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Dáil Éireann debate -
Wednesday, 14 May 2014

Vol. 841 No. 2

Leaders' Questions

A total of 31,000 discretionary medical cards have been taken from very sick children and from people with life-limiting, life-threatening and terminal conditions over the past three years. I have raised this issue on various occasions in the past 18 months at Leaders’ Questions, and the Taoiseach has consistently denied any change in policy or any move to limit and get rid of discretionary medical cards. The Government’s position became farcical when the Minister of State at the Department of Health, Deputy White, said on radio that there was no such entity as a discretionary medical card. That attempt to eliminate the truth and the facts would have done justice to any North Korean leader.

The health service plan set a target to reduce discretionary medical cards. Every Member of the House has been inundated with calls from worried parents and families who have lost medical cards. I have a list of ten people with very serious conditions that I can give to the Taoiseach. One is a 12 year old child, one of six in the world with a particular syndrome, which gives rise to appalling conditions, who is denied a medical card,. Another is a 65 year old woman with multiple myeloma, a terminal condition, who had the card for some years until it was removed. There are many other such cases. There was an incredible report in the Irish Independent about the mother of Ben Hughes who was asked to prove that her child still had Down's syndrome. This is extraordinary.

The chief executive officer of Down Syndrome Ireland says that half of children with Down's syndrome have either been affected by this cull of discretionary medical cards or have lost them.

The specialist nurses of the Jack and Jill Children's Foundation wrote to the Minister for Health. They care for children with life-limiting or life-threatening conditions who need 24 hour care. They say the situation has become particularly vicious over the past two years. It is critical. It is only a matter of time before somebody, most likely a stressed out parent, is pushed over the edge by this unjust system. They see the danger signs: parents worn out, reduced to tears, not sleeping, not coping and worried out of their minds about their child’s medical card. We have all met such parents.

Will the Taoiseach for God’s sake intervene in this scandal which has been going on for the past two years? It is utterly shameful. Most people we meet, irrespective of whether they have medical cards, are asking us in the interests of a decent society look after the sickest, those who need medical cards and make them our priority. Will the Taoiseach intervene, reverse engines and transform the situation?

The Taoiseach must justify that.

I thank Deputy Martin for his question. I recall in 2002-----

(Interruptions).

Deputy Kenny is the Taoiseach now.

Deputy Healy-Rae should know that I always like to remind Deputy Martin of the truth. It is a very important element in Irish life.

A Deputy

They do not want to hear.

The Taoiseach should set up a truth commission.

A Deputy

The Taoiseach supported it.

Deputy Martin has already answered for that.

In 2002, Deputy Martin promised the electorate 200,000 extra medical cards. By the time he left the Department of Health in 2004, it was estimated that 100,000 individuals on low incomes had lost eligibility. That is Deputy Martin’s record.

What about people with cancer or motor neurone disease?

The question of discretionary medical cards, long-term illness cards, or cards for children or people with particular difficulties or for emergency situations is very serious because it impacts on people’s quality of life and causes stress and anxiety.

The Taoiseach is in denial.

A great number of our people who have full medical cards have not used them for quite some time because, as the Deputy knows, the legislation governing medical cards is based on financial hardship, not on medical condition. Community welfare officers in different parts of the country used their judgment in different ways to grant medical cards or not.

Who told the Taoiseach that? Where did the Taoiseach hear that?

That was from Deputy O'Dea. Deputy Martin centralised this process and the same criteria applied to everybody. That is where the problem has arisen because the centralisation does not take into account the particular circumstances that might apply in any individual case.

When Deputy Reilly became Minister for Health-----

We remember that.

-----he requested a detailed examination of the 78,000 people who held medical cards on a discretionary basis, in March 2011. Of the 77,925 discretionary medical cards in circulation on 1 March 2011 their status on 1 March 2014 is that 25,398 people, 33%, still hold a medical card on a discretionary basis; 37,906 people, 49%, now have a full medical card based on an assessment of means-----

They had it already.

That is gobbledygook.

The Deputies opposite may laugh if they want. There are 37,906 people with a full medical card; 14,621 people, 19%, no longer hold a medical card, 3% of them were deceased, 7% did not respond to correspondence; 2% did not complete the review process and 7% completed the process but were found to be ineligible for a medical card.

One of the key goals of the reform of the health system is to ensure people who have challenges-----

They are all own goals in this Government.

-----can get an integrated package of services of care built around their particular needs. The Health Service Executive, on the basis of current legislation which states this is based on financial hardship, may allow discretion – I know families, good luck to them, who may well be very much in excess of the income limit, they might be very high earners - but no matter how far one extends the discretion, one will fall short of particular cases. Campaigners say we must allow a full medical card for persons with a particular need, who deserve to have it for life, but if one applies that logic, everybody who becomes a diabetic, or everyone who is asthmatic might be eligible for a card.

We need to have a discussion on this and I take into account the many cases Deputies have raised here. Nobody should be asked the question: "Is your child still Down's syndrome or not?"

They are being asked that and many other questions as well.

Nobody should be asked that question, Deputy McGrath.

They are being asked.

That is what is happening.

Stay quiet, please.

It is the Taoiseach and his Minister who are doing this.

What is the Taoiseach going to do about it?

I cannot defend somebody in whatever office-----

We are way over time.

-----sending out a reply to a person who suffers from motor neurone disease asking if the person is still suffering from the disease.

It is happening on the Minister, Deputy Reilly's watch.

This is what we have to get right.

It is happening on the Taoiseach's watch.

This is where the Minister, Deputy Reilly, and others are working to ensure that the package of services and facilities are made available to those people in their particular difficulties.

(Interruptions).

Does the Taoiseach want me to hold up a mirror for him?

I understand Deputies raising the question of discretionary cards. I have given them the figures three years on from 2011 but I want them to understand that there is not an attempt here to show lack of understanding, compassion or consideration for people who have these challenges.

The Taoiseach is failing then.

It is a question of getting a system that is fair for everybody. This issue has been raised with me over the years. I have been asked questions such as, "How come this person had got a medical card and I cannot have one?" and "How come this was allowed and it was not allowed in my case?"

(Interruptions).

I will let the Taoiseach back in.

If we are going to have a standard, we need to look at what we are doing here. If it is on the basis of financial hardship, we need to apply discretion as far as we can but we need to put the local integrated package around people who need it to see that they get that care and attention.

Clearly, they are not listening to the Taoiseach.

We are not talking about any old case. People who had discretionary medical cards had them under the legislation. I think most people watching and most people in society would expect a 12 year old child who has profound mental disability, is legally blind, has hearing loss in the left ear, is asthmatic, is non-verbal and is wheelchair bound to have a medical card. That is my point. I am not talking about systems or integration this or that. Most people in society would say, "What in the name of God is going on when a child like that does not have a medical card?"

Deputies

Hear, hear.

Equally, in terms of a 65 year old woman who has multiple sclerosis, osteoarthritis, congenital abnormality of the eyes and other conditions, I think most people would say that person should have a medical card. In terms of an elderly women with multiple myeloma, she had a medical card since 2006-----

A question please, Deputy.

----she has a terminal condition but has had her card removed. The Taoiseach can see that this is a policy. Enormous stress is being caused. Last night I called to a door and I am not going to name the case because it is confidential.

Deputy, we are over time.

This is the case of a person who has motor neurone disease, who is on a ventilator and for whom incredible care is being shown by a loved one. The person's card has only been renewed for six months. This is out of control. It is a disgrace. The Taoiseach should hang his head in shame-----

A question please, Deputy.

-----over a policy that is focused on taking cards from people who need them.

He has been told about it often enough.

The legislation is there to allow it. The Taoiseach has been warned enough by many people on his own side, by Deputies on the backbenches and Deputies from every other party here. This calls for a genuine intervention.

The letter from the Jack & Jill Children's Foundation specialist nurses was sent to the Taoiseach and it made a very good point. It said that the Government should be rolling out the red card for parents who are prepared to look after their children in very serious conditions on a 24 hour basis, not rolling out red tape. That is what is happening right now. They are in dread of the next letter that will come their way advising them that their card is under review and will they please fill in all the forms. That is what is happening. For God's sake, will the Taoiseach do something about it? Intervene and stop it.

Let me assure Deputy Martin that he is not the arbiter of all things that are just and fair in the country.

Answer the question.

His own record speaks for itself - it was disgraceful. I called in the HSE, the Minister for Health and everybody else to discuss these questions-----

(Interruptions).

Deputies, will you stay quiet please until we hear the answer?

-----because Deputies on this side of the House were bringing to our attention very serious cases. I have not heard Deputy Martin say that the law should be changed from what it is at the moment where it is based on financial hardship.

The Taoiseach is wrong there.

I have a case here myself.

(Interruptions).

Please, Deputies, a time limit applies here.

Let us have a conversation about it. If the Deputies want to decide to change the legislation to base it on medical needs as distinct from income and financial hardship that flows form that, well then we are entering a very different sphere here.

The legislation provides for that.

What I am trying to do here is to ensure-----

The Taoiseach has the super majority so he can come up with the solution.

-----that the people who need care, attention, facilities and aids for their particular illness get them-----

What about terminal illness?

-----but of course there are differences of opinion and perception about the medical card, the long-term illness card, the discretionary card-----

-----given in exceptional circumstances,-----

The Taoiseach should forget about the card and think about the people.

-----the emergency card given and people who have particular difficulties.

These are incredibly severe cases.

I said here that in a case involving the HSE, I do not believe it should ask somebody six months further on have they still got motor neurone disease.

That is the policy.

That is not what we want.

That is what is happening.

What is the Taoiseach going to do about it?

Yes, I understand, and that is why we have intervened here to put a stop to that.

It is not working.

Just like other cases where centralised digital recording took place, these cases come to light all the time and each time they do we try to deal with them with a sense of compassion. The Minister, Deputy Reilly, is going to meet with the nurses from the Jack & Jill Children's Foundation to go through these cases so that the State can say of course we understand that people-----

There no compassion.

-----have particular difficulties, some of them for life. I have a case here of a person who has motor neurone disease, who is suctioned ten times a day but is very much over the limit in terms of eligibility. What are we to do? Are we to say that everybody gets a card here?

Of course a person who has motor neurone disease who is at the end stage should get a card. It is obvious. It is elementary.

That person needs 24-hour care and cannot speak, walk or do anything. In our nation's history-----

The Government has been trying to cut them - some 30,000 of them.

-----we would never want to see a situation where they are left without attention or without medical care. The Deputy refuses to focus on the fundamental issue that we are trying to deal with here.

The Taoiseach is refusing to focus.

The law has been there for many years. That is why probably back in 2002-----

More and more cases are coming to light.

-----Deputy Martin disgraced himself with another promise that he could not keep.

The Taoiseach is going back to the last century.

I am giving the Deputies the figures for discretionary cards from 2011 to 2014-----

And we are giving the Taoiseach the cases.

-----and we will continue to show compassion and understanding where that is possible in all these circumstances.

That will be a change.

I ask the Members to have an understanding of the position of the Chair. That question extended for seven and a half minutes over the time allocated.

It was a very important question.

If they want to extend the time allowable, please arrange to do so, but do not have me shouting at them to please finish. That is all. I only apply the rules. Will the Whips ever get together and look at this issue so that we can have some flexibility to ensure I can stop having to call on people to sit down?

I cannot just allow things to drift on and say nothing. I have to try to be fair to everybody. I call Deputy Adams and I will be depending on his generosity.

Go raibh maith agat. The Taoiseach's policy of withdrawing medical cards from sick citizens has no credibility whatsoever. Private Members' business this evening, which is a Sinn Féin motion on this issue, will give him an opportunity to change his tune and to rectify this crisis.

There is also another crisis, a major housing crisis causing untold misery to thousands of citizens, including children. Within sight of this Chamber there are thousands of people, some young and some not so young, sleeping rough on our streets. Other families - thousands of them - are living in cramped, over-crowded conditions with parents and grandparents because they cannot get a home of their own.

Mortgage distress is also a major social issue. The number of families in mortgage arrears is now 136,564. The Taoiseach's proposal, as I heard it on "Morning Ireland", aimed at encouraging banks to lend more only to buyers of new houses reads like an extract from the election stunt section of the Fianna Fáil handbook of strokes and other scams. It does not make any sense in dealing with the crisis. There are also well-founded concerns that his proposal will lead to inflated houses prices. The Taoiseach must know that housing lists in all local authorities are lengthening. The bill for emergency accommodation is spiralling. There is a tenfold increase in the past year in spending by the Dublin Region Homeless Executive on emergency accommodation. The Peter McVerry Trust has dealt with 3,600 homeless cases, mostly young men, in the last 12 months alone and the number of families losing their homes has more than doubled according to Focus Ireland. That spending on housing in Dublin city is to be reduced by €53 million. A radical change of policy is needed.

Sinn Féin's housing spokesperson, Deputy Ellis, has already suggested a plan of investment in social housing that would see the construction of 7,500 new homes on top of current targets.

There is €1 billion of unused money in the strategic investment fund that could be used to stimulate the construction industry, mar is eol don Taoiseach, níl aon tinteán mar do thinteán féin. Will the Taoiseach commit to taking this practical measure as part of a package of initiatives, including the introduction of a right to housing, protection of families from eviction and rent controls?

Deputy Adams talks about changing tunes here. There are a few issues on which he could change tune himself, but I will not go into that now. When he speaks about the housing problem and puts forward Deputy Ellis's view that we should take €1 billion from the National Pensions Reserve Fund and start building houses, even Deputy Adams with all his magic could not conjure up houses in the next six months. Today the Government will launch its construction strategy with 75 specific actions to stimulate this industry. I want the Deputy to understand that the legacy left behind by the people sitting to the Deputy's left is an obscenity on Ireland and its people.

Deputies

Hear, hear.

I refer to pyrite, greed, corruption, planning scandals and credit as if it could be thrown about forever.

The Taoiseach could not care that his councillors were stuck in the middle.

They have gone very quiet.

As I said before to the Deputy previously, the hallmark of the previous Government's catastrophic failure was Priory Hall. It put people into those kinds of housing units.

(Interruptions).

Will Deputies stay quiet please?

Yet again this Government has to come along and clean up the mess.

A Fine Gael-led local authority allowed Priority Hall, for God's sake.

And Deputy Adams's friend built it.

I make no apology for saying I do not accept anybody's assertions that this Government, in cleaning up this mess, will go down the road of creating a further housing bubble.

That was a Fine Gael-Sinn Féin partnership.

There are 100,000 people on the live register who were involved in the construction industry, including plasterers, blocklayers, chippies, tillers, roofers and everything else. We want these people to have an opportunity to get back into the world of work. We want families, young people and those starting on the housing ladder get top-quality housing at affordable prices, not like what we had before and which unfortunately we have discovered in various parts of the country. Today the Government will launch a strategy in this regard. Yesterday, as a further indication of where Government stands on this, €50 million was allocated to the Minister of State at the Department of the Environment, Community and Local Government with responsibility for housing to address homelessness, where a further €10 million is put in, with €20 million for direct construction and €20 million to bring back a further number of houses that are empty and boarded up, and could make very good homes. That will bring the figure involved to 1,800. This is an issue that concerns families, people, jobs, employment and opportunity. It is not about contractors or developers. It is not about greed or bankers.

It is all about the Taoiseach.

It is about people, our economy and jobs for the future.

What about the €60 million the Government cut off?

I interpret the Taoiseach's answer as "No" because I put forward a thought-out suggestion. The Taoiseach talks about people; this is about citizens. There is a difference between people and citizens: citizens have rights, including the right to a home. The Government is going to announce its construction strategy. Will the Taoiseach bring it in here so that we can discuss it and make suggestions? No, it will not come into the Oireachtas with it. It is going elsewhere with it and it is doing the type of thing that the Minister, Deputy Rabbitte, does in an election campaign. People will see through this.

Deputy Adams is a good hand at it.

Would Deputies please allow a reply and stay quiet. I also ask Deputy Adams to stick to his time.

Okay, a Cheann Comhairle. Go raibh maith agat.

This is like a circus.

Deputies should sit here and listen to it. I fear to think what the public thinks about it. People are shouting from the back benches as if they are making a contribution.

I give a thumbnail sketch of a deep crisis of which I am sure the Taoiseach is aware. There is also another issue the Taoiseach did not answer. At the end of my contribution I asked about the citizens who are being forced into homelessness by rising rents in the private sector, yet the Government refuses to introduce fair rent control to tackle this. The www.daft.ie website has claimed that rents in Dublin have increased by 14%, and by 9% across the State in the past year. Fair rents alone will not solve the housing crisis but it must be part of a package of initiatives to help ease the problem.

The building of social housing needs to start now. We are not looking for much and we know what is needed.

Please put your question.

Surely it is the duty of the State to defend citizens against rack-renting landlords by setting rents at fair levels and by providing homes for citizens. Where is the State's duty of care especially to children as the Taoiseach sees it? What is the Government doing to tackle this crisis, which will only worsen in the time ahead?

I met a young mother yesterday evening on one of the streets where I was canvassing. She had three children under five and she cried bitter tears in that she had been sent to a very small apartment with inadequate facilities in an area that is used by drug pushers and drug users. It was a very powerful statement made by this young mother. At the height of the boom in 2006-----

I want to talk about now, today.

Perhaps we should also talk about the past as well.

We will talk about now, today.

In 2006 there were 93,000 housing units completed. The corresponding figure for last year was 8,000, a reduction of 91%. We have a construction sector that is about half the size it should be and is very much below European standards. We should be building 25,000 to 30,000 houses a year.

Give us the investment fund then.

That is why some €88 million has gone into the coffers of the Minister of State with responsibility for housing for social housing. It is why NAMA wants to provide 4,500 houses over the next two to three years. It is why we want to see a return to the construction sector with the hopeful creation of 60,000 jobs between now and 2020.

We need to have a process for dealing with the valid claims of young couples and young people to get a start on the housing ladder with affordable quality housing built by people who know what they are doing. We do not want to have apartment after apartment fired up and after they are occupied we discover they either have pyrite or are like Priory Hall. We are not going back there. We will get this right in the interests of the people, jobs, the citizens and our country. In that sense we will need to wait some time before we can put blocks on the ground and put people in those houses.

Even with the proposal of Deputy Ellis - good man that he is - of putting €1 billion on the table, we would still have to wait 18 months or two years before the families can move in.

That is not what his leader says.

We need to start now.

I call Deputy Catherine Murphy.

What about the €30 million for Pairc Uí Chaoimh?

In the last budget the Government cut housing by €60 million.

We added €88 million.

Block the ears.

I called Deputy Catherine Murphy.

What happened at-----

It allocated €30 million for Pairc Uí Chaoimh.

If Deputy Ellis cannot control himself he should leave the Chamber and stop annoying himself.

We are in a crisis.

Commentary on the Guerin report has rightly focused on the failings of the Garda Síochána on specific issues and in specific cases. What has gone mostly unremarked upon is the Mr. Guerin's criticism of how a lack of resources has contributed to the problems we are dealing with today. Chapter 2 of the report highlights that no inspector was allocated to Bailieborough Garda station during the relevant times. That chapter also describes the station building in Bailieborough as a relic of policing of a different age. The report also highlights the problems of inadequate Garda resources in neighbouring localities, increasing the pressure on already stretched Garda resources in Bailieborough.

The same situation exists in several Garda divisions. Resources are stretched to their maximum and some areas are significantly more disadvantaged than others. These include areas that have had a consistent population growth over the past decade or two, such as Meath, Wexford, Laois, Offaly and Kildare, which is the worst in terms of the ratio of gardaí to population and is significantly below the national average.

This is supposed to be dealt with in the policing plan each year. If one measures the demographic changes and the CSO crime rates, as I have done, the only conclusion one can draw is that the policing plans are a work of fiction.

I sought a meeting with the former Minister for Justice and Equality to talk to him about this but he told me it was the exclusive responsibility of the Garda Commissioner. I then sought a meeting with the Garda Commissioner who told me he would not meet me but he put me on to the Assistant Commissioner who I had met previously. He had told me that the strategy in regard to resources was that in each division one holds what one has, so there would be no movement. That is a particular difficulty at a time of embargo.

What function will the new independent Garda authority, which is due to be up and running later this year, have in regard to the deployment of Garda personnel? Will it deliver a police service which will be able to meet and respond to be the changing needs or will we see the same situation apply but under a different Garda Commissioner?

I thank the Deputy. Her question and comment at the beginning related to the situation that has applied from the foundation of the State up to the present time where the Commissioner of the day was always responsible for the day-to-day running of the Garda force and the Minister for justice of the day, with few exceptions in the past, did not interfere with that. Obviously, there would be meetings between the Garda Commissioner and the Minister of the day in respect of the requirements of the Commissioner to run the Garda force in terms of facilities, vehicles and aids and appliances for gardaí to do their job. That was an issue raised consistently by Minister after Minister.

The decision of the Government to move to an independent statutory authority to deal with the Garda will remove politics from the running of the Garda in the sense that the Commissioner who makes recommendations to Government, and who has always done so, in respect of Garda divisions, the running of and the senior personnel in the Garda will become part of the requirement of and the responsibility of the independent statutory authority.

I do not want to attempt to spell out the way this will work in its finality because I would like to hear the views of Members when we discuss this. As I said the day before yesterday, the committee I chair, which is a new Cabinet committee dealing with the requirement to bring forward the model and structures for the independent statutory authority will have its second meeting on Tuesday of next week. I hope to come back to the House with recommendations or a structure it can debate in July.

I listened to different speakers say it is very important to get this right. It is critical the people have faith, belief and credibility in the integrity of the force but also that those who work in it have pride in what they do.

I am hearing comments from different parts of the country about what should or might be done. All I want to say is that all of these comments and observations will be taken into account, as will the views of the Members. The decision is to move to an independent statutory authority away from the current situation where the Commissioner of the day makes all of the recommendations, including the recommendations for approval by Government of promotions and so on. What one has to see is that it is independent, properly representative and that it has functions. The Minister for Justice and Equality will come back to Government in due course with her memorandum on that, the Government will make its observations and the House will have its opportunity to do the same.

The rebuilding of morale cannot be postponed. A myriad of reports and expert inquiries have to be concluded but the morale issue is important because we do not want to be back here talking about the Guerin report in the same way we talk about the Morris report.

Chapter 20 of the Guerin report states: "But discipline is not merely the absence of insubordination. Discipline is application to the task at hand". The task at hand and how one carries out that task is very much dependent on the resources available to one at any given time. If a district finds itself lacking in Garda personnel, Garda accommodation, Garda cars and all the associated services, then one can bet one's bottom dollar that it will find itself lacking in the discipline to which the Guerin report refers in chapter 20. It is incredibly important this issue is dealt with and that the force, or elements of it, can be moved according to the needs and to the crime statistics. This situation of "one holds what one has" is not acceptable because some parts of the country will do very poorly out of it if that continues.

I think the Taoiseach accepts that poor management and distribution of personnel and resources have a significant impact on crime detection and morale across the force. If the expert review identifies resource needs will the Government meet those needs, because there certainly are gaps? If they cannot be filled by moving people around the country, it will have to be filled in another way. It seems clear that may well be something which is thrown up by some of the inquiries.

I thank Deputy Murphy. Her points are valid in respect of morale being a requirement, that people have pride in the job they do and that they Garda force, as a unit, has high morale. There are a number of things on which the Minister will be able to work to improve that in the shorter term. Clearly, in terms of the force itself as a professional competent force, issues have been identified by the Guerin report which the Government will address, with the Minister's propositions to come back after the decisions made yesterday are implemented.

On the question of resources being available, one does not need an expert group to recognise there is always a need for extra resources. The former Minister, Deputy Shatter, fought very hard for extra finances for vehicles and facilities for the gardaí in order for them to do their job. We do not need an expert group to tell us that. Resources for any Department are contingent on the overall position of the economy and how the Government structures its budget. Of course, it is impossible to do a job competently as a professional force if facilities are not made available and, if they are not available to the level one would expect, morale always suffers but it is not always the issue.

I take the Deputy's point about resources being static in each of the districts. The districts themselves have changed but I agree it is a case of "if needs be" where provision has to be made to service the community and citizens and to provide the facilities for the force to do its job as one would expect. These points are valid. As the decisions of the Government are being implemented and as we move towards the statutory authority and its responsibility, the Deputy will have the opportunity to contribute and to make these points to see where they might be practical and, where acceptable, to be implemented.

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