Micheál Martin (Cork South Central, Fianna Fail)
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9. To ask the Minister for Health the number of medical cards that have been withdrawn in 2013; and if he will make a statement on the matter. [40013/13]

James Reilly (Dublin North, Fine Gael)
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The number of cards that have been issued following review and the number that have been withdrawn is not readily available in the format requested by the Deputy. Details of the number of medical cards and GP visit cards are provided to my Department each month by the HSE. These figures are currently provided on a net basis, showing the balance after new cards have been issued and other cards, as appropriate, have been deleted from the executive's database - for example, following a review of a person's circumstances. The most recent figures provided to my Department by the HSE reflect the position as at 1 September 2013 and show 1,863,062 medical card holders and 124,361 GP visit card holders.

Billy Kelleher (Cork North Central, Fianna Fail)
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There is no point in beating around the bush here. There has been a change in the policy for awarding discretionary medical cards. Every Deputy in this House is inundated with people who historically had been awarded a medical card based on health needs on a discretionary basis. I accept that there is no change to the guidelines, because there are no guidelines on discretion. However, the evidence shows that the number of medical cards awarded on discretionary grounds has been reduced dramatically and is now under 59,000. There has been a continuous pretence that nothing has changed, but something must have changed because we have reduced the number of medical cards by such a large amount.

I would like to quote from an article in The Irish Times today about the Ombudsman, Ms Emily O'Reilly:

[The Government] also had an absolute right to govern, she said, and if it wanted to get rid of schemes that was its right. “But what is not right is if they are not clear and open and honest in relation to what they are doing.”

Alex White (Dublin South, Labour)
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The departing Ombudsman also said that her officials' examination of complaints about the removal of discretionary cards showed "nothing substantial had changed in relation to the regulations that applied." The report went on to state the following:

In the past, in situations where a person's income was above the threshold, appeals officers looked at other factors, such as their level of illness or need for equipment or medication, she said. Now people are being denied cards where their income exceeds the limit.

Billy Kelleher (Cork North Central, Fianna Fail)
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We can debate this forevermore, but there are now fewer discretionary medical cards out there than was previously the case. At one stage, 80,000 medical cards were given out on a discretionary basis, but that is now down to 59,000. Clearly, there has been a tightening of the discretionary award. I believe this is purely a budgetary exercise, because the fact is that these were given to the sickest people in our society. The HSE has decided to withdraw them as a cost saving measure because they are the medical cards that are most expensive to the State. It is a cynical exercise and we see it time and again. Deputies from all sides are inundated in their offices every week by people who are very ill. One example is a person with motor neuron disease and a child with Down's syndrome and other complications who had a medical card that has been withdrawn. That is happening wholesale and the Minister of State cannot deny it. The pretence that there has been no change in the awarding of discretionary medical cards is quiet bizarre. It is unacceptable that the Members opposite pretend there has been no change. There has been no change. Discretion is being used and they are deciding not to grant the cards.

Simon Harris (Wicklow, Fine Gael)
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On the question of medical cards being reviewed and potentially withdrawn, I wish to draw to the Minister of State's attention to an issue that some farmers are experiencing. They have an income level whereby they are not eligible for tax, yet the HSE demands that they produce audited accounts. It is demanding a higher burden of proof than Revenue does. Will the Minister of State investigate this matter with a view to the HSE and Revenue sharing information? Some low-income farmers must incur accountants' fees just to qualify for medical cards to which they are already entitled.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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No matter what effort the Minister of State may employ, he cannot discount the fact that there has been a reduction in the number of discretionary medical cards. The Minister acknowledged it during his last engagement with the health committee when he stated that discretionary cards were no longer being granted to cancer patients in the same way as previously. Ms Laverne McGuinness, a senior representative of the HSE, also admitted that the number of people on discretionary medical cards had decreased. How does the Minister of State square the circle? The reality is that we are dealing with people who are victims of the new assessment, policy or whatever. People are suffering the loss of medical cards on which they depended. We want to see those cards restored.

Alex White (Dublin South, Labour)
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At the risk of irritating the Deputies with repetition, it has never been the case since 1970 that the law provided for the allocation of medical cards to persons on the basis of illness. Discretion does not suggest that someone must have the card. It means that someone must apply a particular assessment to a situation. This is what we are doing. It was centralised two years ago. We have not denied the change in the numbers. There is no pretence - the numbers are the numbers. We have given all of the numbers. Indeed, I have provided numbers for 1 September to the Deputies. All of the facts are before the House, as is proper. The Deputies will also be aware that there has been a significant increase in the number of medical cards in the system generally. It must be acknowledged.

I will consider Deputy Harris's point. I do not disagree with it, but the extent to which we have information and clarity from Revenue, the HSE or otherwise to ensure that the system works is an advance, not the opposite.