Discretionary Medical Cards: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Caoimhghín Ó Caoláin on Tuesday, 13 May 2014:
That Dáil Éireann:
noting the:
— continuing dramatic fall in the number of persons granted or retaining discretionary medical cards;
— persistent refusal of the Minister for Health and the Government to recognise the reality of this reduction and the hardship it is causing, despite numerous representations from the public, representative groups and Oireachtas Members;
— last-minute pre-election acknowledgement by the Minister for Health, prompted by a meeting of the Fine Gael Parliamentary Party, that a problem exists;
— statement by the Minister that he has asked Fine Gael Deputies to give him a list of ‘hard cases’; and
— Minister’s floating of the vague notion of a ‘third tier’ of services; and
calls on the Government to:
— reverse the cuts to discretionary medical cards imposed in the Health Service Executive, HSE, 2014 service plan;
— ensure that the HSE treats with due respect, consideration and compassion all applicants for medical cards, taking fully into consideration not only incomes, but the burdens imposed by medical conditions, illnesses and disabilities;
— consult with all Oireachtas Members, and not on a selective party political basis, on the effects of the cuts on citizens;
— extend free general practitioner, GP, care to all on a programmed, timetabled and transparent basis and in such a manner that, at the least, no one entitled to a full medical card under the current rules will lose any of the services provided under the card in the context of a free-GP-care-for-all system; and
— clearly set out in legislation entitlements to health care and, in line with the recommendation of the Constitutional Convention, provide for an amendment to the Constitution to recognise the right to health care.
Debate resumed on amendment No. 2:
To delete all words after “Dáil Éireann” and substitute the following:
“notes that:
- under the Health Act 1970, eligibility for the medical card scheme is primarily means-based and that the means basis for eligibility has been subsequently re-confirmed in legislation by the Oireachtas;
- the Health Act 1970, as amended, provides that persons who ‘are unable without undue hardship to arrange general practitioner’ services for themselves and their family qualify for a medical card;
- the Health Service Executive, HSE, is obliged to operate in accordance with the health legislation with respect to each individual and that the HSE’s assessment for a medical card must ‘have regard to the overall financial situation’ of an applicant;
- the centralisation of the processing of medical cards at a national level, rather than at a local level as was the case before mid-2011, facilitates the assessment of all applicants for medical cards in a consistent and equitable manner irrespective of where they reside in the State;
- the HSE has produced national assessment guidelines to provide a clear framework to assist in making reasonable, consistent and equitable decisions when assessing each applicant;
- there has been no change in the policy, whereby the HSE continues to apply discretion to grant a medical card where a person’s income exceeds the income guidelines; and
- the HSE’s national assessment guidelines facilitate the application of discretion by decision makers in responding to the needs of the applicant when additional or exceptional circumstances exist;
commends the Minister for Health on directing the HSE to set up a clinical panel to assist in the processing of applications for medical cards involving discretion, where there are difficult personal circumstances;
further notes that there is no target to reduce the number of medical cards granted where discretion was applied; and
commends the Minister for Health:
- and the Government on providing resources to meet the increase in the number of medical cards and general practitioner, GP, visit cards since March 2011, which now stands at over 1.9 million or 42% of the population;
- on the passing of legislation to abolish restrictions on GPs wishing to become contractors under the medical card scheme;
- on the implementation of legislation to achieve savings under the medical card scheme through the use of generic drugs and reference pricing;
- on the savings being made in the cost of drugs for the medical card scheme through negotiations with pharmaceutical drug suppliers;
- on directing the HSE to examine how it can best assist patients and families to access the full range of supports and entitlements from the health service so that individuals, who are not entitled to a medical card, could still receive services that meet their needs;
- on commencing the most radical reform of the Irish health system since the foundation of the State, where access to health services will be based on need and not on ability to pay;
- on the publication of the White Paper on universal health insurance, which underpins the Government’s resolve to deliver on the programme for Government commitment to end the inefficient and inequitable two-tier system and establish a single-tier health service, whereby everyone will be insured for a standard package of primary and acute hospital services under a universal health insurance system, which will be founded on the principle of social solidarity; and
- and the Government on commencing the introduction, on a phased basis, of a universal GP service without fees for the entire population within its term of office, as set out in the programme for Government, with the initial phase to provide a universal GP service to all children aged five and under."
- (Minister of State at the Department of Health, Deputy Alex White).
I thank the Ceann Comhairle for the opportunity to speak on this very urgent and important motion. I support the many people who need medical cards as a matter of medical priority. Any society or state that does not look after its sick, elderly and disabled is one without compassion and a sense of social justice. They are required in this debate. It is time for tough decisions to ensure we protect the health of all our citizens and that is why I urge the Government to reverse the cuts to the discretionary medical cards imposed in the HSE's 2014 health service plan. There has been a continuing, dramatic fall in the number of people granted or retaining discretionary medical cards. Despite numerous representations from Deputies, Senators and city councillors throughout this State, the Minister for Health and the Government have persistently refused to recognise the reality of this reduction and the hardship it is causing. The Government has proposed the vague notion of a third tier in the health service.
I ask the Minister to reverse the cuts to discretionary medical cards. We must ensure the HSE treats all applicants for medical cards with due respect, consideration and compassion. We must ensure all Members of the Oireachtas are listened to on this issue. We must put health back on top of the political agenda and ensure we have equality for people in need. It is unacceptable in any society that people with disabilities, the elderly or sick people are denied medical cards. It is unacceptable for any Minister or Government to say they will consider individual cases. We were promised a democratic revolution, reform and equality. We must ensure medical cards are given to the people who need them. The Government must not turn its back on senior citizens, the elderly and the disabled.
Last week a journalist from the Mail on Sunday contacted me. I had raised this as a Topical Issues matter on several occasions some months ago. The journalist asked me if the situation was the same or had deteriorated or improved. I told her what I saw, and what everybody else was saying, that it was getting much more difficult for people to get discretionary medical cards. She asked me if any of the people I was dealing with would talk to her and, to my surprise, when I telephoned six people every one of them was willing to go public. When people will put themselves in the public arena at such a stressful time to show what is going on demonstrates that things have changed.
This morning I raised the issue of a little girl, Moya Nason, who has cerebral palsy and who was featured in the article last Sunday. Moya is one of four children and is the only daughter of Orla and Andy Nason. They do not know what they will do if her medical card is taken away. Like several people, they have an extension until 31 May, and people are worried that once the election is over the extensions will also end. That is what they are saying to me. I know a family with a cardiac baby who has a feeding tube. One parent has had to give up work to care for the baby at home. Although the family is not terribly far above the income threshold, the baby did not qualify for a card. Something is wrong and we must seriously examine it. While I understand what the Minister of State is saying regarding putting services in place, that is in the future. These people are in the here and now and are very concerned about it. While they expected to pay the local property tax, water charges and the universal social charge, they did not expect their vulnerable children to be hit by the Government. It is shameful.
It is no secret that the HSE is an incredibly dysfunctional organisation. This House has had to listen to horrendous accounts of how vulnerable citizens are being let down by the Government and its appalling decisions to support refusals of medical cards. Although the Taoiseach told us earlier that it was unacceptable, there are so many cases, some in instances where the condition is either terminal or incurable, where there must be some more fundamental problem.
Is it partly a consequence of the public sector recruitment embargo and the fact that the Minister has outsourced much of the function of reviewing and assessing medical records? A German company called Arvato is reviewing medical cards. Is it correct that its staff has no training, no backup from the HSE or community welfare offices and no Garda clearance, are on the minimum wage and have no knowledge of our health situation? Arvato has replaced another private company which did a similar job. Perhaps that is one of the reasons we are getting the most bizarre judgements and decisions. The people charged with making those decisions have not been given the proper training, wages and conditions. It is a consequence of a bigger picture.
The other reason is the change in policy the Government has brought in and the damage it is wreaking on families. A seven-year-old girl in my area has infantile scoliosis and has had medical treatment since she was born including plaster casts and back operations. Although her family had a medical card since 2009, it was withdrawn in 2013 on the basis that their income was over the limit, even though the child's medical condition was worsening and their outgoings had increased. Despite going everywhere, they were consistently refused a medical card for the child. Although taxpayers and citizens are working and paying all the levies, when they need help they get no support. It is cruel and it is almost incredible that the Labour Party is in government while this is happening.
I thank the Technical Group for allowing me some of its speaking time.
I support the motion before the House because what has happened in the past three years is a disgrace. It is ironic that it is only now that the Minister for Health and the Taoiseach are waking up to the problem we have with medical cards, and it is only a couple of weeks before an election that they are admitting there is a problem. On this side of the House we have known there has been a serious problem with medical cards over the past three years as the goalposts have been moved. People in their 80s and other elderly people, as well as people with disabled children, are being sent letters of notification of a review of medical cards. These are people who had a stamp on the card indicating it would be valid until January 2016 and who thought they were safe and secure because they had the card. All of a sudden such people are receiving letters and they are terrified when they get their post. When these people's cards are up for review, in many cases the result is the card being taken from them.
Even as late as today we hear how people were written to and asked whether a child still had Down's syndrome. For God's sake, what people are sending out these types of letters? At the end of the day, the buck stops with the Minister for Health, the Taoiseach and the Cabinet, which has collective responsibility. What about the lambs sitting behind the Cabinet with their heads down and their mouths either shut or open gathering flies and dust? These are the backbenchers but are they saying anything at parliamentary meetings? What is Labour doing about this and is it standing up for people by asking about people's entitlement to medical cards? Are they all sound asleep, not realising what is happening?
The Minister for Health is coming to Kerry next week. He is coming to coming to open a few hospitals, etc., with which he had nothing to do in the first instance.
He did not provide one cent for them.
He inherited them. He is coming down with a smile on his face.
That is enough for the vox pop. It is enough for the local radio. You can stop.
The Deputy should conclude.
I want my chance to conclude. The Minister is coming down to open hospitals but he has terrorised people from Valentia to Tarbert by taking away their medical cards. These are disabled, elderly or sick people. At the end of the day, the buck stops with him and the backbenchers who now seem to have a voice. Where was their voice when it came to standing up for people?
Deputies Joe McHugh, Eamonn Maloney, Ann Phelan, John Lyons, Michelle Mulherin and Jerry Buttimer are sharing time.
I am tempted to retort to the last speaker's contribution but I will not do so.
We are on the cusp of an election and that contribution will go down well in the Deputy's constituency and the local electoral areas. It is important to point out that although the Minister, Deputy Reilly, is not getting the credit for opening hospitals, it is funny that when the shoe is on the other foot, he would get the blame if things went wrong. That is politics and we are all men and women enough to live with that.
I acknowledge the presence of the Minister of State, Deputy White, in Letterkenny General Hospital this week when he opened a new pharmacy unit, and he was also in a position to inspect the ongoing good work on the developments in the aftermath of the worst crisis ever at the hospital last August when it was flooded. The Minister of State would have got a sense of the resilience and proactive nature of the staff, as well as the community's response to an absolute disaster last August. Although the matter has not yet been turned around, the Minister of State would have got a sense that things are going in the right direction. We were glad to have him there to see that first-hand.
We will not get a more emotive issue than medical cards and entitlements for people who are very sick, vulnerable and at their weakest. This can become a political matter and can be played to the advantage of some. Whether in Government or part of the Opposition, we all work in constituency offices with people, and we would all call for means to improve the process. The new system is centralised now, as opposed to the old system where we could contact people in Donegal, for example, when dealing with local people. We must acknowledge that the people working in the new centralised unit in Dublin are working hard and not just treating the process as a 9 a.m. to 5 p.m. job. They are working hands-on and experience the emotion of the issue. It is not a matter of being empathetic for the sake of it but they are going through the work. Perhaps we can get extra resources to the centralised unit. The appeals office in Ballyshannon is similarly staffed by excellent people doing their best, despite appeals piling up. Perhaps we could put extra resources in there as well. I know the Minister for Public Expenditure and Reform, Deputy Howlin, will read the transcripts of this debate and we must keep a sharp focus on the area.
Many of the people who come to my office are at their weakest and it is difficult for them to prove entitlement. This is how anxiety develops so we must consider that process of having to prove an entitlement through bank statements, medical evidence and doctor correspondence. That is hard work when people are at their weakest, and I know the Minister of State is very conscious of that. If we can critically evaluate the process and try to make it easier, people with cancer or severe health conditions will have an easier time. People are in a particular state of mind when they are trying to battle their own health challenges, and that is the difficulty. This is not just about having a medical card to go to a GP at every turn as it is also a financial issue. People may not have enough money to pay for prescriptions at a pharmacy so we must be very conscious of such difficulty.
Some people may miss the financial constraints so we should consider how this happens. Not every couple or single person is in the same position and although there may be a top line in financial considerations, not everybody is in the same boat. We should be creative and constructively critical in ensuring the process is not arduous or putting extra pressure on people at a very low ebb. These people may have had a medical card up to 2016 or 2017 but have had to prove their entitlement again. This contributes to much angst and we should be conscious of that.
There was a system of free medical cards given willy-nilly to those over 70 and it is difficult to take these from people or critically evaluate the position. At the same time the process must take in every individual's personal circumstances, which is also difficult. We must keep the patient to the forefront, especially the most vulnerable. When people are at their weakest we must try to simplify the system to ensure we protect the vulnerable.
The debate about medical cards has been ongoing since their introduction in this jurisdiction, with its foundation in the work of that great socialist, Mr. Aneurin Bevan, the son of a Welsh coal miner. The concept of a medical card is about giving access to the medical system to the poorest people. It is a very precious and honourable process but it has never been without its teething problems across the water. It has been debated, on and off, since its introduction in the post-war period, and this is not the first time there has been a contentious debate about them.
I view these issues with reference to the basis of the concept.
We have medical cards to ensure that those who do not have money have access to a GP. This applies not only to the individual but to his or her family. We should be proud of that. No system is without fault. Opposition Members have made valid points but we have to find a way to make this system better and ensure the people I am talking about have access to medical care. I am glad we make access to a doctor affordable. The emergency card for people who are terminally ill, because that happens, is progressive. We should cherish that. It is not without its problems. Like other Deputies, I have met people who have managed to get the emergency card in the shortest period and others for whom, naturally, it does not quite work out that way. There are criticisms on both sides regarding the imperfections of the system.
We should not lose sight of the fact that 42% of the population have medical cards, that is 1.8 million citizens. I know the number fluctuates. According to the HSE medical review for 2014, by year end an additional 60,000 medical cards will be issued. Given that the country is scraping itself off the bottom, to be able to contain medical cards and provide them to people who genuinely need them is the function of all parliamentarians. This debate illustrates the need for reform of the health system. If there was a change of Government tomorrow, God spare us, the new Government would be confronted with the difficulties that face this Government and the HSE, lack of money, the country getting off its knees and trying to provide fair access to health care for those who cannot afford to go to a GP or cannot access medical services.
This issue is extremely important to me and my constituency. Sometimes we pay lip service to debates. Tonight we should endeavour, with the Sinn Féin Members who are left in the House, to conduct a mature debate on medical cards. The system is not perfect but I do not want to terrify the public. It is a particularly Irish trait to terrify the wits out of people, no matter what we try to introduce, and spend the rest of the time trying to claw back the ground we lost.
I want to work with the Minister of State and I know he is committed to trying to solve some of the extremely difficult problems surrounding medical cards. We can do it only if we step back and see the difficulties. When people are afraid they cannot see a way forward. People have come to my constituency office who are terrified of the medical card review and of the bureaucracy they must deal with. If we try to work with them and make a good sound argument, 93% of people have their cards renewed. We should not lose sight of that fact.
This is the second time I have spoken about medical cards in the House. To reiterate what I said previously, the medical card system was centralised to make the system fair and depoliticise how they were granted. In the past people did not get medical cards because they were entitled to them, or on the basis of medical evidence, or because of their low income. In some cases people got them because of the political party they supported. Centralising the system to depoliticise the process is the right thing to do. I accept there are difficulties but we will work through them.
Many people have called to my office saying their medical cards were removed because they slightly exceeded the financial threshold. Their medical need, however, outweighed their income but this was not taken into consideration. While in general the issuing of medical cards based on financial circumstances is very clear and definite, there are problems where people do not meet the criteria but have large medical expenses due to ongoing long-term illnesses or disabilities. This is not taken into consideration. Why should someone's financial means override their medical and personal hardship when assessing for a discretionary card? This is the second time I have expressed this view in this House.
There are also people who may not regularly need to attend a GP but when required, may need the security of a card should something happen. Sometimes it is most important to have the psychological security of having the medical card. The same people may be in receipt of medication on a long-term basis. They may also require the additional services associated with the medical card, such as those provided by the public health nurse. This is one of the difficulties we must face.
There are other groups of people such as cancer patients who are in remission. They should retain a full medical card for at least three years, irrespective of financial means. The provision of services in addition to free access to their GP, is of pivotal importance to many cancer patients and their families. We need to maximise this. Ultimately, this system not only has to be fair, but has to be seen to be fair.
Many recipients are unnerved when they receive a letter of request for renewal because it is so formal and no real guidelines are provided. I commend the Minister of State who is committed to tackling the issue. Fairness must be the core of the medical card system.
I worked as a secondary school teacher for 13 years before becoming a Deputy as I have said on umpteen occasions. One of the keys to being a teacher is to deal in fact not hearsay. I am not saying that anybody here today spoke completely on the basis of hearsay but all debates should be based on fact. If some facts are of concern we need to address them.
I read through the briefing material that sets out the facts of the situation and through the material detailing the allocations of medical cards for the past ten years and while it has been reiterated already I want to compare the allocations at that time and now. Some 28.3%, or 1.145 million, of the population, had a medical card ten years ago and we expect that percentage will have risen to 40.8% by the end of this year. Many more people have a medical card today compared to ten years ago. People who are listening to or watching these proceedings or sitting in the Chamber might think that is due to the fact that more people are unemployed and they qualify on the basis of their financial circumstances. However, the facts speak for themselves; incrementally year in year out, bar perhaps one year when the figures plateaued, more people received medical cards each year during the past ten years. That is a fact.
We know that more people have a medical card now and that must be acknowledged. If a person was to come and listen to this debate, he or she would think that medical cards are being withdrawn on a mass scale and that almost everybody who had a medical card has had it removed, but that is not the case. The fact is that many more people have medical cards today compared to ten years ago, that number issued has been growing year in year out through the good and bad times and this Government has increased the number of cards issued. As Deputy Maloney said, 60,000 odd additional people who do not have a medical card now will have one by the end of the year.
Another fact, as we all know, is that medical cards have been removed from people who perhaps in the light of things may have been entitled to a card. That seems to be factual. We need to sort out that fact, examine why that is happening and rectify it. The Minister of State is trying to do that.
I went out to Primary Care Reimbursement Service, PCRS, building in Finglas in my constituency a number of years ago to see how the new centralised system processes medical cards and in fairness to the public servants there they are doing a good, decent job. When a service is centralised or there is a move from one system to another, there can be kinks in the system that create problems and it is a question of identifying those and solving them. If people are still getting letters, and we heard about some of the cases that were mentioned today and I do not want to question them because I do not know the individuals concerned, those issues need to be sorted. If a person genuinely qualifies for a medical card, he or she should be entitled to it and all the necessary systems should be in place to make sure that happens. The centralised system is operating better today as opposed to this time three years ago but there are some kinks in it that are still causing problems. Nobody who is entitled to a medical card should be without it.
I wish to raise a few matters that I find frustrating. Even in a case where the guidelines would indicate that a person who is genuinely entitled to a medical card having regard to their circumstances should qualify sometimes that person does not qualify. Most of us, unlike the Deputy from Kerry, do not sensationalise matters and look to vox populi. I am not referring to the Sinn Féin Deputy from Kerry who is present but to a previous speaker and those who were here earlier will know what I am talking about. I can remember being only short of printing a medical card for a person who ended up qualifying for it and this was prior to the Minister of State's watch. This problem has been around prior to his watch and he should not be taking complete responsibility for it. Some people seem to have forgotten that.
We need to establish our debate around the facts. We need to deal with the issues that are coming up where things are not working out on a factual basis and we need to come up with solutions. The Minister of State is working on those types of issues and we speak regularly about them. If we want to give medical cards to some people who we think should have them, that would involve changing the legislation based on criteria other than finances and so on. It is important that we deal with this issue in the context of the facts and they have been missing at times. I cannot stand sensationalism because it scares people and we should not be in business of scaring people.
Without doubt the issue of medical cards is the single most common one raised at my weekly clinics around the county and that seems to be the experience of other Members throughout the country. A person may be making an application for the first time for a medical card. As a result of the level of unemployment, increasingly more people cannot afford private health care and are being pushed to seek a medical card. The applications I deal with may be for a discretionary medical card for a person who is seriously ill with cancer or some other serious illness, a medical card for a person aged over 70, a review or an appeal and the list goes on. I would like to be very honest and fair about what I say here because this is a very delicate issue. People are vulnerable and are coping with an illness; those are the cases that I believe mostly need to be addressed, as opposed to those related to the basis of means. I am talking about people with serious illnesses or illnesses that seem to fall between two stools. We cannot be throwing oil on a fire - we can try to assist and examine the issue fairly and get solutions, but it is not helpful to incite fear in people, especially considering what they have to deal with.
Along the lines of what Deputy Lyons said, it is important in the national context that this debate allows us to examine what is happening in terms of the figures nationally. The Minister of State has told us that there are no changes in regard to the rules for the issue of discretionary medical cards. We know it is expected, based on figures that have been given, that an additional quarter of a million medical cards will be issued by the end of this year compared to the beginning of 2011 when this Government came into office. Some 41% of the population have medical cards and 49% have medical or GP cards. In terms of the reviews that caused so much fear for people, 96.5% of those with medical cards retained their cards.
With regard to those aged over 70, 93% have access to free GP services and retain that facility and about 80% have retained their medical cards, even in light of recent changes. Those headline figures are reasonable enough but there has been much fear and consternation about this issue in the media. Having had the experience of dealing with people who have had a difficulty or an issue in getting a medical card, I could offer a few reasons as to why they have found that to be the case. The system is not compassionate, reactive or responsible enough to hard cases. I have dealt with many cases and in one case the person concerned, who had a serious illness and really needed a medical card, felt that by the time they got the card the good was almost taken out of it such was the trauma of the process for the family but, nonetheless, that person got their medical card.
People's documents are lost too frequently. That is a basic issue. Documents cannot be found sometimes even when they have been sent by registered post. We are entitled to expect more than that for the people we serve. I have helped people to get a medical card and three months later their cases are being reviewed even though there has been no change in their circumstances. It is no wonder that fuels the idea that we are trying to take people's cards from them. There is something wrong there as well.
I know of a case where a mother had a baby with Down's syndrome. The child had complications and on the child leaving hospital the parents applied for a medical card. Nobody advised them of the long-term illness scheme or of the drug repayment scheme. I know the parents concerned, whom I will not name, will not mind my saying this because they have talked about it locally. Their child was due to be taken home from hospital on Christmas Eve and the mother was told that they would have to get certain equipment and they had to buy it using their credit card to bring her child home so that the child would be safe over the Christmas period. Nobody at any point told them of any of the other rights and entitlements they had and I find that unbelievable.
I have spoken to the Minister, Deputy Reilly, on this issue on a number of occasions in terms of the cases that have been brought to my attention and having listened to the experiences of colleagues. He has spoken of an integrated care package which would provide care for people who need appliances, medication and so on and these may meet their needs in many cases. An information campaign must be undertaken. I cannot understand why the PCRS cannot advise a person that if they are not entitled to a medical card they could be entitled under the long-term illness scheme or the drug refund scheme.
It does not seem to give out any information like this.
On the budget situation and the term "probity", we know a target was set to bring down spending from €133 million to €23 million. We need to be realistic. More people are applying for medical cards and it is a demand-led service. When the budget is being examined by the Cabinet if we are serious about delivering medical cards to people, the budget must match it.
We all recognise that medical cards are of extreme importance. They represent a very important social support that is supposed to provide access for those who cannot otherwise afford their required medical care. We must always remember that the primary purpose of medical cards is to support the patient. This focus on patients and their needs sometimes gets lost in the political infighting and in the system.
Everyone in this House is aware of very difficult stories of people who are just over the income limits and people who are over the income limits and have certain medical conditions, but cannot get a medical card. There are heart-breaking stories that all of us in this House can share. In saying that we, as politicians, have an obligation to reflect on the system and how we can make it better on behalf of the patient.
When people get letters stating their medical cards are being reviewed, it causes distress even if it is only a simple review process. For some people these letters translate to "they are trying to take away my medical card" or "I've lost my medical card". Thankfully, in 93% of cases this does not happen. However, sometimes those working in the system processing the medical cards do not realise the impact their letters have on the individuals and their families.
Tomorrow the members of the Joint Committee on Health and Children will travel to Finglas to visit the PCRS. We will highlight with the staff and management at the centre the personal impact of how the system affects the patient. I pay tribute to the staff at the PCRS for the work they do as public servants.
While I accept there are difficulties in the health system, we must also recognise that in the past three years improvements also have been made, although these were not alluded to in the motion before us tonight. These improvements are down to the reforming Ministers and the hard work and dedication of staff in the health service.
At the peak of the boom and the beginning of the bust, adjusting for our very young population, Ireland had one of the most expensive health systems in the world. Since the Government came to power it has managed to do what Fianna Fáil failed to do - none of its Members is present in the House which shows their dedication to the health system - it has increased services even as it has cut costs. Hospital budgets have been reduced by 11% since 2009 while the number of people treated has increased by almost 13%. This is equivalent to a 24% productivity improvement. However, this is not about productivity but about the quality of the staff in our services. The number of people waiting on trolleys in 2013 was a third lower than in 2011 when those numbers were chronically high and this year already there has been a 9% reduction compared with last year.
The Government's reform programme can and will do even more to make the system more efficient. However, as a Member of the Dáil and a public representative, I am becoming increasingly uncomfortable about the level of savings being demanded in the health area. There seems to be a view among some that health is some kind of public sector ATM and if one just presses the right buttons, it can continue to deliver cash savings. The bottom line is that we have an ageing population and demand is growing. We cannot keep asking the men and women who work in the health system or the citizens who depend on the services that they deliver to keep taking a financial hit in the health area. It is not fair and it is completely unrealistic. I hope that in the wider health debate leading to UHI we will recognise that health services are demand led and are about people.
If we want a medical card system that does not operate on the basis of who one knows, as it was in the past, but functions based on the needs of people, we must change the legislation and change our approach to health which the Government is doing in regard to UHI. We must have in place regulations that allow the officials to make appropriate decisions so that we can meet the health requirements of those most in need in a way that is humane, full of empathy and that recognises there are people whose medical conditions deserve the medical card and the long-term illness scheme.
I challenge the Sinn Féin Members opposite. Their motion did not outline their solution and the way forward. They need to put the meat on the bones of their motion. They should not just play politics and go for populism. They must show us what is their policy by revealing their hand. I respect Deputy Ó Caoláin as a valued member of the Joint Committee on Health and Children. I call on him and his colleagues to attach to their motion the substance of what their health policy is because talk is cheap and they have done a lot of that in recent weeks.
I call Deputy Tóibín, who is sharing with Deputies Ó Snodaigh, McLellan, Crowe, Pearse Doherty and Martin Ferris.
Some 1 million people in the State have been pushed into poverty and low-income and allowing some of these people to have medical cards is not a claim to fame, but a claim to shame in reality. Discretionary medical cards have been withdrawn - there is no argument about that. In the past three years 18,810 discretionary medical and GP-visit cards have been withdrawn. There is not a Deputy in this House who has not been contacted by individuals calling at their offices to detail the situation befalling their family members or themselves.
Specialist nurses from the Jack and Jill Children's Foundation have described the situation as critical. An open letter to the Minister for Health details how it is affecting them. Is it not shocking that those on the front line who are dealing with this on a daily basis are often the last to be listened to? These specialist nurses paint a compelling and distressing picture of the real life outcomes arising from the Government's decision to reduce the budget allocation to medical card provision.
In their open letter the nurses describe the situation regarding discretionary cards as critical. The letter states:
Parents are worn out, reduced to tears... worried out of their minds in relation to their child's medical card. The "lucky" ones who have a temporary 6 or 12 month medical card live in dread of the next review and the whole torturous process of form filling, rejection letters, more visits to GPs for supporting evidence etc. etc. etc. which starts all over again.
We are particularly worried about the parents who suffer in silence. The parents who have given up already. Depressed and beaten into submission by a system that is just too hard, where parents have to fight for every little support for their child.
What is truly shocking is that it has taken until recently for the Minister for Health and the HSE to finally concede that there is in fact a problem. The HSE's director of primary care has described as indefensible the withdrawal of discretionary medical cards from some patients. The Minister, Deputy Reilly, has floated the idea of a third tier in the medical card system. However, despite these admissions the policy remains in place. Reviews continue and discretionary cards are withdrawn from children whose condition has often deteriorated since the card was first awarded and their parent's financial situation in many cases has worsened.
It is impossible not to be emotive on this issue, which is such a difficult issue for citizens. What does it say about the values of the State, when Ministers stand up in the Dáil and justify withdrawing a medical card from a child with a debilitating medical need? What does it say about the State when it in effect abandons these parents who are caring for these children? Collectively in recent years we have had to face up to the trauma inflicted on children and young women in industrial schools, the Magdalen laundries and of course Bethany Home whose survivors have yet to have their injustice recognised by the State.
We should be in no doubt that today's treatment by the State of our most vulnerable citizens is tomorrow's moral scandal.
How can any Government believe it is acceptable or right for this State to treat sick children in this manner? There is increasing evidence that this Government has little interest in the type and scale of reform necessary to fix the broken health system. The hurt and the anger felt by citizens across the State is palpable.
In Navan, our hospital services have been savaged in the past number of years. The HSE took surgery services away from our hospital in 2010. It was only when the hospital campaign put 10,000 people on the streets for a rally that we managed to reverse that services cut but only partially. The Minister of State's senior colleague, the Minister, Deputy Reilly, addressed that rally and stated that there would be no more cuts to services in the hospital in Navan until a new regional hospital was built, but this clearly has not happened. Somebody in the Department thinks it is a good idea for 19,000 people who use Navan accident and emergency department to go to Drogheda. The INMO asked for Drogheda to be closed to new admissions approximately four weeks ago because of the overcrowding there. Overcrowding leads to delayed diagnosis, delayed treatments, the spread of disease and sub-optimal outcomes.
This Saturday, another 10,000 people will take to the streets in Navan to defend our accident and emergency department. However, sick children, who face the cuts, will not be able to protest because they will not be able to make it to that protest. The Minister and the Government are going down the path of least resistance and that is where they are imposing the cuts. I urge the Minister of State to turn away from the path of least resistance and ensure these discretionary medical cards are in place.
I thought it was important that I take part in this debate because it is a harrowing one which we should not be having. The true measure of any society can be found in how it treats its most vulnerable members. I urge the Minister and this Government to think about the sentiments contained in that saying. If people were to look at the whole debacle around the medical card issue, in particular discretionary medical cards, they would understand that the score cards the Taoiseach mentioned when he appointed the Ministers would state they have failed miserably, in particular those with life threatening diseases, those who are terminally ill and those who have conditions which do not go away and which they are being asked to prove time and again as reviews take place. We have seen such cases in the media.
I and every other Deputy can instance cases where people have come to us, although, thankfully, we have been able to intercede on their behalf. In some cases, the HSE has eventually listened to the cases we have presented and has renewed the medical cards. However, it should not be up to me or to anybody else in this House to intercede because the documentation I receive is the very same documentation the HSE receives and loses quite regularly, as others have said. It cannot make a determination, or else it makes the wrong determination, in the cases of people who have terminal diseases. I have dealt with too many cases in the past number of months for this to be a once-off clerical error. The system denies everything in the first instance in the hope that people will go away or will experience anxiety, frustration and give out about the system but will not do anything about it. Earlier, a Deputy talked about the fear factor and that this debate would generate fear among the public. We are not generating fear among the public; it is the HSE and the refusal to grant a medical card to people in those circumstances which are generating fear among the public.
I dealt with a case recently of somebody with Huntington's disease. His wife did not apply for a medical card and yet she got one while the person who is terminally ill - there is no change in such cases but regression - and who has the same income did not get a medical card. That is absolutely crazy. It took three months for the HSE to grant a medical card which resulted in trauma for that family. They are not constituents of mine but they came to me as a last resort because they had gone to others who did not manage to get a medical card. After one look at the documentation, I said this was crazy.
I have dealt with cases in my area also and time and again where it is blatantly clear that a case warrants the granting of medical cards as there is not enough income to sustain the family if it has to pay for medical devices, medical care and so on and yet the State refuses the person the medical card. Time and again it has not taken into account the fact that the disposable income of a family will have disappeared not just because of the crisis, but because of budgetary cuts, the universal social charge, the property tax and the increase in energy price and so on. That all adds up and yet the Government ends up forcing an ill person to make a decision as to whether to heat the home to keep well or to pay for medicines out of what little the person has. Far too often, the person makes the wrong decision which will cost the State a lot more at the end of the day because he or she will end up in the accident and emergency department or in hospital because he or she did not get the care required. The bureaucracy is absolutely crazy.
Time and again forms are sent to elderly people who are asked the same questions they answered the last time they applied. The situation will not have changed. Their mother-in-law's maiden names will not have changed. If one is an 80 year old person, who cares what the mother-in-law's maiden name is? I would say the mother-in-law is well dead at that stage. That is how crazy the system is.
I will give one example of the uncaring attitude of the HSE. Recently, a 20 year old, who is mentally and physically disabled, was told that his allocation of incontinence pads was to be reduced to two per day. That shows the attitude of the HSE. That must change and a more caring approach must be taken to people in our society who deserve medical aid.
I agree with previous speakers that the withdrawal of medical cards is probably the issue we have to deal with most on a daily basis in our constituency offices. There is not a Deputy in the House who does not have heartbreaking cases of people being refused discretionary medical cards. We could wallpaper the building twice over with the representations we have made on behalf of our constituents. It is frustrating for us but it is a matter of life and death for many men, women and children we represent.
It is in these very corridors that the real decisions about medical cards are made. It is Government policy that determines whether someone receives the lifeline of a discretionary medical card. My experience as a public representative is best reflected in some of the stories of my constituents but a huge concern to me would be the many people presenting to my constituency office who cannot afford their medications and are not taking any medication at all. A two year old with juvenile idiopathic arthritis needs a drug called methotrexate which comes at a cost of €250 per month but it is not covered by the drugs payment scheme currently. The family applied for the medical card and was refused but that is now under appeal. The family live in fear that if it loses this appeal, it will be forced to pay €3,000 per year required to cover the cost of the drug.
The Government's practice of random reviews of the over 70s is harsh and unnecessary and it has also led to chaos and stress for some of our most vulnerable senior citizens. Notices go to wrong addresses. I had two cases in the past two weeks where the renewals were sent to the wrong addresses and the people's cards were stopped. This is not acceptable. As a result of Government cuts and shortages, these senior citizens lost their medical cards. It is Government policy which is causing this stress and heartache.
Another thing which I cannot understand and which I have come across on at least six occasions in the past few months is where sixty nine and a half year olds are having their medical cards reviewed. By the time the review is done, they turn 70 years of age and they have to go through the process again. This has not just happened once or twice but it seems to be happening quite a lot.
Another case in my home town of Youghal concerns a family of nine whose medical card went to its old address.
Because of the mistake, the family lost their medical card and had to reapply for it. The process is supposed to take 15 working days but it has taken several months and the family has had no cover for the entire period. The confusing part of the situation is that when the card was previously due for renewal, the letter came to the current address and therefore it is difficult to understand how on this occasion the letter went to an address the family lived at years ago.
Further bureaucracy is heaped on those citizens who are having their cases reviewed. The State will not accept evidence during the process of a review. In other words, if a family is refused a medical card and if they choose to have the application reviewed, it must be done within 14 days. Any extra evidence including medical letters, letters from agencies and consultants may well take longer than the two weeks allocated. Those important support letters are then excluded from the review. The very evidence needed for the review is being excluded. Further to that, if there is a change of circumstances in the family when the review is taking place, that too is ignored.
The Government is being given the opportunity to change the situation. It is decision time for the Government in terms of whether it will continue to oversee a chaotic medical card system or if it will step up to the plate and radically reform it. Another issue relates to paperwork constantly going missing. People register paperwork yet it still goes missing. When e-mails are sent a request is made that they are sent again with scanned documents that also go missing.
Sinn Féin calls on the Government to reverse the cuts to discretionary medical cards imposed in the Health Service Executive service plan for 2014. We call on the Government to ensure that people receive the due respect, consideration and compassion they deserve when applying for medical cards. The recent announcement by the Minister for Heath that he intends to introduce universal health insurance is deeply concerning. It is a radical shift in public health policy and it will only serve to make a genuine universal health care system even more difficult to achieve. It puts private insurance companies at the centre of our health care system which is deeply concerning. We call on the Government to set out in legislation entitlement to health care and in line with the recommendation of the Constitutional Convention to provide for an amendment to the Constitution to recognise the right to health care. I urge Government Deputies to support the motion.
On a daily basis in recent weeks, the television, radio, newspapers and Internet have been saturated with countless cases where medical cards have either been withdrawn or made almost impossible to obtain for the most seriously ill children. Every Deputy in this House has probably been lobbied or made aware of a number of such cases in his or her constituency. We are approached daily with stories of difficulty, hardship and constituents who are out of their mind with worry. They call seeking advice on appeals or ways to get back their medical card.
The status quo does not point to a system that needs tweaking or a new set of directives. In reality, to borrow a phrase from the Minister for Transport, Tourism and Sport, Deputy Varadkar, the HSE medical card system is not fit for purpose. It does not serve well at all the people in need of its support. In fact, sick people and their families are viewed as a burden or a thorn in the side of the health service. Nowhere is that more apparent and scandalous than in relation to children. It is bad enough that through misspending, improper planning or preparation, a lack of political will and the inaction of successive Governments, sick children in this country continue to endure decades waiting for a proper and desperately needed new children's hospital. Now it seems that those most in need of the medical services of the State are being sidelined by Government policy as the system deliberately tries to rule them out rather than welcome them in.
Could someone explain why a constituent of mine should have her medical card withdrawn for her eight year old with cancer in favour of an unconditional medical card for a healthy five year old next door? Where is the logic or fairness in such a decision? Could anyone explain the situation to the family or the child? Families faced with a seriously ill child do not have the time or energy to do anything else but concentrate on coping and dealing with the illness that has befallen their child. Do those involved in the health system not realise that? The last thing such families need at such an immensely difficult time is to have to negotiate with a difficult, time-consuming and grossly unfair system to secure full eligibility to health care for their child.
In the past 44 years since the 1970 Health Act, no significant campaign has been mounted to change what is a problematic and archaic system. I suspect this is because families faced with a seriously ill child, while badly served by the system, can do nothing more than put all their energy and time into the care of their children and home. It is an understatement to suggest that many have remained quiet, unheard, anonymous and voiceless. That is understandable. However, this week I am aware of a new campaign by parents to effect change on the outdated and crude Act that governs medical cards. I can only imagine that this is because the situation has become critical for so many families that they are left with no other option.
Our Children's Health campaign is a sincere effort by parents that aims to make an addendum to the 1970 Health Act that will grant an automatic medical card to any child diagnosed with a life-threatening or serious illness or a congenital condition for the duration of their treatment and beyond. That would remove any possibility of mistakes or, as one Member said, sinister political party cards and unjust discretion on the part of the HSE when granting medical cards. It is only right that families with seriously ill children would be afforded every support by the State without condition, prejudice or arbitrary complicated and humiliating means testing. I and my party have great sympathy for the parents and their children and will listen and support their just cause.
It is not good enough for the Government to continue to say it will look at the situation and issue further guidelines and instructions to HSE staff, or indeed ask them to be friendlier or more approachable in their dealings with hard cases. It is time for rights-based policy and legal change in this area in order that we can say that as a society we will protect our most vulnerable citizens and put children first, especially children and their families, who through no fault of their own have to endure devastating hardship, not because of means but due to life-threatening or life-limiting illness.
The slogan was "Every little cut hurts". It is very clear that the slogan has borne fruit because there are many people hurting from the little cuts and the big cuts that have been introduced by the Government and the previous Government. We know that €30 billion has been taken out of the economy over the past six years. We debated last year’s budget in the autumn of last year which included a figure of €130 million for what were called "probity measures". They were medical card cuts. Yet we hear the backbenchers and we will hear the Ministers say there is no such policy in place. We heard the Chairman of the Joint Committee on Health and Children talk about the heart-breaking stories of those who were just above the eligibility threshold but the message to them was to suck it up because it is not a policy issue, it is a systems issue. Staff should just be nicer to people when they tell them they fail to meet the guidelines in terms of eligibility for a medical card or in cases when a card is being reviewed and one is no longer entitled to one. The message from the Government is to suck it up because it is very clear it is not taking the blame. The blame lies with the civil servants and public sector workers who are not nice enough to those who apply for medical cards or have their cards reviewed.
The Minister has a new language to describe the situation. He used to speak about medical cards being renewed but now they are reviewed. In the real world everybody knows what is happening. Everybody knows that it is a real and vicious cut to the eligibility for medical cards. In my offices in Donegal, Gweedore and Ballybofey every single week, a number of medical card issues present. The cases relate to both old people and young people. When the Government initiated a whole-scale review of medical cards, streams of people came to my offices. Elderly people broke down in tears in front of staff in the office because of the fear they would lose their medical cards. Not all of them did but some of them did. They are people who built the health service, who contributed to running the country, who kept this country alive in very difficult times and the Government has abandoned them in their hour of need.
As other speakers stated, there are many heartbreaking stories which would bring us to tears. The Minister wants his own Deputies to give him a list of hard cases, but they are to be found in every village and parish throughout the State. The Government needs to accept there has been a change in policy and a targeting of the elderly and the weakest in society. The Minister also needs to acknowledge he is not up to the job. He has presided over a fiasco in the Department of Health for the past three years. Perhaps he did not hear, but some of his backbenchers have started to call him a reforming Minister, and this is code if we have ever heard it.
The figures are undeniable. In March 2011, before the so-called revolution, 97,120 people held full medical cards or GP visit cards on a discretionary basis. In March 2014 the figure was 78,310. This is a drop of almost 20%. It is not down to any great improvement in the lives or income of people. We know this much. It is down to the heartless cuts imposed by a Government which is out of touch with reality. This is what is at the core of it. We only have to listen to other evidence provided by Down Syndrome Ireland, which stated half the people with Down's syndrome have either had their medical cards cut or are in danger of losing them due to Fine Gael and Labour Party policy.
The Government is out of touch. The fact the Minister is even asking for a list of hard cases shows he is completely out of touch. What really hurts people is how they are treated unfairly. Did the Minister see the documentary, "Jackie's Story: My Life My Legacy" which was screened on TV3 last night? If he did not see it he should do so. He should examine how the health system failed this woman. She has a terminal disease and is preparing for her own funeral. She is concerned about her children. The Minister should listen to her words as she explains how she could not afford her prescription and had to leave the medication on the counter. Later that evening the fair pharmacist paid the prescription charges. This is not an isolated story. Pharmacists in Donegal have told me similar stories, perhaps not with regard to patients who are terminally ill with cancer. Anybody watching the programme would have to have a heart of stone not to be reduced to tears. This was broadcast in the same week the Minister for Finance stood on the tarmac as he watched Donald Trump roll into Shannon Airport. There needs to be some fairness in society. We need some equality. The Government needs to stand up for those silent sufferers. I ask the Minister to do the right thing and reverse the cuts.
It seems that nowadays I stand up here more often to talk to, and even plead with, Ministers about the distress I see in my constituency and the people who approach me for help. The single, clear message coming from this Government is that if one is in trouble, one is on one's own. If one's mother needs care, if one's child has special needs, if one has lost one's job, if one has an accident, if one's child gets into trouble, whatever it is, do not come looking for support or help from the Government. No, if one has a problem one can pay to resolve it or go away, even if that problem is a long-term, terminal, painful or immobilising medical condition or disease. If one has no money to pay, then tough. The Government is about balancing books, the bible according to the troika, and after that no humanity, solidarity, compassion or ordinary human decency comes into it.
The Minister, the Taoiseach and the Tánaiste have stood in the House and told us, again and again, that there was no change in criteria for issuing or, more commonly, withdrawing discretionary medical cards, even though we know that in 2009 the rate of discretionary medical cards was one in 18, but last year it had dropped to one in 33. The Minister knows this too, and it is a shame on him and the Government. As the election campaign progressed over the past few weeks and Fine Gael and Labour Party canvassers had the audacity to knock on people’s doors, they were told again and again of the suffering caused by the withdrawal of medical cards. They got windy and the Minister got a roasting at a Fine Gael parliamentary party meeting. That is when we began to hear about a third tier and the amazing discovery by the Minister of some hard cases which were causing concern, and he then referred to administrative problems.
I would love to know what he calls a hard case. What is the definition of a hard case around the Fine Gael and Labour Party Cabinet table? Would it be, for example, like a couple in my constituency, where she has asthma and he has a heart condition and high blood pressure? Their cards were taken away and during every one of the months it took to get them back, they had to make a hard decision. What decision was this? It was which of them would get their medication and which of them would hope for the best, as they could not afford to fill the prescriptions for both of them. They came to the decision that her inhalers were more important. This man ended up in hospital with a stroke as he had gone without his blood thinning medication for so long. Would this be a hard case?
Deputy Doherty mentioned Jackie's story. Jackie is my friend and neighbour. I am well acquainted with her story and have been for quite a considerable time. It is a hard case. This woman is going to her death. She was denied prescriptions by the Government and the HSE. Would this be a case that causes concern for the Government?
Leaving aside human compassion and decency, it saves no one any money that instead of giving the man I mentioned his medication, the health service now has the greater cost and use of resources of treating him in hospital for a stroke. This man will end up in rehab, probably in Dún Laoghaire. There is not a Deputy in the House, or a canvasser going from door to door, who has not heard about the suffering, hardship and stress that this is causing.
In the circumstances, I see how the Minister was quoted in the Irish Examiner as stating "My main concern is two-fold — number one, that people get the care they need but number two, to protect the taxpayer." To protect the taxpayer against what? Does he really expect us to believe that people are faking illness to get a medical card in order to pull off some sort of a scam? In his anxiety to root out some kind of imaginary scam on behalf of the taxpayer, he has ignored the advice of those on the front-line of the health service: the family doctor, the local GP and the men and women who call again and again for the resources to run a proper primary care service. Best practice internationally, expert reports and recommendations and simple cop on indicate that a properly funded and resourced primary care service is the least expensive and most efficient way to keep the population healthy. It is the way to go to stop people getting seriously ill and the most effective vehicle for health promotion. When I go home this week I will see Jackie again, as I do every week. What the Government has done to Jackie and the couple I mentioned is an indictment on what it has done to the people of Ireland.
At the outset, I want to reject out of hand the notion that there is any deliberate culling of cards as Deputies Ó Caoláin and Kelleher allege. During the course of the debate yesterday, and again this morning during Question Time, Deputies continued to insist that there has been a change in policy in the application of discretion. I reject this. The health service must operate within the bounds of the law set by this House, and I expect it to do so in a respectful, fair and equitable manner.
The Deputies point out that the number of medical cards issued on a discretionary basis has decreased, and this is true, but it is important that we understand why this is the case, and that we are honest about this, particularly with the people we represent. There is no deliberate cull as the Deputies would like people to believe. Rather it is the case that many households whose income was previously marginally over the threshold, and therefore got a card on a discretionary basis, subsequently experienced a fall in income, and now qualify for a medical card without any need for the exercise of discretion.
It is important that Deputies understand the facts, and do not twist them so as needlessly to frighten people.
Since the Government came into office, approximately 6% of those who held medical cards issued on a discretionary basis in March 2011 have been found ineligible. In other words, the vast majority still have a medical card.
Of those who had medical cards issued on a discretionary basis in March 2011, approximately one third still have a medical card because the Health Service Executive has exercised discretion. Moreover, nearly 50% of them still have a medical card because their income is below the guideline and there is no need for discretion to be applied. However, that does not suit the story from the Deputies opposite. The balance, approximately one eighth of the total, lost eligibility as they did not respond to the renewal notice, did not complete the review process, were deceased or other family members were awarded a card.
I assure Members that I am very concerned about these cases. As a medical doctor, I know only too well the worry and practical difficulties that can result from the loss of a medical card, especially for those who have had a card for some time. However, I also have an obligation to ensure that the health system operates within the law as it stands. Unfortunately, that means that in some cases, even when medical expenses are taken into account, the household's net income remains over the guideline amount and often by several hundred euro a week. I also have an obligation to ensure that discretion is applied fairly and this was not the case in the past. For example, in 2009, while three medical cards were issued on a discretionary basis per 1,000 of the population in County Meath, the equivalent number in north Cork was 53, that is, more than 17 times as many. Was that fair or equitable? I do not believe this situation is acceptable and nor does my party or the Government. That is why the Government is committed to ending the unfair two-tier health system and to bringing in universal access to primary care under a universal health insurance policy. However, I realise that some of the households affected include people with ongoing medical conditions. As I wish to ensure a supportive and compassionate response in such instances, I have asked the HSE to consider how best we can ensure these families receive all the supports that are available because in many instances, medical needs can be met without a medical card and without recourse to a means test.
The Government remains committed to delivering a fair, safe and high-quality health system in which people can access health services on the basis of their medical need rather than on their ability to pay. It is making progress and although it is not there yet, the Government has provided funding for the increased number of medical and GP-visit cards issued since it came into office. This funding means that at present, 42% of our population has access to GP services without charges. Moreover, the Government has done what its predecessors did not even try to do, which is to reduce the high costs in the health system in order that more people can be treated and can be treated more quickly and better. I am determined to press ahead with the most radical reform of the health system in the history of the State. The Government is working hard to end the inefficient and inequitable two-tier system it inherited and to replace it with a fair, safe and high-quality health service, supported by universal health insurance where access to services is based on need and not on ability to pay. This is right for the health system. It is right for the health service staff who have worked so hard, making significant personal sacrifices to reduce costs, while delivering better outcomes and most importantly, it is right for patients and all users of the health service.
I call Teachta Adams, who is sharing time with Deputies McDonald and Ó Caoláin.
This week, the parents of seriously ill children launched a new statewide campaign, Our Children's Health, to protect their medical cards. In response, the Government's newly appointed Minister for Children and Youth affairs, Deputy Charles Flanagan, stated: "I would hope that everybody who needs a medical card in this country [mar dhea] would have one." He needs to do much more than hope. First, everyone who needs a medical card does not have one. The Minister for Health and everyone else knows this. Second, this type of response, which is indicative of a dysfunctional Government, is causing serious distress to many citizens. It is pathetic and completely unacceptable. The Government, from the Taoiseach downwards, is denying its role in creating and sustaining this crisis. However, it has been brought to its attention time out of number by Opposition parties here in the Dáil, as well as by Labour Party and Fine Gael backbenchers. Incidentally, where is the Labour Party tonight? The test of those backbenchers will be how they vote on this motion later.
In case the Minister is in any doubt in this regard, the HSE's national director of primary care, Mr. John Hennessy, has acknowledged the reality. He has stated the removal of discretionary medical cards from some patients has been indefensible. He has stated it is causing unnecessary levels of anxiety and frustration for families, particularly those families dealing with serious disability. Moreover, the root of the scandal is the willingness and indeed the eagerness of the Government and the Minister for Health to allow seriously ill and vulnerable citizens to be targeted in a money-saving exercise. Access to medical card cover is subject to a means test instead of medical need and that is wrong. Mr. Hennessy has argued that the renewal process in certain cases involving profound disability requires a far more integrated process in a way that ensures all entitlements and health service supports, particularly non-means tested services such as supplies of medicines, equipment and other support services, are maximised.
As Members debate these issues with the Minister, families are dealing with serious illness and disabilities in their homes. Their burden is being added to by the decisions the Minister is taking. For example, Ms Mary O’Kane from Laytown is 86 years of age and is living alone. Her medical card was withdrawn following self-assessment. There is no way of checking whether elderly citizens such as Ms O'Kane ticked the incorrect income boxes on their forms and lost their cards as a result. Lily Redmond from Grange Rath, Drogheda, has been diagnosed with Down's syndrome and has food aversion issues. She has attended a range of specialists and therapists. She has never eaten solid food and can only ingest fluids. She is yet to walk and still goes about on her bum. Lily’s parents only discovered her medical card was withdrawn following a GP visit. Eve North, a 12 year old girl from the same locality, also had her medical card taken. Ms Pamela Donnelly from Julianstown has sleep apnoea, which requires the use of a continuous positive airway pressure, CPAP, machine. Although she is under GP and hospital care, Ms Donnelly's full medical card was withdrawn following a review citing income in excess of guidelines. However, a GP-visit card does not cover the cost of the CPAP machine, which is €111 per month, and as a result, she has had no machine as of January 2014. Another citizen from Bettystown, whose name I will not give, has cancer. He has undergone surgery and chemotherapy and still is attending hospital for follow-up. He requires a colostomy bag daily. His medical card was withdrawn because he exceeded the income limit. However, he cannot afford to provide his own colostomy bags. Sin an scéal.
These families across this State, have no one, apart from their families, who are providing them with solidarity. No one from the State is wrapping their arms around them. They feel isolated, afraid and confused. They are particularly affronted by what the Minister and the Taoiseach say in this Chamber. The Government amendment to the Sinn Féin motion is insulting. It asserts that the assessment of medical cards is facilitated in a consistent and equitable manner. The Minister does not know what "equitable" means. The amendment also states there has been no change and ends in an ego trip. There is a commendation for the Minister for Health in the name of the Minister for Health. That says it all.
There has been a cull of discretionary medical cards. This is a matter of recorded fact and the figures record that fact. The Minister states he must act within the parameters of the law and he cites the Health Act 1970. The Minister persists in the untruth that there has been no policy change when the facts shout out the contrary. Allow me to give the Minister two precise examples of this policy change. First, I will cite the case of young Katie Connolly, who is a six year old child from Cork whose case I raised in November 2013. Katie had been entitled to a medical card since birth, which was the correct thing because Katie has Down's syndrome and a number of medical complications.
The circumstances of the Connolly household have not changed, they did not win the lottery and indeed, Katie's medical needs have not receded in any way. In fact, if anything, they have increased. Yet young Katie and her family are faced with the situation where her medical card has been taken away. That is the fact.
Young Alex Kyne Coyle is ten years of age. The Minister may have seen him on the television with his mother and father, Annette and Declan. Young Alex has Mowat Wilson
syndrome. He cannot walk or talk, is tube fed and has seizures. Two or three weeks ago, he, too, had his medical card taken away. These are the facts, these are the cases and, by God, these are hard cases in anybody's language. Yet when we put the motion before the House, we get from the Minister a delusional and robotic response. That is what his response amounts to. I do not know if he is in a complete state of denial. I do not know if he is comfortable simply to look away from these cases to try to make believe that they do not exist. The families who find themselves in this situation do not have that luxury because they care for their children, or in other cases for an elderly parent or relative, day in and day out. The fact of the matter is that policy has changed. Katie and Alex were deemed at one point eligible for their medical cards and then the policy change occurred and their medical cards were taken away.
Deputy Adams has already noted the commendation to the Minister in the Government amendment. He is commended not once, but twice. Whatever about the Minister and his self-belief in his own brilliance in the discharge of his duties, I find it unbelievable and very hard to understand how any backbencher from Fine Gael or the Labour Party could come in to this House, against a backdrop of situations like those faced by Katie and Alex, vote in favour of a motion that commends the Minister so generously, and turn his or her face away from these very hard cases.
I will give the Minister some cause to reflect on words from Declan Coyle, the father of Alex. He sums up the position far more eloquently than any of us here:
I have a dream that the Government policy-makers will remove their hearts of stone and replace them with hearts of flesh. I have a dream that our Government Ministers and politicians will reflect the kind, compassionate, caring, loving people of Ireland and stop attacking the weakest and the sickest. I have a dream that no family with special needs sick children will live in fear and dread. I have a dream that a woman who wrote to me recently about her friend will never have to go through this trauma. Her child was very very sick. She spent days and nights on the floor by the hospital bed. The HSE hounded her and pulled her medical card. Her friend organised a campaign. She got 10,000 to sign up. She organised a silent protest outside Our Lady's Hospital. Eventually the mother of the extremely sick child got her card back. Last March, her beautiful, beautiful child died. Her precious child is now in the arms of the angels.
If the Minister is not amenable to logic and argument from the Opposition benches, I appeal to him to listen to those words from Declan Coyle, from the voice of experience. I ask him again to do the right and decent thing. Do not just talk about the hard cases. Give assistance, succour and return the medical cards to those very hard cases.
Ba mhaith liom buíochas a ghabháil le gach Teachta a ghlac páirt sa díospóireacht. I thank all Deputies who took part in this debate last evening and this evening. If anything, the contributions have strengthened our resolve, not just Sinn Féin Deputies but all of us who have demonstrated a real understanding of the issue at the core of this debate, to challenge what is currently taking place with the medical card system and to press the Government to relent. There is no excuse for any member of Government or any Member of the Oireachtas not knowing the depth of hardship, anxiety and grief being caused by the denial of medical cards to people who desperately need them. We heard last night and again tonight, some of the many examples. It is particularly harrowing where a child with a severe disability or a serious illness loses a medical card. It was disappointing to witness the Minister of State, Deputy Alex White, dancing on the head of a pin. He said in his contribution that for ease of discussion he would use the term "discretionary medical card". He later said "there is no such thing as a discretionary medical card". He also said that medical cards are awarded by the HSE where the HSE "exercises discretion in circumstances where a person exceeds the income guidelines". Let us try to get this straight. There are no discretionary medical cards, there only medical cards awarded on the basis of discretion. Could somebody figure that out? More important, would somebody attempt to explain it to the many irate families who have had their medical cards taken from them when they truly deserve them and needed them?
The Minister of State disputes the figures I have cited. I will repeat them because the source is his own senior Minister, Deputy Reilly. The number of people with full medical cards and GP visit cards on a discretionary basis in March 2011 was 97,120 and by March 2014, this number had fallen to 78,310. The Minister of State should not get stuck on March 2011 because there is a three year passage here. There was certainly nobody else getting access to discretionary medical cards over that period by the figures the Minister of State himself has used. I will not attempt to unpick the rest of the figures and the percentages cited by the Minister of State last night and in the course of Question Time today. The key figure I have highlighted, plus the testimonies of people coming to every Oireachtas Member on a weekly if not daily basis, are more than enough to show the adverse results of Government policy and HSE practice in the lives of real people. It is real people of whom we speak. I agree that the medical card system is primarily income-based, but it has always included, at its core, a crucial element of discretion. That key discretionary element has been eroded by this Government for so-called cost-saving reasons and for none other. It is as crass as that over the past three years. The Minister does not like the word "cull" but this cull of discretionary medical cards has been done under the term of "probity". One of the dictionary definitions of "probity" is"'uprightness and honesty". The implication is that the Department and the HSE are rooting out dishonest people who have wrongly claimed for medical cards and who have been enjoying them for some time. On the contrary, let the facts show that it is the Government, the Department and the HSE who are less than honest. They are claiming to treat people equally but they are choosing the easy targets, the families whose income is over the threshold, many with members with serious illnesses or disabilities and for whom the cost of health care is a huge burden. That is the reason they qualified for a discretionary medical card in the first place.
I wish to thank especially those who continue to campaign outside this institution on this most important of issues. I want to recognise especially the specialist nurses from the Jack and Jill Foundation and all others, including Aoibheann's Pink Tie, for their campaigning and for their continued efforts to try to bring reality to the Minister and to his colleagues and to this Government. I urge all Deputies, on all sides of the House, to truly represent their constituents. Nobody in this House can be unaware of the real hurt and pain that exists as a result of this cull. The canvass in the local and European elections has certainly focused minds and brought this home to everyone's knowledge and attention. I appeal to everybody here to support the Sinn Féin motion as tabled, to recognise that it is time for those at the helm of our health services, including the Minister and his junior colleagues, to take their heads out of the sand and to recognise what is happening across society today. It is not about numbers and statistics but about people who are suffering unnecessarily.
Amendment put:
The Dáil divided: Tá, 72; Níl, 36.
Tá
- Bannon, James.
- Barry, Tom.
- Bruton, Richard.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Byrne, Eric.
- Cannon, Ciarán.
- Carey, Joe.
- Coffey, Paudie.
- Collins, Áine.
- Conaghan, Michael.
- Conlan, Seán.
- Conway, Ciara.
- Corcoran Kennedy, Marcella.
- Creed, Michael.
- Daly, Jim.
- Deenihan, Jimmy.
- Deering, Pat.
- Donohoe, Paschal.
- Doyle, Andrew.
- Durkan, Bernard J.
- Farrell, Alan.
- Feighan, Frank.
- Ferris, Anne.
- Fitzgerald, Frances.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Griffin, Brendan.
- Harris, Simon.
- Hayes, Tom.
- Heydon, Martin.
- Howlin, Brendan.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Kehoe, Paul.
- Kelly, Alan.
- Kyne, Seán.
- Lawlor, Anthony.
- Lyons, John.
- McGinley, Dinny.
- McHugh, Joe.
- McLoughlin, Tony.
- Maloney, Eamonn.
- Mitchell, Olivia.
- Mitchell O'Connor, Mary.
- Mulherin, Michelle.
- Murphy, Dara.
- Murphy, Eoghan.
- Nash, Gerald.
- Neville, Dan.
- Nolan, Derek.
- Noonan, Michael.
- Ó Ríordáin, Aodhán.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Reilly, Joe.
- O'Sullivan, Jan.
- Perry, John.
- Phelan, Ann.
- Phelan, John Paul.
- Reilly, James.
- Ring, Michael.
- Ryan, Brendan.
- Spring, Arthur.
- Stagg, Emmet.
- Stanton, David.
- Twomey, Liam.
- Wall, Jack.
- Walsh, Brian.
- White, Alex.
Níl
- Adams, Gerry.
- Calleary, Dara.
- Collins, Niall.
- Colreavy, Michael.
- Cowen, Barry.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Grealish, Noel.
- Healy, Seamus.
- Healy-Rae, Michael.
- Kelleher, Billy.
- Kitt, Michael P.
- Mac Lochlainn, Pádraig.
- McConalogue, Charlie.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McLellan, Sandra.
- Martin, Micheál.
- Mathews, Peter.
- Murphy, Catherine.
- Ó Caoláin, Caoimhghín.
- Ó Fearghaíl, Seán.
- Ó Snodaigh, Aengus.
- O'Brien, Jonathan.
- O'Sullivan, Maureen.
- Smith, Brendan.
- Stanley, Brian.
- Tóibín, Peadar.
- Troy, Robert.
- Wallace, Mick.
Tellers: Tá, Deputies Paul Kehoe and Emmet Stagg; Níl, Deputies Aengus Ó Snodaigh and Caoimhghín Ó Caoláin.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 72; Níl, 36.
Tá
- Bannon, James.
- Barry, Tom.
- Bruton, Richard.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Byrne, Eric.
- Cannon, Ciarán.
- Carey, Joe.
- Coffey, Paudie.
- Collins, Áine.
- Conaghan, Michael.
- Conlan, Seán.
- Conway, Ciara.
- Corcoran Kennedy, Marcella.
- Creed, Michael.
- Daly, Jim.
- Deenihan, Jimmy.
- Deering, Pat.
- Donohoe, Paschal.
- Doyle, Andrew.
- Durkan, Bernard J.
- Farrell, Alan.
- Feighan, Frank.
- Ferris, Anne.
- Fitzgerald, Frances.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Griffin, Brendan.
- Harris, Simon.
- Hayes, Tom.
- Heydon, Martin.
- Howlin, Brendan.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Kehoe, Paul.
- Kelly, Alan.
- Kyne, Seán.
- Lawlor, Anthony.
- Lyons, John.
- Maloney, Eamonn.
- McGinley, Dinny.
- McHugh, Joe.
- McLoughlin, Tony.
- Mitchell, Olivia.
- Mitchell O'Connor, Mary.
- Mulherin, Michelle.
- Murphy, Dara.
- Murphy, Eoghan.
- Nash, Gerald.
- Neville, Dan.
- Nolan, Derek.
- Noonan, Michael.
- Ó Ríordáin, Aodhán.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Reilly, Joe.
- O'Sullivan, Jan.
- Perry, John.
- Phelan, Ann.
- Phelan, John Paul.
- Reilly, James.
- Ring, Michael.
- Ryan, Brendan.
- Spring, Arthur.
- Stagg, Emmet.
- Stanton, David.
- Twomey, Liam.
- Wall, Jack.
- Walsh, Brian.
- White, Alex.
Níl
- Adams, Gerry.
- Calleary, Dara.
- Collins, Niall.
- Colreavy, Michael.
- Cowen, Barry.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Grealish, Noel.
- Healy, Seamus.
- Healy-Rae, Michael.
- Kelleher, Billy.
- Kitt, Michael P.
- Mac Lochlainn, Pádraig.
- Martin, Micheál.
- Mathews, Peter.
- McConalogue, Charlie.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McLellan, Sandra.
- Murphy, Catherine.
- Ó Caoláin, Caoimhghín.
- Ó Fearghaíl, Seán.
- Ó Snodaigh, Aengus.
- O'Brien, Jonathan.
- O'Sullivan, Maureen.
- Smith, Brendan.
- Stanley, Brian.
- Tóibín, Peadar.
- Troy, Robert.
- Wallace, Mick.
Tellers: Tá, Deputies Paul Kehoe and Emmet Stagg; Níl, Deputies Aengus Ó Snodaigh and Caoimhghín Ó Caoláin.
Question declared carried.
The Dáil adjourned at 9.30 p.m. until 9.30 a.m. on Thursday, 15 May 2014.
