have been laid down by HIQA.

We should examine the situation regarding ORVs. It is amazing that Mr. O'Brien can come in here and say that in the first 90 days they were called out 629 times. Let us be very clear. The fact that these very expensive vehicles are driving around the country and are unavailable to deal with emergencies should be examined. However this is just one item of the malaise at the top echelons of the NAS. The NAS is under-resourced and to pretend it is not is an insult to the professionals who are trying to provide a good service and, more importantly, the many people who depend on that service, some to their detriment in terms of injury and loss of life.