Leaders' Questions

People throughout the country are receiving letters notifying them of a review of their medical card eligibility and entitlements. In many cases, medical cards are being taken away from people, which causes great anxiety and distress to them. Within this general cull of medical cards there has been a particularly nasty focus on those with serious illnesses who had discretionary medical cards. They may have been over the income threshold but because of the seriousness of their medical conditions, including cancer and motor neurone disease, they were in receipt of a discretionary medical card.

The figures tell the story. A few years ago, about 80,000 people were in receipt of discretionary medical cards but that figure has now fallen to 56,000. That reduction of 24,000 discretionary medical cards within the system affects young children with multiple complex conditions, many adults with severe illnesses, as well as incapacitated senior citizens. It is a nasty, underhand and sneaky attack whose bottom line is to save money. It is hitting the most medically compromised within our health service. It is hitting patients who can least afford to lose their medical cards because of the additional expense and costs associated with their illnesses and medical conditions.

There have been ongoing official denials about this matter from the Taoiseach, the Tánaiste - as late as last Thursday - and the HSE. I was struck, however, by a letter published in The Irish Times on 25 July 2013 from Professor Orla Hardiman.

A question, please.

She said she had read with interest a statement from the HSE indicating that those with severe and life-threatening illnesses would continue to receive medical cards. Professor Hardiman wrote:

I am puzzled by the disparity between the policy as enunciated and our recent experience in the motor neurone disease clinic. Within the past few months, I have drafted many letters to the HSE in support of appeals by people with advanced motor neurone disease who have been refused medical cards.

Will the Taoiseach reverse this policy and restore discretionary medical cards to those who have had them taken away?

I thank Deputy Martin for his question. There has not been any change in the policy that is adopted here. The number of people with free access to GP care is now the highest in the history of the State. Some 43% of people now have access to free GP care, while 40.7% have medical cards and 2.72% have GP visit cards. In the past two and a half years, there have been an extra 250,000 people with access to and eligibility for free GP care. As of 1 August 2013, some 1.866 million people have a full medical card and a further 131,000 have a GP visit card, which is a total of 1.991 million.

When the Government was elected to office, discretionary medical card applications were not routinely assessed by medical personnel. The Minister for Health, Deputy Reilly, instructed the HSE to establish a clinical panel to assist in the processing of applications for discretionary medical cards. This process allows for medical professionals to have an input into granting a medical card to people who exceed the income guidelines but who face difficult personal circumstances, such as a particular illness. We all know people who are in that category. Discretionary medical cards are awarded to people who are unable, without undue hardship, to arrange GP services for themselves and their families.

The number of discretionary medical cards has fallen because more than 22,000 such card holders now qualify for an ordinary medical card as they now meet the income eligibility. Since 2011, 22,584 individuals who were previously recorded on the medical card register as having eligibility for discretionary medical cards are now registered as ordinary medical card holders because they meet the income eligibility.

The HSE is entitled to award medical cards only in accordance with the Health Act 1970, so applicants must be assessed. The Act states that persons who are "unable without undue hardship to arrange [GP] ... services for themselves and for their [families]" qualify for a medical card. Therefore there is not, and never has been, an automatic entitlement to a medical card for persons with a specific illness. That is the position as outlined in the Health Act 1970, to which I have referred. There is no legal basis for what people might call a cancer medical card or a motor neurone disease card. Of course, that does not mean that in applying the assessment, those people do not qualify under particular circumstances for a medical card.

There is also the question of discretionary medical cards in emergency situations. A system has been put in place for the provision of emergency medical cards for patients who are seriously ill and who are in urgent need of medical care that they cannot afford. Emergency medical cards are issued by the HSE within 24 hours of receipt of the required patient details and a letter of confirmation of the patient's condition from a doctor or medical consultant.

With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and that the applicant will follow up with a full application within a number of weeks of receiving that emergency card. As a result, medical cards are issued to a named individual with a limited eligibility for a period of six months. This is always applied with the flexibility that community welfare officers used to have.

There is a slightly different interpretation of discretionary medical cards for persons who are terminally ill. Once the terminal illness is, unfortunately, verified, patients are given an emergency medical card for a period of six months. Given the nature, urgency and sensitivity of that issue, the HSE has put in place an expeditious process to ensure such people receive those cards as quickly as possible, and rightly so. Therefore, the HSE ensures the system responds as quickly as possible to the variety of circumstances and complexities that such individuals face in what are traumatic personal situations.

I am not talking about the general population because the number of medical cards currently being issued is a function of joblessness. High unemployment equals higher numbers of medical cards being issued. I asked the Taoiseach a specific question on discretionary medical cards. In many ways, however, his answer is in denial of the reality on the ground. I quoted Professor Orla Hardiman from the motor neurone disease clinic as stating: "I have drafted many letters to the HSE in support of appeals by people with advanced motor neurone disease who have been refused medical cards." That rubbishes everything that Taoiseach has just said. Professor Hardiman added: "I have also written many letters for people in the terminal stages of their illness, whose medical cards have been withdrawn for reasons that are entirely unclear."

That letter was published in The Irish Times on 25 July 2013. In an article on 7 August 2013 by Paul Cullen dealing with this specific issue, Professor Hardiman again rubbished claims that emergency medical cards were issued to terminally ill patients within 24 hours, stating they were "simply untrue".

Files in my constituency office include that of a 12 year old boy with serious health issues who was refused a medical card. In addition, a six year old boy with very complex medical issues was refused a medical card. A number of adults with complex medical issues have also been refused medical cards. I am not talking about holding on to their discretionary medical cards. The cards were taken from them or applications were refused.

The Deputy should put a supplementary question.

People who hear responses from the Taoiseach, the Tánaiste and the HSE cannot equate them with the reality on the ground. That is the experience of most Deputies here also, given the numbers of people who have come to them in the past year. Last year's budget signalled that about 40,000 medical cards would be taken out of the system.

It is those who are medically most compromised who are suffering. There is no point telling me there has not been a change: there has been a change and most people on the ground are experiencing it. The Taoiseach needs to dig deep and ensure this change is reversed.

I am sure Deputy Martin will agree that following the change to central processing, applications for medical cards or discretionary medical cards are now all treated on the same basis. For years we had a situation whereby individual community welfare officers, based on their assessment, could make a recommendation for the issuing of a medical card as applied under the old health board system. Any Deputy who served in this House will have engaged in that process in respect of cases brought to their attention by people in different circumstances seeking to be awarded a medical card.

In the case of applications for discretionary medical cards or in respect of persons with a serious or terminal illness as I have already stated a process is in place for the issuance of an emergency card for a six month period but it must be based on medical evidence. The Deputy mentioned a particular case. I would like him to make the details of that case known to me, if possible.

This is systemic.

There are many such cases.

The Taoiseach's time is almost up.

As an elected representative, particular claims are also made to me. The bottom line is that more than 22,000 people who previously held discretionary medical cards do not now have them because they are eligible for an ordinary medical card. Since this Government took office, more than 250,000 additional people who previously did not have a medical card have been awarded one. We now have the highest ever number of medical card holders in the history of the State. The Government wants to proceed to a process whereby we have the best health system, which will respond quickly to the needs of people in any of the categories mentioned by the Deputy.

The National Ploughing Championships got under way this morning. Tá mé fíorchinnte go n-aontóidh an Taoiseach liom nuair a guím ádh mór ar na heagraíochtaí agus na rannpháirtithe uilig a glacfaidh páirt sa chomórtas ar feadh an trí lá ar a mbeidh sé ar siúl. Some 200,000 people are expected to attend the ploughing championships, which is worth an estimated €36 million to industry and the economy. It is a sign of great vibrancy and resilience. Mar is eol don Taoiseach, tá tuath na hÉireann faoi ionsaí. All is not well in rural Ireland. The Government's austerity policies have perpetuated huge levels of unemployment, emigration and poverty in rural communities. Austerity is stripping communities of essential services, including schools, guidance counsellors, hospitals, post offices and Garda stations. New taxes and charges such as the property tax, VAT increases, motor tax increases and septic tank charges have increased this pressure.

In marked contrast to the positivity of the ploughing championships the social fabric of rural Ireland is being undermined by a growth in isolation and loneliness. The Taoiseach will be aware that the second largest numbers for suicide are among those working in agriculture. What is the Government's plan for rural Ireland? Is it more cuts? Will the forthcoming budget provide for further cuts in the lifestyle, values and infrastructure of people residing in the countryside? Why not take the opportunity to instead establish a jobs retention fund for small businesses, to provide incentives for local producers and initiatives which give people hope, young people job opportunities and emigrants a reason to return? Perhaps the Taoiseach will outline the Government's strategy for the future of rural Ireland?

I hope Deputy Adams will attend the ploughing championships during the course of the week. It is an expression of modern Irishness and the evolvement of the former Spring Show into a magnificent showcase for Irish industry with particular reference to the agri-sector. As pointed out on a number of occasions by the Minister for Agriculture, Food and the Marine, Deputy Coveney, exports this year and next year will reach the €10 billion target, which is a magnificent achievement in terms of systems, competency, professionalism and standards in the Irish agri-sector.

The engagement we have had with the different representatives of the farming communities and the outcome of Ireland's Presidency of the Council of the European Union in so far as reform of the Common Agricultural Policy, CAP, is concerned and the implications therein for Ireland point to a very bright future, assuming we can meet the targets we have set ourselves. However, there are issues outstanding, including land transfer, which is an issue for younger farmers in the knowledge that when quotas are abolished, there will be further increased opportunities for development of productivity off-land. The Minister, Deputy Coveney, has met with the different groups in respect of their particular concerns about specific agricultural schemes, which in the context of preparation of the forthcoming budget, the Minister considers very important.

I should point out to Deputy Adams that the real issues are productivity off-land and the provision of jobs in rural and small town Ireland as distinct from large urban Ireland. The capacity of ConnectIreland to deliver to more outward regions is strong. For example, the recent announcement of ten jobs in Kinvara and other jobs in Longford and Portarlington, in which locations we would not normally expect IDA delivery. It is not true to say that the tragic phenomenon of suicide is confined to rural Ireland: it is a phenomenon right across the country. Money has been ring-fenced to allow the Minister of State, Deputy Lynch, deal with that phenomenon. The Deputy will be aware a great deal is happening in that regard.

We are ahead of all the benchmarks set for the agricultural programme for 2020 and intend to remain so. Ireland's reputation as a grass-based agri-economy allows us to make further advances. The Deputy will be aware of the negotiations with the Chinese Government following the strategic partnership agreement and that interest has been expressed by Japan and a number of other North African countries in further expansion of the Irish agri-sector. Given from where we have come and the reform of the CAP achieved by Ireland during its Presidency of the Council of the European Union, the future, while challenging, looks bright. One can never know what natural calamities might occur but in so far as the Irish agri-sector is concerned, its development into the future is the central priority of Government.

I asked the Taoiseach to outline the Government's strategy for rural Ireland on this the opening day of the ploughing championships but he has declined to do so. For the record, I did not say that rural Ireland was bearing the brunt of suicide. I know that is not the case. What I said was that the second largest numbers for suicide are among those working in agriculture. That needs to be examined and corrected.

I am a supporter of ConnectIreland and try in my own small way to advance that project. The ploughing championships is an exhibition of what is best about rural values, the meitheal and cabhair na gcomharsan but that is not reflected in the Government's policies. It is these policies that are stripping away essential services across the countryside. The biggest indictment - I am not articulate enough to explain this - is the communal and societal damage and hurt inflicted on families by the scourge of emigration, which is particularly felt in rural Ireland. One cannot walk the length of oneself in rural Ireland without meeting someone whose son, daughter or two or three sons or daughters, whom they reared and put through education, have emigrated to play their hurling and football in Brisbane, Melbourne, Toronto or Manchester. What the Government needs to do is reverse this.

Austerity is not working. If the policies of austerity underpinning the Government were to underpin the values of society, we would not have a ploughing championship or credit union movement and there would be no Cumann Lúthchleas Gael or all-Ireland football or hurling finals. I appeal to the Taoiseach to use the budget as an opportunity to reverse austerity and to adopt policies which get people back to work and our young people home again, grow small businesses and make society reflect the values that will be evident in Stradbally in the next few days.

We all share the fundamental principles which make Irish people different from many other peoples. Imprinted in our DNA is an understanding of interdependence and interconnection. This is because of emigration, which did not start in the past ten years but has been taking place for many centuries. This is one of the reasons the capacity to involve the vast majority of the Irish diaspora and avail of their experience, ideas and assistance is being worked on as an issue for further discussion at the economic forum which will be held in the near future.

Submissions are being received by the Ministers for the Environment, Community and Local Government, Deputy Hogan, and Agriculture, Food and the Marine, Deputy Coveney, from the chairman of the group dealing with rural development, Mr. Pat Spillane. The group will look at the questions which are causing anxiety and concern and try to address them. This will mean being able to provide access to credit for small and medium enterprises, listening to entrepreneurs who have ideas about making it easier for people to get off the live register and enter the world of work, including part-time employment, and generating ideas for transport, communications, broadband and other such facilities.

One of the priorities for rural areas is to harvest to the best potential what our land can produce to the highest standard and to be part of the movement towards reaching a target of €10 billion in agricultural exports. It also means enhancing basic opportunities, with access to employment and job opportunities being spread around the country. This is not easy to achieve in a short time.

I had the privilege of meeting 500 Irish people in China. They live there by choice and will decide to return in their own good time, based on experience. As I stated, there are Irish communities in San Francisco, Seattle, Boston, Birmingham and elsewhere and they followed those who went before them. What we can do is reverse the economic mess we inherited, provide an opportunity to restore our economy to a good, strong and healthy position, emerge from the bailout, fly again independently and become masters of our destiny. This is what the Government has been doing since we were privileged to be elected to office two and a half years ago.

The austerity policies introduced by the Fianna Fáil Party and continued by the current Government, despite a commitment given during the general election campaign not to do so, are hitting individuals and families on low and fixed incomes very hard. A survey on income and living conditions carried out by the Central Statistics Office in February 2013 found that one quarter of the population experienced two or more types of enforced deprivation in 2011, the Government's first year in office. This figure was higher than the figure for 2010. Fuel poverty, which is one form of enforced deprivation, is having a particularly devastating effect on elderly people, the sick, those in poverty and individuals and families on fixed incomes. It has increased in the Government's term of office, during which savage increases in energy prices have been permitted. I remind the Taoiseach that electricity prices increased by 14.8% in 2011 and 5.9% in 2012 and will increase again in October, while gas prices increased by 22% in 2011 and 8.5% in 2012 and are also due to be increased in October. According to the National Consumer Agency, it costs approximately €1,000 to fill a tank of home heating oil, with the cost increasing by 18% in 2012 alone. These increases could be described as indirect attacks on the living standards of ordinary people. They are condoned by the Government, which has deliberately increased fuel poverty by introducing direct cuts to living standards since taking office in 2011. These included a reduction in the number of free electricity units from 2,400 to 1,800, which was introduced when the Government was barely a wet week in office, and a cut in the duration of the free fuel allowances from 32 weeks to 26 weeks in the 2012 budget.

The Deputy must ask a question.

The Government cut free electricity units in the 2013 budget and increased carbon tax on solid fuel, which will also double next year.

Elderly people and those on low incomes are caught in a pincer movement as they seek to deal with increased prices and taxes and Government cuts in benefits and allowances. As a result, the Society of St. Vincent de Paul is spending €6 million per annum to help people keep their homes warm and lights on. Age Action Ireland, a national charity for elderly people, has stated that people must choose between heating their homes and buying food and elderly people are going to bed as early as 7 p.m. to stay warm or switching off their heating and heading for the nearest shopping centre where they can sit for hours in a warm atmosphere.

The Deputy should put a question to the Taoiseach.

This is unacceptable. Government policies are damaging the fabric of society. Surely the Government must abandon its approach to the elderly and those on fixed incomes by reversing the cuts to fuel and energy allowances introduced since it took office in 2011.

The Deputy did not ask a question. He made a number of observations for which I thank him.

He asked whether the Government will reverse its cuts.

He made a statement that we should reverse the cuts; he did not ask a question.

Deputy Healy, like other Deputies, is in contact with people in his constituency. The Government is not immune to the difficulties people have to face and has been cognisant of them as we have attempted to make decisions, difficult as they are, to sort out the economic situation. Only this morning, the Minister for Finance, Deputy Michael Noonan, pointed to the need for the Government to reflect, in so far as it can, the difficulties and tribulations people are having. It is not the case that we are abandoning people who are in difficult circumstances to their lot. We have moved from a point where 250,000 jobs were lost in a three year period, Ireland's access to international markets was blocked, interest rates for Government borrowing stood at 15% and the country had no strategy to deal with these matters to a point where the position has been reversed and 3,000 jobs per month are being created in the private sector.

Owing to the way in which the memorandum of understanding was framed, the Ministers, Deputies Noonan and Howlin, were able, in their early engagement with the troika, to negotiate to have the minimum wage reinstated. In addition, the Minister for Finance was able to remove 330,000 people from the universal social charge in the budget. There was no increase in income tax and no reductions in primary social welfare rates in budget 2012 and budget 2013, while mortgage interest was increased for those who purchased homes between 2004 and 2008.

While I understand the nature of the surveys to which the Deputy referred, a great deal of assistance is available. Community effort in helping people in difficulty has never been at a higher level.

Clearly the biggest debt that most families face is mortgage debt and the Government has resolved to help families that are struggling through a range of actions that are now in place and we expect them to be delivered on. These matters have been the focus of Government and will again be the focus of what we have to do in preparing the budget for 2014 as a stepping stone to emerging from the bailout, to send out that signal further enhanced, if one likes, by the outlook upgrade by the ratings agency, Moody's, last week which had a direct impact on bond yield spreads. People may not realise these matters impact on the country. As its reputation as a location for investment improves, it impacts on the jobs situation, which is the ultimate goal, being the biggest catalyst to restoring the health of the economy. In that sense as the Minister, Deputy Noonan, pointed out in terms of the budget for this year, these matters are of concern to Government and hopefully can be reflected in the fairest way possible.

I call Deputy Healy who has one minute.

In case the Taoiseach did not understand the question, I will ask it again. Will the Government reverse the cuts to the energy units and the free-fuel scheme that have been made by the Government since 2011? What I have heard suggests the Government has lost touch with reality completely. I am sure the Taoiseach is aware of very important research directed by Professor Goodman of the Dublin Institute of Technology, peer reviewed, publicly funded and launched by the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte. That research has shocking findings. It found, for instance, that there was an excess of winter-----

It is a supplementary question.

I am asking the question.

The Deputy has only one minute.

There are 1,281 excess winter deaths and the majority of those deaths arise from cold-related conditions, such as respiratory illnesses. Crucially that research found that this death rate is among the highest in Europe and even higher than in Scandinavian countries which are much colder in winter than Ireland. These are absolutely shocking findings that were researched and peer reviewed, and launched by a Minister.

I thank the Deputy.

In view of those findings, will the Government now reverse the cuts to the fuel allowance, particularly its duration which was cut by six weeks? Will it reverse the cuts to the energy units of the household benefits package implemented by this Government?

We have a general policy of attempting to make homes more comfortable, warmer and better insulated. Some time ago the Minister for Public Expenditure and Reform, Deputy Howlin, announced the allocation of €50 million for that purpose.

I do not accept the Deputy's assertion that we have lost touch with reality. Very much on the contrary, we engage with people on a very regular basis about the situation in which they find themselves. It is not a situation of their making, but it is a situation that arose because of how our country was allowed to drift. We need to correct that drift and that is what we are doing.

I cannot give a direct answer to the Deputy's question about the reversal of changes in the free-fuel scheme or energy units in the household benefits package. The Minister, Deputy Rabbitte, referred to this in the energy area. The question the Deputy asked is a matter of budgetary policy and I will not answer it now. As the Minister for Finance, Deputy Noonan, pointed out, the Government needs to be cognisant of the difficulties and hardship that many people experience. While we have a difficult job to do in presenting a budget for 2014, we intend to do that in the fairest way possible and to show in so far as can be done a degree of flexibility where it can be applied. However, I cannot answer any individual question about the budget. That is a matter for collective decision by the Cabinet over the coming weeks.