Mary O'Rourke (Fianna Fail)

In her speech, the Tánaiste reiterated the comments she has made on radio and in various interviews with media commentators. She spoke clearly about the provision of medical cards, particularly for those on the margins. I refer to those who are deemed to be ineligible for medical cards because they exceed the limits by €5 or €10, rather than those on the margins of society, who are clearly eligible for medical cards.

Senator Feighan said earlier that he does not think politicians should be involved in making the case for people in need of health care. He is hoping for a kind of never-never land if he thinks it will ever happen that politicians will not have such a role. I am sure the Cathaoirleach, the Minister for Health and Children and the two Ministers of State at her Department who have been to the House this evening will agree that health is the area of care about which politicians are most often asked during constituency clinics. I encounter three or four such cases each weekend.

We all know it costs between €35 and €45 to visit a doctor, before one has to find the money for the cost of a prescription. Many parents, especially mothers, who try to balance their domestic budgets for the week find that they cannot afford to pay for the visit to the doctor or the prescription costs for one of their children. Children have many needs during the first few years of their lives. Parents may have to call a doctor for ailments which may seem insignificant in retrospect, but which are highly important to them at the time. One cannot remove the element of care or urgency in the minds of parents when they are addressing such issues.

I have great faith in the Tánaiste's ability to fulfil the commitment she gave this evening to extending medical card eligibility. I strongly urge her to fulfil it, although I appreciate that she cannot do so overnight. She was quite right to refer to improvements in the number of people in employment and the increases in salaries and wages. I continue to have concerns about parents of young families and people who are deemed ineligible for medical cards for the sake of a small amount of money. Such cases are very difficult. Other Senators have said that politicians' constituency duties should not be related to the health sphere of activity. I do not agree that public representatives should be removed from all such spheres of activity, however. What is the point of politics if one cannot take up particular cases?

I wish to discuss the so-called discretion of the CEOs of the health boards. When I first became involved in this area, the CEOs used to have great discretion. If a particular person's application for a medical card was rejected, one could submit an appeal on his or her behalf to the relevant CEO. The CEOs I encountered, most of whom were men, supposedly reviewed the case. In years gone by, there seemed to be a much greater level of acceptance of the need for such exceptions. The appeals one made were normally accepted if a fair case was made. In recent times, however, the parameters of the eligibility criteria seem to be rigidly adhered to in the cases I encounter. The guidelines are not as flexible as I think they should be and, indeed, as the original scheme envisaged they should be. I am certain that the room for flexibility and discretion has lessened extraordinarily.

The CEO of a health board is only as good as the money available to the board for disbursement. I would like the appeals system in health boards to be restored to its former vigour and weight. I am sure the Minister of State understands these matters well because he has come across many cases in his professional role. Politicians do not live in isolation — they have to stay in touch with the real world. Is the Cathaoirleach anxious to say something to me?