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

I welcome the contributions from Deputies on both sides of the House. We do not claim to have a fount of wisdom on this side, but we know there is a difficulty concerning the granting of discretionary medical cards. The review process is laborious and takes a long time.

The Minister of State says there has been no change to how discretionary medical cards are awarded. However, a profoundly disabled child with intellectual disabilities and many other medical complications may have been awarded a discretionary medical card based on the medical evidence presented at the time. If that card is withdrawn at a later date, there has obviously been a change in how the awarding of such a card is assessed. Such children should be entitled to the continuance of that medical card because there has been no change in their medical circumstances. Regardless of the family's financial circumstances, the person was granted the card in his or her own right because of their medical condition.

Discretionary medical cards are now being withdrawn. Mr. Jonathan Irwin of the Jack and Jill Foundation has stated that parents are receiving cold letters from the HSE in relation to applications for medical cards and GP visit cards. The letters make no mention of the child involved and boldly state: "Your application will be considered closed unless additional information is received to support your application within 21 days of the date of this letter." The HSE letters seek evidence of fire and contents insurance, mortgage payments and expenses incurred. The Minister of State knows the form.

The bottom line is that these people are applying for a medical card based on their extreme medical needs. That is the basis for awarding a discretionary medical card. Quite clearly, the HSE is looking at existing discretionary medical cards and is applying the financial guidelines in assessing them. That is what is happening. There is no change in the guidelines, but the financial guidelines under the Health Act 1970 are being applied to assess eligibility for discretionary medical cards. That is how they are being withdrawn.

There is no point in trying to convince Deputies, who have made contributions in this debate as well as having tabled numerous parliamentary questions on the difficulties involved in securing discretionary medical cards for people with profound medical needs, that this is not the position. That is why I have kept the motion's wording tight and specific, targeting the issue of discretionary medical cards.

There is a disconnect between what Ministers have said and what is being said by Government backbenchers, even though they used couched language with phrases like "issues of communication" and "difficulties in informing families". What they are really saying, however, is that discretionary medical cards are being withdrawn for no valid reason other than that there has been a deliberate change of policy in how such cards are assessed, granted, reviewed and appealed. There can be no other reason that such children would have discretionary medical cards withdrawn. If the Minister of State can explain that to me, I would like to hear it because, unfortunately, their medical conditions have not changed one bit. The incontrovertible evidence is there in black and white in case after case, so I urge the Minister of State to review the process quickly.

My major concern is that this is a budgetary exercise. Next week, the Minister of State will expect applause from Labour Party Deputies about granting free GP care to children under five. Is the Government asking a profoundly disabled child to fund free GP care for under fives? If so, we have a major problem in this country in terms of our priorities. The Minister is saying he will give a free GP card to every child under five, but at the same time a person who is profoundly disabled, with major medical conditions, and who may have life-limiting illnesses, will not be granted a discretionary medical card based on their individual needs. If so, that would simply be shameful. Whatever is announced next week, I hope the Minister is not taking discretionary medical cards from thousands of people in order to fund his pet topic.

I wish to thank every Deputy who has spoken on this motion. I know the vote will be lost but I urge the Minister of State to re-examine this matter. The Government amendment states that "the HSE has produced national assessment guidelines to provide a clear framework to assist in making reasonable, consistent and equitable decisions when assessing applicants". That is the change of policy.

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