Leaders' Questions

Deputy Micheál Martin

In recent months, thousands of people have received letters from the HSE initiating reviews of their medical card entitlements and, in many instances, removing their medical cards. This has caused huge anxiety, grief and concern throughout the country. Many of these people are elderly and in receipt of medical cards. Nowhere is this more cruelly felt than in the persistent underhand campaign to reduce the number of discretionary medical cards. In essence, a discretionary medical card is for people who are over the income limit but have a chronic long-term illness necessitating high medication costs and visits to doctors.

I will give the Taoiseach an example. Yesterday, a 68 year old gentleman called to see me. He had received such a letter taking the card off him. The card's expiry date was 2021. This person has a very complex medical history with multiple issues necessitating high medication and so on. He has been out of work since 1985 because of his medical condition but the card was taken off him, which shows the campaign that is under way.

The grief and concern felt by people was added to by the Minister for Health last week when he confirmed that cancer patients are no longer entitled to a discretionary medical card unless they are terminally ill. I read a response to the Minister in a blog from a cancer survivor yesterday.

An Ceann Comhairle

Does the Deputy have a question?

Deputy Micheál Martin

The level of outrage and anger articulated in that blog is something he should read because the phrase "not such a bad diagnosis at all" was adding insult to injury and is something that people with or who have come through cancer cannot comprehend. The person talks about the financial hellhole that the condition entailed involving numerous medications and visits to doctors. Many survivors and many people with cancer are very angry. They see this medical card as the saving grace and lifeline during such a condition. Could the Taoiseach get the Minister to apologise and withdraw those remarks? More importantly, will he reverse the policy of not facilitating people with cancer with discretionary medical cards and stop the policy of reducing the number of discretionary medical cards held by people with long-term chronic illnesses? In recent years the number has been reduced by 21,000. A campaign is under way and I call on the Taoiseach to stop it and reverse it.

The Taoiseach

The medical card has always been an important element of this country's society. When they were operated by the various health boards through clinics throughout the country there was a more personal connection with those who applied for them and it was always possible to explain directly what an individual's circumstances might be. At present more medical cards are issued than ever before.

Deputy Joan Collins

There is more need.

The Taoiseach

Deputy Martin raised an issue about discretionary medical cards which, according to newspaper reports, have been reduced by 20,000 in recent years. He called on the Minister to apologise in respect of a particular case. I do not have the details of this case and I invite the Deputy to send them to me and I will have the Minister examine it.

When a person gets the results of a series of tests which show a major complication or ailment it is always a huge shock. The discretionary medical card was available for particular purposes. I do not have the details of the case Deputy Martin mentioned-----

Deputy Micheál Martin

It is not a case; it is a policy change regarding cancer.

The Taoiseach

-----but if the person has been unemployed since 1985 and has multiple issues, with other complications as well as cancer, and a card issued to the person involved until 2021 has now been withdrawn, there is a reason for somebody making this decision and we need to find this out. I have no doubt about the veracity of the case mentioned by the Deputy, and if the person has been out of work since 1985 because of medical complications, and has cancer and multiple issues which make life very challenging, I do not see why a decision was made to suddenly alter a previous decision made in good faith to issue the person with a medical card until 2021 when it would be reviewed. Medical cards have always been reviewed on an annual or biannual basis. Sometimes people moved away or passed on, and sometimes an ailment cleared up or the complication was such a medical card might never be required again but discretionary cards are a particular type of card and are issued to people with particular problems.

The Minister, Deputy Reilly, is as concerned as anybody else that those who deserve cards should have them. I do not suggest the person mentioned by Deputy Martin should not have a card but we will investigate this case and I would like to see the results of the inquiry myself.

Deputy Micheál Martin

The Minister, Deputy Reilly, stated cancer can range from a desperate diagnosis to not such a bad diagnosis. He confirmed it is now Government policy not to issue medical cards to cancer patients unless they are terminally ill. This is the point I made. It is this statement which has caused such outrage and anger.

I read extracts from the blog I referred to yesterday. The person who wrote it stated her not such a bad diagnosis brought her to her knees in ways one could only know if one had been handed one. She stated the medical card was the one saving grace in her life and still is. She details the doctors, pills and antibiotics and describes how it was such a financial hell. She was not terminally ill and is 14 months clear of cancer.

The Minister and HSE have stated one will only receive a discretionary medical card if one is terminally ill with cancer and any other cancer diagnosis no longer qualifies. The discretionary medical card was available for people with cancer and other life-threatening illnesses and for those who did not have cancer but who had long-term chronic illnesses. The reason was the necessity for frequent visits to doctors and dependence on a significant amount of medication.

Will the Taoiseach reverse this policy on cancer and discretionary medical cards and stop the ongoing underhand campaign to reduce the number of discretionary medical cards being issued, which was signalled in the budget when the eligibility thresholds were raised and it was stated 20,000 cards would be taken out of the system this year? It was under the radar and buried in the detailed documentation of the budget. People are now beginning to see it with letters coming in the door taking medical cards from them. This is the reality of life on the ground in terms of discretionary medical cards and I ask the Taoiseach to reverse this policy.

The Taoiseach

There is not a household in the country which has not been affected by cancer, including mine, and everybody understands the gravity and shock which comes with the dreaded word being diagnosed, but it is true to say medical science has advanced to a great degree in the past 30 years and many of the initial diagnoses of cancer are treatable and are dealt with and people move on to live very normal lives for a very long time. In other words, their cancers get cured, although clearly not in all cases.

Deputy Timmy Dooley

It is costly.

Deputy Barry Cowen

It has a financial dimension.

The Taoiseach

Professor Kerin and the researchers involved in breast cancer research in Galway do enormous work. I spoke to somebody whose wife went through this quite recently who told me he would never again question the necessity of having centres of excellence, because his wife received such wonderful treatment and is now deemed to be clear.

Deputy Micheál Martin

I accept the treatment is much better.

The Taoiseach

This is wonderful and is an advance of medical science.

A total of 43% of the population now have medical cards and last year the number of people covered was 1.854 million. This year we want the figure to reach 1.9 million people.

Deputy Micheál Martin

I am speaking about discretionary medical cards.

The Taoiseach

The number of medical cards is increasing-----

Deputy Micheál Martin

It is because of unemployment.

The Taoiseach

-----and so is the cost.

Nobody would disagree with the gravity of the situation which arises when cancer, leukaemia or motor neurone disease is diagnosed.

Deputy Micheál Martin

Will the Taoiseach re-examine it?

The Taoiseach

Most people in the House have friends and family involved. The principle which underscores medical cards, as the Deputy knows because he was in the Department previously-----

Deputy Micheál Martin

It has changed.

The Taoiseach

-----under the Health Act 1970 is to provide comprehensive free medical care to anybody who cannot without hardship afford it. The decision taken allows for a case-by-case analysis of whatever the consequence of diagnosis might be. I will see to it the Minister examines the case mentioned by the Deputy-----

Deputy Micheál Martin

I am not speaking about a case.

Deputy Michael Healy-Rae

We all know such cases.

Deputy Micheál Martin

I am speaking about the policy on cancer patients and medical cards.

An Ceann Comhairle

We are over time.

The Taoiseach

The policy is to cover 1.9 million people in the country with medical cards this year.

Deputy Micheál Martin

I asked about the policy regarding cancer patients and discretionary medical cards.

The Taoiseach

This number is rising-----

Deputy Micheál Martin

The Minister made a statement last week-----

An Ceann Comhairle

Please stop interrupting.

Deputy Micheál Martin

All I want is an answer to the question I asked.

An Ceann Comhairle

This is not Question Time.

The Taoiseach

It is not true, as I understand it, to state the Minister or the HSE stated one will not receive a medical card unless one has terminal cancer. The Minister disagrees with this and is clear he did not state this.

Deputy Timmy Dooley

What did he say?

The Taoiseach

The Health Act 1970 sets out the general principle of which Deputy Martin is well aware-----

Deputy Micheál Martin

Will the Taoiseach confirm the policy is not what the Minister stated last week?

The Taoiseach

-----which is that a person is entitled to comprehensive free medical care in the medical card system in situations where, by virtue of hardship or financial difficulties, he or she cannot meet the costs.

An Ceann Comhairle

I ask Deputies to respect the Chair. We are four minutes over time on this question.

The Taoiseach

It is not true that because somebody gets cancer suddenly the Minister states one will get a medical card only if it is terminal. I will have the case followed up.

An Ceann Comhairle

I ask Members please to stick to the time limits or arrange through the Whips to extend them. Do not ask me to run the Chamber on the basis of limits when Members do not adhere to them.

Deputy Gerry Adams

Last night was the fourth night of recent violence in the North. Police officers have been attacked by rioters still wearing their orange regalia. Many police officers have been injured. There were attacks last night, including bomb and petrol bomb attacks on St. Matthew's Church and on homes in the Short Strand. Violence from any quarter must be condemned and deplored but what we are witnessing on the streets at this time is naked sectarian aggression.

I do not believe the scenes we are witnessing reflect the majority within the Orange Order and the loyal orders and more especially the majority of citizens in the North. I hope the Taoiseach will join me in saying that solutions can only be found through dialogue involving the loyal orders and residents of the host communities. The experience of Derry and other areas is evidence of that.

I argue specifically again very strongly that we must all recognise that Orangeism is a part of who we are as a nation and a people. The loyal orders have the right to parade and to promote their sense of identity but that must be on the basis of equality and tolerance. We cannot tolerate sectarianism, bigotry or incitement to hatred. Will the Taoiseach join me in calling for an end to the street protests, appeal for calm and urge the order to enter into real dialogue on the contentious parades? The Taoiseach will recall that I have constantly argued for the Government to be in continuous contact with the British Government as part of its responsibility as co-guarantor of the Good Friday Agreement. The Agreement specifically affirms the right of citizens to live free from sectarian harassment. Has the Government spoken to the British Government on the recent violence?

The Taoiseach

The answer is “Yes”. The Tánaiste was in direct contact with the Secretary of State, Ms Villiers, on the matter and the Minister of Justice in Northern Ireland, Mr. Ford. Everybody agrees with the sentiment Deputy Adams expressed that there should be harmony and community peace in Northern Ireland.

On the morning of the recent North-South Ministerial Council in Dublin Castle the Orange Order issued a statement saying it wished to engage with communities in the Ardoyne about the parade and the issues that might arise. Clearly, the Government supports the role and the remit of the Parades Commission and the PSNI, which has been under serious pressure in carrying out its duties in terms of maintaining peace and community cohesion.

The Orange Order addressed the Seanad last year and made its comments. I met it myself. Clearly, Deputy Adams will not find anyone in disagreement with the sentiment he expressed in the House. All we can do is reinforce the message by continued direct contact with the representatives of the British Government and of the political parties. I am also aware of the comments made by Vice President Biden. Everyone is now aware of the appointment of Richard Haass, the experienced special envoy, to chair the work dealing with parades, protests, flags, symbols and emblems dealing with the past. Those are serious issues. I saw some of the television pictures of naked sectarianism at work and it is not a pretty sight.

This House should unite in its call to all the communities to show restraint. This is not good for Northern Ireland, its reputation and the perception of the people of Northern Ireland. Following on the successful G8 summit where the reputation of Northern Ireland and its people was greatly enhanced this does down the economy, in particular of Belfast, and it also does down the reputation of community efforts to have cross-community peace and harmony. In so far as sending that message is concerned, we will reinforce it very strongly and will continue our contacts directly with the British Government and the representatives of the people in all of the parties.

Deputy Robert Dowds

Hear, hear.

Deputy Gerry Adams

I thank the Taoiseach for his answer. I know that there are lots of worries and responsibilities upon the Government at this time but these issues must be continually worked at. It is all relative. The violence was quite localised; it was only in Belfast. It is disastrous for people who live in those small terraced houses in what are called interface areas to live under that constant threat and worry. It is something I would not wish on anyone. A total of 550 orange parades took place over 12 July. That is a huge amount of parades. The full total of parades by the loyal orders was 4,993. That is outside the experience of most people from this part of the island of Ireland.

It is welcome hat Drew Nelson, the grand secretary of the Grand Orange Lodge addressed the Seanad. I also welcome the fact that at the last moment the Orange Order engaged in dialogue of a sort. The Government must find ways of continuously engaging. I refer to normal ministerial visits. I do not mean high profile visits, but small visits to the Short Strand and loyalist areas such as the Newtownards Road. Ministers will be given a very good welcome. That should be possible under the aegis of the Good Friday Agreement. We must find ways to encourage dialogue because that will allow us to find a resolution to the outstanding matters. Could Ministers be asked to visit the North more often, in particular the poorest, most disadvantaged working class areas that suffer the brunt of the sectarian violence?

The Taoiseach

The answer is “Yes”. I spoke to Mr. Nelson last year when he visited Dublin. That was one of the issues the parties discussed for inclusion in the multi-annual financial framework, MFF, of substantial funding under the peace dividend, the inclusion of INTERREG funding, and a recognition that of the many parades to which Deputy Adams referred the vast majority passed off without any difficulty, rancour or confrontation.

Deputy Adams knows better than most that in the interface communities it is community leaders on both sides who are able to bring about a sense of restraint and calm. What happened before and after Christmas did not help the situation. The intervening period of calm was for a small minority a period of build-up to what is happening now. I hope community leaders and the political process will keep very active and vigilant and that we can get through this period with no further serious violence as we have seen in the past.

The answer to Deputy Adams’s question on ministerial visits is “Yes”. Arising from the North-South ministerial meetings, a great deal of work is going on. The fact that the Presidency went from 1 January to the end of June did require a great deal of attention from all Ministers. Deputy Adams can take it that I am determined that Ministers and Ministers of State will involve themselves on a more active basis in visiting areas in Northern Ireland and different communities there in respect of building on the work of the North-South Ministerial Council and the engagement that is ongoing on a constant basis. That is only to be expected and would be in the interests of building further on the harmony between different communities. That will happen from the autumn.

Dáil Éireann debate - Tuesday, 16 Jul 2013

A Deputy

Dáil Éireann debate -
Tuesday, 16 Jul 2013