Micheál Martin (Cork South Central, Fianna Fail)
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Next Saturday there will be an event entitled Walk a Mile in Ronan and Katie's Shoes to lobby for the return of Ronan and Katie's discretionary medical cards. Katie is a five-year-old girl with Down's syndrome and many complications, including asthma and juvenile arthritis. Her medical card was granted based on her medical condition and although her condition has become a little worse since then, her card has been taken from her. Her mother, Jackie Connolly, has been campaigning on this case, which illustrates the appalling impact the change in policy on discretionary medical cards has had on very sick children. Ronan Woodhouse is a child with Down's syndrome and 13 associated illnesses. Last February he lost the medical card he has had since his birth in 2005. Why? Someone said no undue hardship was involved. His mother was outside the Fine Gael Ard-Fheis and the Taoiseach said he would meet her, but that has not happened and her son still has not got his medical card.

The denials go on. I have been raising this for months. The Taoiseach told me anybody who deserved a medical card would get it, but that is untrue. The Minister's statement that there has been no change in policy but only the application of probity is as skewed a statement as I have ever come across and is designed to hide the truth. The Minister of State at the Department of Health, Deputy White, stated in reply to a parliamentary question that from 1 January to October this year more than 10,000 discretionary medical cards had been taken from people. By definition, these are very sick children and adults with significant and rare conditions.

How long must the denials of any change go on? Will the Taoiseach accept that there has been a fundamental change in policy with regard to the allocation of discretionary medical cards and that this change has resulted in the visiting of extraordinary hardships on people and families who deserve much better? I have been talking about this for six months. Shame on the Taoiseach and the Government for refusing to accept what people from all sides of the House have been saying for so long and doing nothing about it but giving us empty, meaningless rhetoric that does not accord with the reality on the ground.

Enda Kenny (Mayo, Fine Gael)
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There has been no change in the medical card policy. Nobody is automatically entitled to a medical card. The problem we had in this country for so long was that different health areas allocated medical cards based on different criteria. Everybody is now treated equally, starting here. Nobody is automatically entitled to a medical card. If a parent, parents or whoever has an income in excess of the guidelines laid down, the discretionary element comes into play. Last week I had a case in which there was a claim for a medical card for someone whose income was €7,000 over the limit not just in the year but every week. I have dealt with a number of sensitive cases in the last month and I am glad that many of these were cleared due to the application of discretion because of the nature of the applicants' medical problems.

Deputy Martin mentioned Ronan and Katie and said that Ronan had 13 illnesses. The director of the HSE has met Ronan's mother on two occasions. I do not have the details of the child's illnesses, but I can understand the frustration. Deputy Martin asked me the question, as he is entitled to, of whether this child is entitled to a long-term illness card.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Children should not have to go through that when they are sick.

Enda Kenny (Mayo, Fine Gael)
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He asked if the child was entitled to appliances and aids and the provision of services on the basis of his needs, as distinct from an illness, via a determination based on discretion. To answer that I would need to have the facts in front of me.

Dara Calleary (Mayo, Fianna Fail)
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It is a child, not a robot.

Enda Kenny (Mayo, Fine Gael)
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I can sympathise with the mothers of Ronan and Katie. Deputy Martin mentioned the Fine Gael political gathering in Limerick. Nobody told me the person involved wanted to meet me. I spoke to several people on the way in. That is not the issue. The issue is that Deputy Martin has a right to ask a question here about two children and a walk that is taking place regarding their discretionary medical cards.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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We should not have to ask.

Enda Kenny (Mayo, Fine Gael)
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There is no change in the policy. Nobody is automatically entitled to medical card. Issues such as income and discretion apply after that. Because of all the cases that were brought to light here I called HSE to the Cabinet sub-committee. It put together a communications system for dealing with sensitive cases. Deputy Ó Fearghaíl may laugh.

Timmy Dooley (Clare, Fianna Fail)
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He is laughing at the Taoiseach.

Enda Kenny (Mayo, Fine Gael)
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I was getting sick and tired of information floating around without reality. One sits down and deals with each individual case. I do not speak for the director of the HSE. He sat down with this mother on two occasions, whether to discuss the details of this case or little Ronan's circumstances I do not know. I do not have that information, but I will find out for Deputy Martin. There has been no change in the policy.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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That is absolute rubbish.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I had a sick man from Castlebar talking to me-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Will Deputy Boyd Barrett stop interfering with Leaders' Questions?

Finian McGrath (Dublin North Central, Independent)
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The Taoiseach is waffling again.

Enda Kenny (Mayo, Fine Gael)
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I can give Deputy Martin the number of discretionary medical cards that were allocated this year. Twenty thousand newcomers were allocated medical cards on that same discretionary basis. Deputy Martin is entitled to ask the question. In many of these cases, where a determination is made on discretion, the person involved might be entitled to a long-term illness card which gives them aids, appliances and facilities for their particular requirements. I am sorry I cannot give a more comprehensive answer because I did not have notice of this and I do not have the details of this particular child in front of me.

Robert Troy (Longford-Westmeath, Fianna Fail)
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Does the Taoiseach want notice of Leaders' Questions now?

Enda Kenny (Mayo, Fine Gael)
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Anyway, it would be unfair to outline the circumstances that apply in an individual case in that detail.

Micheál Martin (Cork South Central, Fianna Fail)
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The child was offered a long-term illness card but many of his conditions do not qualify under the long-term illness card. If somebody met the person they could sort it out. I use these cases to illustrate the problem. I dealt with approximately 12 cases two months ago, including people with varying ages and various conditions or disabilities, including motor neuron disease. Professor Hardiman of Beaumont Hospital said she had never written so many letters. Why? There has been a change in policy.

I cannot understand why the Taoiseach gets up here every day and says there has been no change in policy. Since the 1970 Health Act, undue hardship has been the reason in the legislative framework for giving people with particular conditions and illnesses medical cards. This represents only 0.3% of the entire medical card allocation. There has been a change in policy. The Taoiseach and the Minister for Health keep talking about narrowing the gap and financial thresholds. That is what it comes back to. For the last three years the move has been on to get rid of discretionary medical cards from the system, and it is dressed up in gobbledygook.

Only this morning my office was notified of another case-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy is way over time. Will he, please, facilitate the Chair?

Micheál Martin (Cork South Central, Fianna Fail)
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It concerns a young child with a very rare condition, which I will not name because in doing so I would nearly identify the child.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Please allow the Taoiseach to respond. This is a supplementary question.

Micheál Martin (Cork South Central, Fianna Fail)
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Fewer than ten people in the world have this condition. In the name of God, what kind of system do we have when the Government takes a medical card from such a child? Can the Taoiseach answer that question? I do not think he can. This is a call to stop all of the meaningless rhetoric -----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Will the Deputy, please, co-operate?

Micheál Martin (Cork South Central, Fianna Fail)
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We are talking about giving everybody under the age of five years a medical card. We could start by giving everybody in this category a medical card. That would introduce fair play. We could do this before we start giving out medical cards to anybody else.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This is Leaders' Questions.

Micheál Martin (Cork South Central, Fianna Fail)
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Can sick children and people with multiple conditions be given medical cards? I am asking for a change in policy. Do not tell me it has not changed. It has and I want that change to be reversed and medical cards restored to these young children and adults.

Paul Kehoe (Wexford, Fine Gael)
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The Deputy should have carried on like this when Brian Cowen was in charge.

Enda Kenny (Mayo, Fine Gael)
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Bravo, Deputy Martin - strong talk. The Deputy was the person who, as Minister for Health, signed the working time directive. He was the one who said he would have the problem sorted out by 2004. Ten years on, this is another mess which has been left to us to clear up. The European Commission decided to bring the country before the court as a result of the Deputy's gross incompetence and neglecting his business at the time. I refute his charge in regard to medical cards. I do not have the medical information available to me, but if I did, I probably would not understand all of the implications of the medical requirements involved. However, it is my understanding the long-term illness card granted to the child mentioned by the Deputy does cover the child's illnesses. That is my information, but the Deputy has different information. Neither of us is competent to make the judgment on medical grounds, although the Deputy might pretend that he is.

Micheál Martin (Cork South Central, Fianna Fail)
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It is a probity exercise.

Enda Kenny (Mayo, Fine Gael)
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The Deputy makes the charge that there has been a change of policy, but let me assure him that since the start of the year some 100,000 new medical cards have been granted, of which 20,000 are discretionary medical cards. The Deputy left behind a most unholy mess of a structure that we now have to change.

Micheál Martin (Cork South Central, Fianna Fail)
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It was the Minister of State who said in response to a parliamentary question that there had been a change of policy. Blame everybody else, except yourself.

Enda Kenny (Mayo, Fine Gael)
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Some 20,000 new discretionary medical cards have been granted this year alone. Under the system I have changed, with the communications element of the HSE, where something of this nature is required, the HSE deals with each individual case. The Deputy can wave all the paper he likes, but there has been no change in the policy on the issuing of medical cards. Nobody is entitled to a medical card automatically, but everybody is entitled to have his or her case properly and compassionately assessed. Either the case mentioned by the Deputy is not covered-----

Micheál Martin (Cork South Central, Fianna Fail)
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It is not that case.

Enda Kenny (Mayo, Fine Gael)
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That is the case the Deputy raised.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are way over time.

Enda Kenny (Mayo, Fine Gael)
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The Deputy is entitled to raise the case. Unlike his predecessor who said to me when I had raised an individual case that it was too facile, I will allow that the Deputy is perfectly entitled to raise a case. This is a House of Parliament. My understanding is that the long-term illness card in the case mentioned by the Deputy does cover the medical condition and requirements of the young child involved.

Gerry Adams (Louth, Sinn Fein)
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It is a fact that policy on long-term illness medical cards has been changed. Very sick citizens, including very sick children, should have the right, without equivocation, to a medical card.

I wish to raise a different issue with the Taoiseach. As he knows, US diplomats Richard Haass and Meghan O'Sullivan are conducting intensive discussions on outstanding aspects of the Good Friday and other Agreements. They include legacy issues arising from the conflict. Anyone with an interest in building the peace knows that these legacy issues of the past cannot be allowed to be an obstacle in building the future. Therefore, we need to have a measured and inclusive debate on all of the issues involved. This morning the Taoiseach may have heard that the Attorney General in the North, Mr. John Larkin, had put forward his ideas for dealing with one aspect, the issue of prosecutions. He has expressed the view that there should be no prosecutions for incidents that occurred before the Good Friday Agreement. He has also said the current position favours non-state forces, but that is not the case. We know that the British Government is in breach of a number of international agreements, including some with the Irish Government. There is also, to all intents and purposes, a virtual amnesty for British forces and their allies, while thousands of republicans and innocent Nationalists have served lengthy prison sentences.

I have not yet had a chance to read the Northern Ireland Attorney General's full submission, but I intend to do so. It is good that the Haass talks have encouraged people to make submissions and that he wants to hear the voices of the people, including the voices of victims. Mr. Haass has received a few hundred submissions. Our society needs to have this debate. Can we have some understanding and some measure of reasoned, rational, intelligent and sensitive debate on these issues that will recognise that any mechanism put in place must be victim-centred and on the basis of equality? We have proposed that there be an international independent truth recovery process. Others have different ideas, which is fair. We need to take the opportunity to discuss these matters in order that we can move forward in a way which looks after the victims but also builds a future for the survivors.

I am very conscious, for example, of the upcoming official visit of the President to Britain and all of the other seismic changes we have seen in our time. These need to be measured and discussed, not just in palaces but on the streets, in the laneways and on the hillsides of this island, most particularly in the North. Will the Taoiseach encourage a debate on these matters in the way I have outlined and will he set aside time here to allow that to happen?

Enda Kenny (Mayo, Fine Gael)
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I will. Both the Tánaiste and I met Dr. Haass recently in Dublin. He was invited to come here by the Executive and look at the question of flags, parades and the past. He has gone through a listening process and hopes to conclude his engagement, discussions and recommendations by Christmas. It is only appropriate that there be rational and appropriate discussion. It may well be that at the end of the day there can be some movement on the issue of flags and parades. There is certainly a possibility of movement in that regard.

The question of the past is different because it deals with victims on all sides of the atrocities committed. It would not be helpful for me to comment on the personal submission made by the Attorney General in Northern Ireland. I must respect his views as the holder of a statutory office in that context. It would be difficult for families on either side in what was a dark time in Northern Ireland if we were to follow that advice and put in place what the Northern Attorney General has recommended and were to find, subsequently, incontrovertible DNA evidence of the involvement of a person or persons in a killing on either side. As the Deputy knows, families want closure and there is always a yearning to find out what happened, who gave the instructions and why it was done.

I do not object to having a proper debate in the House or at the Joint Committee on the Implementation of the Good Friday Agreement on these matters. We have given Dr. Haass our full support in the efforts he is making following the invitation he received to deal with the issue of flags, parades and the past. I have offered him every assistance the Government can give him in his work. I offered the same to the First Minister and the Deputy First Minister at the North-South Ministerial Council in Armagh recently.

Gerry Adams (Louth, Sinn Fein)
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I thank the Taoiseach for his reply. I heard Margaret Irwin from Justice for the Forgotten give her view on this matter. She more or less expressed the same view as the Taoiseach on the different impressions victims and their advocacy groups have on these matters. Of course, there are many matters, including the Dublin and Monaghan bombings, where the British Government has been indicted but not come forward. There is no single voice across the victim community. Some want the truth and some a judicial process.

It is really important that we get to a point where we recognise there are different narratives. I am an Irish republican and I believe the partition of the island and British involvement in our affairs are at the core of this, but Unionists have a different view and Fine Gael may have a different view. All of these views and narratives have their own truth and we must get to a point where we lay the narratives side-by-side and respect them all. This does not mean the Taoiseach, Unionists or British Ministers have to change, but that we recognise somewhere in the totality of these narratives lies the truth. All of the different perspectives of what happened, who is responsible and what caused it are useful only if we can plot a way forward. Otherwise they become debilitating, negative and totally and absolutely frustrating, particularly for victims.

How do we encourage and set out such a debate? We must first of all recognise it is a crucial matter. The Government is not a junior partner, but a co-equal guarantor of the Good Friday Agreement and other agreements. It has responsibility to look after everyone in the North, including our Unionist neighbours, and to plot a course forward, in the way described by the Taoiseach, in dealing with the First Minister, the Deputy First Minister, Dr. Haass and others. I thank the Taoiseach for his answer but I would like to see him facilitate here in the Dáil the type of joined up inclusive thoughtful discussion aimed at unshackling us from the past so it never repeats itself and aimed at forging a more hopeful future for the people who have survived the conflict and for our children and grandchildren.

Enda Kenny (Mayo, Fine Gael)
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The House has united on a number of occasions in respect of matters in regard to Northern Ireland. Since the Good Friday Agreement, when people North and South went to the polls and we had validation from the vast majority of the people of the island, this template still stands. However, it might be appropriate if we were to wait and see the recommendations Dr. Haass will put together following his analysis, and his listening and engaging with various elements in Northern Ireland, and see what he puts on paper for consideration by the Executive. If we were to have a debate before this happens it might be interpreted as trying to influence what recommendations he might want to make. When we see the conclusion of his work I am quite happy that we have such a debate here, one of many, where the narratives can be laid out side-by-side and we can see whether there is a conclusion that might move this forward.

It is quite right of the Deputy to refer to the invitation from Buckingham Palace and the Queen to Uachtarán na hÉireann to visit officially. It will be the first State visit by an Irish President since the foundation of the State to Britain. In this sense it speaks for itself in terms of its significance and importance.

The Deputy can take it the Government is quite willing to engage. As I stated to Dr. Haass and other members of the party, it is in everybody's interest that we should be able to bring closure where we can and we should be able to deal with the contentious issues of flags and parades, and hopefully, in the broad spectrum of the families of the more than 3,000 were murdered, killed or maimed South and North, that we will be able to move this on in some fashion. I am up for this, as is the Government. It is the way we do it which is important in the sense of people understanding we are serious about moving Ireland and the island of Ireland to a new place in the time ahead. I suggest we see what recommendations Dr. Haass makes. He is there at the invitation of the Executive. The House is willing to respond appropriately.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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Since the Government came to power it has confirmed the termination of the Ceantair Laga Árd-Riachtanais, CLÁR, programme for high priority, weak rural areas. It has also continued to wind down the RAPID programme, leading to the effective abolition of the programme. The RAPID programme revitalises areas through planning, investment and development. The programmes were developed to assist deprived urban and rural communities which the Celtic tiger had bypassed. These communities had heard of but never saw the elusive Celtic tiger. These areas suffered deprivation for many years with a lack of facilities, services and resources. This was reflected in high poverty and unemployment rates, early school leaving and anti-social behaviour issues.

Since the implementation of the programme there have been improvements in these areas of disadvantage such as the provision of community policing units, the development of community centres for the youth, persons with disabilities and the elderly, the provision of outdoor facilities, training programmes and child care facilities. As a consequence there have been significant benefits to the quality of life in local communities and decreased anti-social behaviour. The Government is throwing all of this away at a time when unemployment in these areas is at unprecedented levels and poverty is increasing. In my constituency the towns of Carrick-on-Suir, Tipperary and parts of Clonmel are affected, as are towns and communities throughout the country.

The RAPID programme had expenditure of approximately €10 million in 2009 but this has been reduced to less than €2 million. This is a reduction of more than 80%, which is ten times the reduction of public spending generally. RAPID co-ordinators employed by local authorities have had their funding withdrawn, which has meant they have either lost their jobs or have been redeployed to other duties. Given the huge and disproportionate scale of this cut to services for the poorest people in the country I must ask the Taoiseach whether the Government has a political agenda to attack the poorest and most disadvantaged communities in the country.

Enda Kenny (Mayo, Fine Gael)
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The answer to that question is "No". The Government has no such agenda. The mandate given to the Government was to sort out our public finances and provide opportunities for jobs for our people. We will never have the type of country we know we can have unless these two principal issues are dealt with. Irish people have come a long way in the past three years. When one asks people, whether they are in the town or country, what they really want, one hears all the usual answers, but essentially everybody wants to have a job and not just a job but a good one. For this to happen we must have a country and an economy running effectively. We did not have this in the profligacy of the so-called tiger years when some gained everything and others lost everything.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It is still going on.

Enda Kenny (Mayo, Fine Gael)
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It is to recast the Irish economy in a way which impacts to the benefit of everybody. This includes the communities mentioned by Deputy Healy. The RAPID programme was very effective in many cases and announcements were made about it which were never followed through. Changes are being made to local government whereby the balance of responsibility between the elected representatives and the executive will see far greater accountability in terms of public moneys being voted and spent in urban and rural areas which have been deprived of facilities and structures for a very long time.

I was recently in Deputy Healy's county and the values of the Irish people have not changed but have strengthened in the sense of community spirit. I notice in the times of hardship and difficulties many people have fallen upon that communities have rallied in a way they did not before. This is something we must encourage and strengthen, and this is part of the €1.04 billion spend the Government will make next year for all areas, town and country, in terms of opportunities, particularly for young people, to live, stay and work at home if this is what they wish to do. The point made by the Deputy is valid, but it will not happen in the way he wants or that anybody else wants unless our economy is functioning properly whereby clearly there is an emphasis from the Government on the opportunity to create jobs and employment and get people off the live register.

The aim would also be to motivate them and give them a sense that they are making a contribution to their localities, counties and the country in general.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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The policy being pursued in respect of the abolition of the CLÁR and RAPID programmes has directly contributed to the loss of 11,150 front-line jobs in the community and voluntary sector. The staff who occupied those jobs served deprived communities throughout the country. In 2012 Brian Harvey presented his report, "Downsizing the Community Sector" to the Irish Congress of Trade Unions, ICTU. Said report showed that the contraction in the sector - on foot of a policy introduced by the previous Government and continued by the current Administration - would lead to 11,150 direct jobs in the community and voluntary area being lost by the end of this year and that by 2015 a total of 17,000, or one third of the total number of jobs in the sector, will have been lost. As already stated, these are front-line jobs which are occupied by those who serve deprived communities. All of this is happening at a time when-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Does the Deputy have a question?

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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-----the Government has given failed banks permission to pay their executives €500,000 per year.

Finian McGrath (Dublin North Central, Independent)
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Hear, hear.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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There appears to be a golden circle involving bank executives, Government advisers and chief executives of voluntary hospitals and, effectively, these individuals appear to be getting away scot free. As Christmas draws near and as increasing numbers of children go to school hungry, I ask the Taoiseach to cast off his role as Scrooge and reinstate funding for the RAPID and CLÁR programmes. I also ask him to reinstate the funding relating to RAPID co-ordinators.

Enda Kenny (Mayo, Fine Gael)
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The Deputy picks a particular line and that is what he wants to do. In the budget for 2013, the Minister for Finance reduced the rate of VAT which applies to the hospitality sector from 13.5% to 9%.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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What has that got to do with disadvantaged areas?

Enda Kenny (Mayo, Fine Gael)
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Not only did that stabilise the industry, it also allowed for the creation of 15,000 new jobs.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Taoiseach should come off it.

Enda Kenny (Mayo, Fine Gael)
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Those jobs were not all created in large urban centres. The Minister has continued the policy in this regard in budget 2014. Not only that, travel tax will be zero-rated from 21 April next and this will lead to 1 million additional passengers entering the country as a consequence of Ryanair's plan to establish new routes. Does the Deputy believe that all of those passengers coming here will stay only in Dublin? Does he not believe that they will visit the areas to which he refers? Is it not right and proper that people should never be confined to projects only and that they should have the opportunity to break out from that-----

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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What about the over 11,000 jobs lost in the community and voluntary sector?

Enda Kenny (Mayo, Fine Gael)
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-----and obtain employment in and contribute to their own communities? I do not deny the value of the RAPID or CLÁR programmes, nor do I deny the value of community employment schemes, the Tús programme-----

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Taoiseach is reading from the wrong script.

Enda Kenny (Mayo, Fine Gael)
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-----the MOMENTUM programme, JobBridge or JobsPlus. These all involve giving people the opportunity to obtain employment, to upskill and better themselves and to make a contribution. Of course Deputy Healy will pick an area which it suits him to discuss. He does not want to understand - perhaps he does not wish to appreciate - the fact that when the Government makes a decision, it can have an impact to the benefit of people. I refer, for example, to the decision we made in respect of the hospitality and tourism sector, which benefited the Deputy's own wonderful county.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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The question I asked relates to disadvantaged communities.

Finian McGrath (Dublin North Central, Independent)
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The Taoiseach is waffling again.

Enda Kenny (Mayo, Fine Gael)
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The decision in question led to the creation of 15,000 extra jobs. As a result of The Gathering, family groups from abroad have returned to visit every county in the country. In total, some 500,000 additional tourists have come here in 2013 and this has contributed to the development of local economies.

The Deputy asked if I am going to restore the funding previous available for CLÁR, RAPID and a number of other programmes. The budget has already been put in place and we have changed the structures relating to the way in which moneys are channelled to local authorities. As a result of those changes - which alter the balance between elected representatives and the executives of local authorities - there will be far greater transparency and accountability. I hope this will have a beneficial impact on the areas, both urban and rural, to which the Deputy refers.