Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

Sinn Féin makes no apology for returning to the issue of medical cards, as well as once again urging the Minister for Health and the Government to listen to and act upon the voices of thousands of people who are being adversely affected by medical card cuts. We in Sinn Féin, and others in the Opposition, have repeatedly brought this to the attention of the Minister for Health and his junior colleagues only to be met with a stonewall. Up until recently, the Minister and his colleagues refused to recognise there was even a problem with discretionary medical cards, even to the point that, at one stage, they denied that such a category of card exists.

The current widespread review and extensive culling of medical cards is causing huge distress and worry to thousands of people. That is undeniable. All Members of the Oireachtas, if they are honest, will testify to the truth of this statement because they know it from the representations they are receiving from constituents and representative groups. The numbers holding discretionary medical cards has fallen dramatically. The Minister's own figures for the number with full medical cards and general practitioner visit cards on a discretionary basis in March 2011 was 97,120. By March 2014, that had fallen to 78,310, a drop of nearly 19,000.

It was only after a recent Fine Gael Parliamentary Party meeting that the Minister grudgingly recognised there is a problem. He was reported as stating, “We’ve asked the TDs to give a list of any of the hard cases they have, the ones that they feel should have been given cards”. This request was confined to his own party colleagues. Did it extend to back bench Labour Deputies? It certainly did not reach me or any of my Dáil party colleagues. The Minister also spoke vaguely about some sort of third tier of services. We found out from the media at the weekend that he has since written to his Fine Gael Party colleagues stating he will not be creating a so-called third tier of medical cards.

Significantly, he also stated unemployment has fallen under the current Government but that there are far more medical cards in circulation now than when the Government came into office. What is not often pointed out, certainly not by the Minister, is that the number of medical cards in circulation is an indicator of income across the population while a great many of the jobs created are low-paid or part-time or are schemes concocted by this Government to disguise the jobless figures. Real, decently paid jobs would indeed see more people earning over the income threshold for the medical card, and thus fewer income-based cards in circulation. That, however, is not the situation in the Government's boasted recovery that is only a recovery for some.

Our focus in this motion is the discretionary medical card. We are calling on the Government to reverse the cuts to discretionary medical cards imposed in the Health Service Executive 2014 service plan. It should ensure the HSE treats with due respect and compassion all applicants for medical cards, taking fully into account not only incomes but the burdens imposed by medical conditions, illnesses and disabilities. The Minister should consult all Oireachtas Members, not just his own party as he has done, on the effects of the cuts on citizens.

In budget 2014, a figure of €113 million of medical card cuts was announced by the euphemism “probity measures”. The Minister for Health has been unable to give us any account of how this figure was arrived at. It was apparently dictated by the Department of Public Expenditure and Reform. When the 2014 HSE service plan was published, the figure had magically changed to €23 million. This surely calls into question the entire management of health funding and health services by the Minister and the Government.

While the Cabinet's juggling with figures is shrouded in mystery, there is no mystery about the effects of the cuts on real people with real illnesses and medical needs. The Minister knows those effects very well. As recently as last Friday, 9 May, he received a letter from the Jack and Jill Foundation's specialist children's nurses. I wish to read some of that letter into the Dáil record:

Dear Minister Reilly,

As the team of nationwide specialist children's nurses responsible for designing and managing home care plans for the 300 precious children under the Jack and Jill Foundation's wing, we are compelled to write this letter to you to outline our serious concerns in relation to the allocation, or rather non-allocation, of discretionary medical cards to our patients. Medical cards have always been an issue since the establishment of Jack and Jill in 1997. However, the situation has become particularly vicious over the past two years. The situation is critical.

It is only a matter of time before somebody, most likely a stressed out parent, is pushed over the edge by this unjust system. We see the danger signs already. Parents worn out, reduced to tears, not sleeping, not coping and worried out of their minds in relation to their child's medical card. The "lucky" ones who have a temporary six or 12 month medical card live in dread of the next review and the whole torturous process of form filling, rejection letters, more visits to GPs for supporting evidence etc. etc. etc. which starts all over again.

We are particularly worried about the parents who suffer in silence. The parents who have given up already. Depressed and beaten into submission by a system that is just too hard, where parents have to fight for every little support for their child.

The medical card system in Ireland is broken. It lacks humanity. Is unjust. Inconsistent. A hellish lottery.

We know it is a real issue on the doorstep for local and European election candidates. We know the pressure coming to bear on you from backbenchers unhappy with the medical card complaints from their constituents. However, it is for the sake of the children, rather than any election process that this system must be radically overhauled. And quickly. Time is something the families of children with life limiting and life threatening conditions don't have.

We will make ourselves available to you to show you the reality of medical cards and the stress being subjected on our families in every community in Ireland. It's time to diagnose the true extent of the problem with medical card allocation in Ireland and to come up with a timely and cost effective solution to the benefit of all, especially the children we support.

Our call to action is simple Minister. Review, refresh and redesign this system of discretionary medical cards. Recognise the child in his or her own right. The system is broken and we need you to fix it.

The Jack and Jill Foundation and other representative groups, such as the charity Aoibheann's Pink Tie, which works with children with cancer and their families, have repeatedly pointed out the significant problems they encounter with the medical card system. This includes the excessive bureaucracy, the distress of parents not knowing where to turn, and the worry that a card has been refused or an existing card will be discontinued. They point to the massive savings to the State when families look after their very ill children at home rather than in a hospital bed.

During this debate, we will hear many examples of what the Minister has called hard cases.

These are by no means exceptional. They are far too common. I quote one experience of many posted on social media by the Jack and Jill Foundation:

Having spent months filling in forms in an attempt to get a medical card for my 3 year old who had a stroke (which she didn't get) I often thought if the HSE cut out a lot of the red tape and bureaucracy and staff repeatedly telling me to send more and more forms etc there would be a lot more money for medical cards for the people who need them. I knew my income was over the limit and was applying for my daughter's card based on her medical needs (I couldn't get a splint for her leg without one and couldn't buy one either it seems) yet I had to send endless information about my financial status (which is by no means excessive) over 4 months ... waste of time and money which could have paid for several splints! ... And don't get me started on the stupidity of having to reapply yearly for children with lifelong conditions.

We, in Sinn Féin, support the principle of free GP care for all, but this Government has undermined public support for that principle by its skewed policy and mismanagement of the health services. People are rightly asking why a healthy child of five will automatically qualify for a free GP card but an older sister or brother with a severe disability, with a rare disease or with cancer will not.

At the conference of the Irish Council of General Practitioners, ICGP, last weekend, a County Wicklow GP, whose disabled patient was the subject of a discretionary medical card removal, told the meeting that the removal of these cards was the "single most evil thing our society is standing over". She stated if the discretionary medical card issue was not addressed she would have no stomach for taking part in the planned free GP care scheme for children under six. Mr. John Hennessy, the HSE's national director of primary care, - one should heed this particular contribution - stated that the way some had been treated was indefensible and described one case as an example of "how we should not be doing things". A GP from Galway told the ICGP meeting his medical card patient list had been reduced, from 800 to 600.

We, in Sinn Féin, are calling for a clear, time-tabled and transparent roll-out of free GP care for all. Anything short of that will only serve to increase inequality. We also need to see this done in such a manner that at least no-one entitled to a full medical card under the current rules will lose any of the services provided under the card in the context of a free GP care-for-all system.

I have tabled a parliamentary question for answer tomorrow in the course of Minister's questions on the process and formula used by the HSE to assess financial hardship in the case of discretionary medical cards. I have asked, in the interest of transparency, for the precise nature of this analysis for new applicants or those seeking to retain their medical cards and who have been diagnosed with motor neurone disease, MND. There can be no doubt that those with MND face significant financial hardship as a result of their progressive and terminal illness. As the PQ lottery has placed this question at No. 42 and beyond reach in tomorrow's brief engagement, I invite the Minister to share the detail of his answer this evening when he rises to respond.

Would the Minister like to further comment on the most disturbing and insensitive practice of the medical card managers who repeatedly require those with life-limiting illnesses and permanent disabilities to respond to review after review, despite the ongoing progression of their illness and that they accept the reality that there is no recovery from their disablement? This compounds their hurt and pain and enrages their loved ones and carers.

What of those over 70, over 80 and beyond who, despite their range of infirmities and the steady deterioration of their general health, are regularly subjected to review after review, despite the false assurance on their card that it expires in 2016 or 2020? Why do this to our senior citizens? Why subject them to this constant worry and stress? Why subject them to the distress of having their medical cards taken from them? GP-only cards only go so far. The real issue for them is their medication supply and for many, it becomes a choice between their essential prescription drugs or heating in their home.

This morning I received a copy of a HSE client registration unit letter of the past two weeks. It advises that a couple and their dependent child who have had a GP-only card was being withdrawn because the calculation of their circumstances showed they exceeded the threshold for qualification by €3.17. The consequence of this decision for this family already shows in the strain in their faces and the fear that now occupies so much of their daily and nightly thoughts. Why do this to those who, across the board, have suffered so much from cuts and the austerity agenda of this and the previous Government?

We do not accept the Fianna Fáil amendment as it omits our call for a reversal of the cuts, as well as our call for people's entitlements and rights to health care to be clearly outlined in law. The previous three Fianna Fáil-led governments promised to do this in legislation, with a Bill listed for years but never published. They failed to deliver. The Minister's self-congratulatory amendment is a sad reflection of the ostrich approach to the crisis in health care delivery, especially the hardships being borne by tens of thousands of citizens across the State who have had their medical card withdrawn or their application refused despite their undoubted need.

We believe it is vital that we clearly set out in legislation people's entitlements to health care and, in line with the recommendation of the Constitutional Convention, we call on the Government to provide for an amendment to the Constitution to recognise the right to health care. Is ceart é an curam sláinte. Tá sé bunúsach. larraim ar gach Teachta ar gach taobh den Dáil seo tacú leis an run.

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