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

I move:

That Dáil Éireann:

notes that:

- the number of discretionary medical cards fell from 80,524 at the start of 2011 to 63,126 at the end of 2012;

- in the first seven months of 2013 there was a further reduction of 8,142 such cards to 54,984, a monthly average reduction of 1,163;

- the Health Service Executive (HSE) set a target for 2013 to reduce the number of discretionary medical cards;

- this deliberate targeting was approved by the Minister for Health in the 2013 HSE Service Plan; and

- the targeted reduction to 55,328 in 2013 has already been exceeded;

agrees that the discretionary medical card is essential for those with serious illnesses, the treatment of which can cause major financial hardship;

deplores the decision to deliberately target people in clinical need of such cards;

and calls on the Government to:

- discontinue the targeting of those with discretionary medical cards; and

- ensure that no-one in clinical need is denied such cards where it can cause significant financial distress.

I wish to share time with Deputies Sean Fleming, Browne, Cowen and Niall Collins.

We have been raising the issue of discretionary medical cards for some time. We did so when the budget for this year yeas introduced last December. When, in the context of that budget, a policy of withdrawing and removing medical cards was announced, we highlighted the fact that this would create huge difficulties for many people. On each occasion on which I have raised this issue, the Minister of State, Deputy White, has consistently stated that there has been no change in policy or in the guidelines. However, a cursory glance at the number of discretionary medical cards in the system shows that there has been a concerted effort on the part of the HSE to withdraw such cards. I accept that there has been no change in the guidelines. People are normally awarded medical cards on the basis of their financial means. That is how the system works. People make applications, their financial means are assessed and, based on the relevant criteria, they will either be awarded medical cards or they will not. However, there is also a mechanism whereby discretionary medical cards are granted to individuals whose incomes exceed the limits relating to ordinary medical cards. A discretionary card is awarded in light of the costs a person may incur on foot of the nature of his or her illness. At one stage in excess of 8,000 discretionary medical cards were in the system. I do not know about the overall health profile of the nation. However, I am aware of one thing, namely, there is no way there are fewer sick people in this State than was the case a number of years ago. It is not feasible to suggest that people suddenly appear to be getting better very quickly , that they are not suffering with serious illnesses or that they do not have major needs.

The Minister of State continually states in reply to parliamentary questions that there is a system in place in respect of the awarding of discretionary medical cards. The latter is simply not the case. There is a concerted policy on the part of the HSE in respect of this matter. That policy primarily revolves around the need to reign in the budget. We all know one thing for certain, namely, that discretionary medical cards are used by people who are very sick. As a result of the fact that the individuals involved are so ill, the costs incurred by the State in respect of these cards will always be high. The primary reason for the award of a discretionary card relates to the fact that the people to whom they are given are very sick.

As already stated, I have been consistent in raising this matter in the Dáil and I have tabled numerous parliamentary questions in respect of it. I have in my possession a list of individuals who, despite what one might believe, had their discretionary medical cards revoked. In some instances people have undergone both review and appeals processes but their discretionary medical cards have not been reinstated. Almost all of the individuals on the list to which I refer have illnesses which cannot be cured. The first of them is a young boy of six years of age who has profound intellectual and physical disabilities, who is confined to a wheelchair, who does not have the use of his limbs, who is incontinent and who cannot communicate. The card relating to this boy was withdrawn as part of a review. Following a protracted row with the HSE, a discretionary card was awarded for a period of six months. This is in respect of a child with profound intellectual and physical disabilities and all of the other problems to which I refer. I cannot understand how the Minister of State can stand over a system under which the medical card of a child whose physical and intellectual circumstances will never improve could be revoked and then replaced, following a review, with a six-month discretionary card.

Those in government appear to be on a merry-go-round whereby they continually state that there has been no change in policy. There has to have been a change in policy. Such a change is quite evident from the figures provided in replies to all of the parliamentary questions we have tabled in respect of this matter. There is no doubt that the number of discretionary medical cards has been reduced dramatically. Another of those on the list to which I refer is a boy who will be three years old in December, who has Down's syndrome, who is profoundly deaf, who requires substantial daily care, who has serious medical needs and who has an intellectual disability. This child's medical card was also revoked. Is the Minister of State seriously saying that he can stand over this change in policy? There is no point in his even suggesting that there has not been a change. What is being done is underhanded and represents a sleight of hand. I say this because medical cards awarded on discretionary grounds are now being assessed in the context of the guidelines relating to cards awarded on the basis of people's financial means. Such cards will, of course, be revoked because they were granted on the grounds of medical need and not on financial grounds. This is why there are 20,000 fewer discretionary medical cards in the system than was previously the case.

Another of those on the list I possess is a man who has lung cancer, who was recently diagnosed as bipolar and who half of his right lung removed in March. His medical card, which was granted to him three years ago, was withdrawn. I am highlighting this matter because I am of the view that the Minister of State does not want to stand over what is happening. He knows in his heart and soul that it is appalling that, under the current system, medical cards can be taken from children and adults such as those to whom I refer. I instanced specific cases because what the Minister of State is being told and what is happening on the ground are completely different. There is not one Deputy in the House who would concur with his view that there has not been a change in policy. In parliamentary questions and during debates on health, Members continually highlight the fact that discretionary medical cards are being taken from those who are most ill.

We await next week's budget with bated breath. The Government has been flagging the fact that it intends to provide free GP care for those under five years of age. We all welcome this but who is going to pay for it? Will it be the six year and three year old boys or the man with lung cancer to whom I refer? I have a sneaky suspicion that they will have to pay for it. The Government's mandate is based on its commitment to introduce universal health insurance and free GP care for everybody. As matters stand, no one has free GP care and those who are extremely ill and who have the greatest need of health services are suffering most. The Government has stated that health care should be provided not based on one's ability to pay but rather on one's need. Those to whom I refer are the people who need it most.

Another man whose name appears on the list in my possession is over 70 years of age. This individual has terminal stage cancer, he is being fed by means of a percutaneous endoscopic gastrostomy, PEG, tube, he can no longer move or speak, he is confined to a special wheelchair, he has dementia and we was awarded a GP-only card. The Minister of State cannot, in all good conscience, state that there has not been a change in policy. There has been a fundamental shift in policy. The nature of that shift is very simple: the Government is withdrawing discretionary medical cards on a continual basis. The Minister of State is correct in stating that there has not been a change in the guidelines. This is because there have never been guidelines in respect of discretionary medical cards. These cards are awarded at the discretion of the relevant individuals. In other words, it is their responsibility to consider the circumstances and needs of individuals and then make the decision to either award or not award a card. It has been stated that there has not been a change in policy. Neither have the illness profiles of people with physical or intellectual disabilities or those with particular medical needs changed but they can no longer obtain medical cards on the discretionary basis on which they were previously awarded. Of course there has been a change in policy in respect of this issue.

We are calling on the Minister of State and the Government to do whatever it takes to reverse this sinister, nasty attack on the sickest and most vulnerable people in our society.

This motion is an indication that, on a continual basis, Members on both sides of the House are raising this issue. If the Minister of State, Deputy White, does not believe me, he should read the parliamentary questions day in, day out on discretionary medical cards being withdrawn and asking the Minister to intervene.

I raised this issue on Leaders' Questions as far back as last January. At the time, the Taoiseach told me to send him on the individual cases. I do not expect the Taoiseach to be involved in every case because, as he says, he is a very busy man. However, the reason I sent him on the cases is that it is unbelievable that Members opposite can defend this issue. I raised the case of a woman in the House who has had a double mastectomy and is on chemotherapy. Her medical card was taken from her but eventually she was given a GP card.

In all conscience, the Minister of State, Deputy White, must accept the veracity of this motion. The amendment to the motion is an insult to the thousands of people who are waiting for reviews, who are trying to receive discretionary medical cards and who are trying to put forward their medical and financial evidence but who must wait months on end for a decision. Unfortunately, in the vast majority of the cases, the decision is to take medical cards granted on a discretionary basis rather than to grant them.

See this speech in context