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Dáil Éireann debate -
Tuesday, 17 Jun 2014

Vol. 844 No. 1

Leaders' Questions

It is 18 months since I began to raise the issue of the removal of discretionary medical cards from very sick children and people with life-limiting and life-threatening conditions with the Taoiseach. In fairness, he has moved from a position of total denial of any policy change, which resulted in a dramatically high number of cards being removed from so many deserving people, to blaming a systems failure. The latest phrase given to this policy decision of the Government is an "unintended consequence of a budgetary decision" which is how the Minister for Health, Deputy Reilly, put it today.

I put it to the Taoiseach that is some hell of an unintended consequence for thousands of families across the country because it has put families through hell and back in terms of the anxiety and the stress caused and the expense many have had to incur. Today, there was an announcement by the Minister for Health in regard to a decision which the Government says will restore some of these discretionary medical cards which have been removed from people and we hear it will be around 15,000 such cards.

I put it to the Taoiseach that the removal of these cards is going on as we speak. I do not know if the Taoiseach read page 10 of the Irish Daily Mail today which highlighted the desperate case of young Cormac O'Neill, a 12 year old born with a rare filamin A gene disorder. The family spent €850 in one month alone on his medicines as the card was taken from him. I received details of another case yesterday from the mother of a child with a very rare condition. In that case, the card was removed from a 13 year old with multiple disabilities and I can give the Taoiseach details of the case. I received details of a third case of a five year old who lost the medical card which he has had since he was two years of age. It is unbelievable that this continues.

In regard to the decision which has been taken, will the Taoiseach outline to the House how many cards will be restored? Will all of those who lost discretionary medical cards have them restored? Will those who lost medical cards as a result of this decision be refunded for the cost of medication they have incurred since the discretionary medical cards were wrongly taken from them? Given all of the stress and anxiety caused, will the Taoiseach, on behalf of the Government, apologise to all the families concerned who wrongly had their discretionary medical cards taken from them?

This matter is not as simple as it looks. The Minister for Health brought a memorandum before the Government today to approve the reinstatement by the HSE of cards withdrawn on foot of a person's circumstances where the HSE had considered that the exercise of discretion should be taken into account where medical circumstances applied.

The period covered is 1 July 2011 to 31 May 2014, inclusive. A decision was made to centralise the examination of medical card applications. Deputy Martin is aware that the exercise of the discretionary right to medical cards varied greatly from county to county. In some counties, depending on the nature of the examination, the approval rate for discretionary cards could be very high, while it was very low in others. The decision to centralise the system and to have equality of examination-----

It is inequality.

-----resulted in many families being severely inconvenienced. I am very sorry that many of the cases that were brought to light on foot of the examination of discretion caused a great deal of stress for people.

I will get the exact figure for Deputy Martin but approximately 13,000 cards will be restored to people who had cards that were awarded on a discretionary basis taken from them since the decision was taken to centralise the examination system. They should receive their cards back within the next four weeks. The question that arises is what one does in respect of ordinary medical cards for which applications are being made and on which a review continues and in cases where an appeal is lodged. The first criteria is to deal with cards that have been withdrawn that had been issued on a discretionary basis where undue hardship applied and where there were particular medical circumstances. A number of such cases were outlined in the House recently and the impact the withdrawal of the cards had on families. I have not seen the newspaper to which Deputy Martin referred, or the cases he outlined, but the decision made by the Government was to cease the review that was under way in respect of discretionary cards that had been awarded in order that people who have had a discretionary card given to them should continue to have one because of the suspension of the review process. I do not know the cases Deputy Martin spoke about but following the decision of the Government, those who have a discretionary medical card should continue to have it. I will have the cases checked. It is clear that the decision made today was to deal with those who had been awarded discretionary cards whose cards were withdrawn for whatever reason on review. The issue is an administrative one as distinct from a legal one. The point is to give the cards back to the people who had them awarded on discretion and who lost the card following the review.

This is a very serious issue in that the Taoiseach has said 13,000 cards will be restored - the Minister said something similar in his press release, 15,000 - but the bottom line is that if one looks at the HSE performance report of January 2011, there were 80,000 discretionary medical cards. The reply we got at the end of April from the Minister of State, Deputy Alex White, with whom the Taoiseach is very familiar, mentioned approximately 50,000 discretionary medical cards. That means 30,000 medical cards were taken from people in the interim, not 13,000 or 15,000. What about the other 15,000 people? Will they have their discretionary medical cards restored?

The Taoiseach will have to haul in Alex.

Too much playing around with the figures is going on. I quoted from official sources - the HSE performance report of January 2011 and Parliamentary Question No. 540 of 10 June 2014. The number of discretionary medical cards reduced from 80,000 to 50,000, which means 30,000 cards were taken back. Will those who lost their medical cards also receive a refund because clearly by restoring them in the aftermath of the elections the Government has accepted that they were wrongly taken? Can I take it that all the extra costs for medication and therapy will be restored to those who lost their cards? Critically, we want to find out about the other 15,000 who have had their discretionary medical cards taken from them and who should also have them restored.

The estimate is that the cost of the restoration of discretionary medical cards is approximately €13 million. The Government approved the funding today.

What else will be cut?

The information indicates that the average cost of €1,130 per annum per discretionary card is what is involved. A total of 5,288 discretionary medical cards were refused renewal. Their reinstatement cost is €1,130 per case. A total of 7,118 discretionary medical cards were refused renewal and were replaced with a GP visit card. The reinstatement cost in each case is €880. A total of 2,899 discretionary GP visit cards were refused renewal and the reinstatement cost is €250 in each case. The estimated annual cost is €13 million.

I am talking about the difference between 50,000 cards and 80,000 cards.

It is what the Government did before the review commenced.

While it is recognised that the director general of the HSE may act on his or her own initiative to take account of an ad misericordiam appeal on a case-by-case basis to reinstate a discretionary card where, due to exceptional individual medical circumstances, a person did not respond or reply either to the review or appeals system that was going on, the estimate is that the number of cards to be reinstated is 13,300 cards at a cost of €13 million.

Yes, but 30,000 cards were taken away.

Please. We are over time.

The problem is that the Government cannot afford to reinstate them.

They were discretionary cards that were withdrawn on review since 1 July 2011. As Deputy Martin is aware, the vast majority of cards were re-awarded to people-----

No, I am not. That is a myth.

The Taoiseach should not go down that road.

When? It must have been a joke.

The number approved by Government is of the order of 13,300 cards at a cost of €13 million. People should get back their discretionary cards in the next four weeks.

The Taoiseach is not entitled to his own facts.

I do not know the ten cases which Deputy Martin mentioned but the review of discretionary medical cards has been suspended and the value of such cards should continue.

A total of 30,000 cards were taken back.

I appeal to speakers to stick within the time limits.

You are kicking the can down the road, Paddy.

I listened to the Minister for Health announce on RTE Radio the restoration of some medical cards. It would have been far better if he had come into the Chamber to make the announcement and for it to be scrutinised, but that is not the way the Government works. I asked two weeks ago for the Minister for Health to make a statement on the appointment by him of the chairman of the west and north-west hospitals group. I asked the Taoiseach the same question last week. I am still waiting for an explanation. In the meantime, the individual has resigned. Incidentally, the Minister's first response to a question from Teachta Ó Caoláin was to defend the appointment but to date no explanation either for the resignation or the original appointment has been given to the Dáil or the public.

Last week, I also asked the Taoiseach what has happened to the original files on which decisions were made about people's entitlement to a discretionary medical card, which the Ombudsman said are lost.

We can only deal with one topic on Leaders' Questions.

I am talking about the Department of Health, a Cheann Comhairle.

We are not going through the entire Department of Health on Leaders' Questions.

That is okay, but you should just let me say my piece, please, a Cheann Comhairle.

Once Deputy Adams sticks within the rules, I do not mind.

Thank you. Please try to avoid interrupting me if you do not mind.

I will interrupt you, Deputy, if you are out of order.

Okay. Go raibh maith agat.

I hope you understand the rules like everybody else.

I think it is very interesting that when I ask the Taoiseach a question, you interrupt me.

No. Excuse me, are you trying to imply that I am defending somebody?

Did you not hear what I said, a Cheann Comhairle?

I am listening very carefully.

I will repeat it again.

I ask you to resume your seat while I am on my feet.

Rules apply in this House. You know that on Leaders' Questions one is entitled to one topic. I am only applying the rules as they stand. Would you please adhere to them? Thank you.

I am talking about the record of the Minister for Health and I am also trying to get answers from the Taoiseach to questions which I have asked three weeks in a row. The Ombudsman says the files are missing.

I raised this with the Taoiseach and while officials from his office got in touch with my office, I am still awaiting a reply on this matter.

I welcome today's announcement and commend those citizens who fought to achieve this U-turn. There are, however, questions the Taoiseach has not answered and which the Minister is not available to answer. Will those citizens adversely affected through the removal of their medical cards be compensated for the hardship and costs they endured as a result? Will he confirm the administrative cost of this change will not be taken from front-line services? Given the confusion and distress caused by his Government’s handling of this entire issue, will he state clearly that everyone who needs a medical card will get one? Will he agree this embarrassing U-turn is further evidence that his Minister and Government are making up policy as they go along and that the Minister for Health should go?

I think it is a case of the extent of the impact on families being recognised by the Government. It is not all perfect by any means.

The Taoiseach only realises that now.

It has been going on for a year and a half.

We recognise, following the centralising of the medical card system, that the inequality in the level of discretionary cards awarded was higher is some parts of the country than in others. In other words, some counties had a very high level of discretionary cards awarded while others did not. In the centralising of that system, clearly significant numbers of families where there were children, in particular, with complicated medical circumstances were very badly stressed.

This has been the case for the past two years.

It has been for over two years now.

I regret that very much.

The decision made by the Government today is to restore discretionary medical cards that were withdrawn on review from July 2011 to May 2014. It will cost €13 million but will not be taken, as the Deputy put it, through a reduction in further front-line services. The Government decided today that this will be dealt with later.

It is also true that between July 2011 and May 2014 approximately 10,000 discretionary medical cardholders did not respond to or complete the review process. Neither did approximately 4,500 discretionary GP cardholders. I do not know the numbers at this stage who may qualify under that process. The Minister for Health has no objection at all to coming into the House to give details of the individual numbers if Deputy Adams wishes to put down a public notice question. I am sure the Ceann Comhairle may in time reflect on that.

The important point here is the Government has made a decision to restore those discretionary medical cards that were withdrawn on review from people. They should have those cards returned to them in the next four weeks.

The clinical panel set up by the Minister will continue its work on the assessment of the medical circumstances that will allow for people to avail of medical facilities based on medical grounds. That is an area in which we all can have an input in the time ahead.

The Taoiseach has still not answered my question on the missing files on discretionary medical cards or on the resignation of the former chair of the west and north-west hospitals group.

Coming back to the issue of medical cards, that was a Cabinet decision. While we think the Minister should go, men, mainly, sat around a table, decided upon this and it is then explained away as an unintended consequence.

Like an army council meeting.

I do not genuinely understand how, when the decision was made to remove medical cards, someone did not have the wit or the social conscience to ask what the likely consequences would be. Will the Taoiseach explain how this Cabinet decision was made? Similar decisions were made to take away allowances from people with disabilities, for example. There is all sorts of confusion about the figures. The Minister spoke about 15,300 people being affected. The Taoiseach spoke about 13,000, while Mr. John Hennessy, director of primary care, quoted a figure of 30,000 and the Minister of State, Deputy White, 50,000. A while back, the figure used to be 80,000. Will everyone who needs a medical card get one?

The restoration of some medical cards has been described as a temporary decision. Will the Taoiseach explain what this means?

I answered the Deputy’s question last week in respect of the resignation of Mr. Daly from the west and north-west hospitals group. I stated then that after this was brought to the Minister’s attention, he was dealing with it in a very serious fashion.

Why did he resign? It was the Minister who appointed him and defended him.

An issue arose with a conflict of interest about the awarding of a measure of work to a company associated with the former chairman. When this was brought to the attention of the Minister, it was dealt with seriously and the chairman resigned. I understand Mr. John Killeen has assumed the role of interim chairperson of the board. I answered that question for Deputy Adams last week.

As Deputy Adams will be aware, the current legislative base for the issuing of a medical card is the Health Act 1970. What it is concerned with is undue hardship which is defined with reference to household means. When a person applies for a medical card, the question asked is if there is undue hardship based on the household means. If a person is ruled out of receiving a medical card on that basis, then one then has to see how much discretion could apply to deal with a particular undue hardship. That was, however, implemented in a very uneven fashion and, accordingly, in an unfair fashion. In some places discretionary cards were issued with very little analysis and in others with very stringent analysis. The equalisation of that process resulted in many thousands of people being severely affected.

The Minister has asked the clinical panel to examine the setting out of a policy framework that will take account of medical conditions as a method for having access to medical facilities. In fact, the Health Act 1970 does not specifically refer to medical cards but to the issue of access to medical facilities based on undue hardship, taking into account household incomes.

The Government’s decision today is clear. All those who lost the discretionary card awarded to them on the basis of the central review from July 2011 will have those cards restored on an administrative basis. They should have them back within the next four weeks. That means that people who have lost a medical card awarded on discretionary grounds because of exceptional medical issues will have those cards restored to them.

It will be only half of them.

The cost of that will be €13 million, which the Government approved this morning.

That is the first figure the Taoiseach has had right in a long time.

The whole issue of inquiries has been very much in vogue with much chatter over the weekend. The focus, however, has been on the wrong inquiries. It is quite clear that the toothless banking inquiry is not going to expose anything, except maybe a few politicians to a bit of badly needed publicity.

That is for you, Ruth.

It has dawned on many citizens now that the Oireachtas inquiry into banking has about as much chance of getting to the bottom of what happened in the banking sector as Billy Bunter would have in finding out who robbed the school tuckshop. It is a joke. Instead, maybe the Taoiseach will focus on a different inquiry, one which might have the chance of actually succeeding, if he had the will to set it up in an appropriate manner.

I refer to the statement yesterday by the broad cross-section of academics, NGOs and public figures which presented a cast-iron case for why a public inquiry into the policing of the Corrib gas project should be held. Everybody accepts that our mechanisms for Garda accountability have been found not to be fit for purpose. Is it not logical against this backdrop of one of the longest-running police operations in the history of the State, in an area deemed to be the most heavily policed in Europe, coincidentally in the Taoiseach's backyard, where more than 100 complaints to GSOC have been made, that the Taoiseach would agree this obviously should be the subject of an independent inquiry? Such an inquiry has been sought for a long time by national and international human rights campaigners such as Archbishop Desmond Tutu and the UN special rapporteur for human rights defenders. The campaign yesterday outlined 22 reasons such an inquiry needs to take place, ranging from the lack of legality of arresting people without charge, protesters being hospitalised, phone tapping-----

What about the investment?

-----retired gardaí working for the IRMS and Shell and the fact that all of the regulatory and monitoring agencies have been demonstrably shown to have been subverted by Shell.

The €1 billion investment should be welcomed.

The question I need to ask the Taoiseach is whether he is aware of the meetings of the Shell committee of managing directors in London prior to the commencement of the Shell project when it discussed whether the company had sufficiently well-placed contacts in the Irish Government and among the Irish regulators, an instance which it said it would investigate further and which set the scene for everything else that followed? Is the Taoiseach aware of the continued police harassment and intimidation of the local community, including a very serious incident in Pollatomish the weekend before last?

If the Taoiseach is not aware of these instances, will he make himself aware of them and visit the residents, his constituents, and tell them how he reconciles this with his previous statements that we are on the cusp of a new Garda regime?

I am glad to note the political policy regulatory structures on banking governance will be examined by the Oireachtas committee free of any direction from the Government-----

That is some U-turn in a week. Fair play to the Taoiseach.

Can we deal with one topic please?

Will the Taoiseach instruct seven or nine of them not to take the Whip?

The Taoiseach came in here last week and told us something different.

-----free of any instruction from the Government and free to do as an Oireachtas committee can do under the new Act-----

It is an act all right. It is a double act.

An act of pirouetting at its best.

-----which is to make its own determination of its terms of reference regarding who it should examine and call, and the period it should apply. I take scant notice of the comment from the side by Deputy Martin who was involved-----

I made the comment.

It was Deputy Dooley who made the comment.

-----in a decision where there was a private inquiry held into banking with a specific time limit, admittedly carried out by a very competent person-----

Uisce faoi thalamh now.

-----who conducted 140 interviews. It was a time-constrained private banking inquiry. It is only appropriate that the Oireachtas committee under the new inquiries Act should be enabled to hold a public inquiry-----

You should have put Deputy Paul Kehoe on it.

Are there time constraints on it?

There is an enforced Government majority.

-----into the issues of governance, regulatory authorities and policy positions.

What topic are we dealing with?

I am quite sure the members of the committee will play their full part in what is a matter of real substance and interest to the Irish people, that this should never happen again.

Ask the two Senators to step back.

Do not worry, Joe will sort it out.

I am well aware of the 14 years of difficulty in respect of bringing to shore the Corrib gas field. I understand tunnelling finished in recent days, the tunnel will be backfilled-----

Has the Taoiseach finished tunnelling?

He is going directly down.

-----the pipe to bring the gas ashore will be put in and gas should flow from the Corrib field within the next six months or so. This is to be welcomed.

I am also aware of and have had occasion in the past to visit members of the Rossport and Pollatomish area when they were in Wheatfield prison. I have had engagement with them over the years. I have also had engagement with the many Irish people who have been working on the site over the past 14 years. I am not aware of the minutes of the Shell committee meeting in London before this began, but I am aware that when this was first put in place by Enterprise Oil, it was badly handled in the beginning on many sides. As one more notable than I stated, were one to do things again, one might do them very differently or some things not at all.

Was that Deputy James Reilly?

In any event I welcome the fact the standards employed in the Shell development are of the highest. In the area in the past 14 years, 200 to 2,000 people have been working on a daily basis-----

And a €1 billion investment, which should be welcomed.

-----which has been a very significant financial and economic injection into the locality which I know very well. I hope the field will be brought ashore for the benefit of the people in the next 12 months.

Given all of the files which exist on this, all of the court cases and all of the decisions made on it, I do not agree with Deputy Daly that there should be a full public sworn inquiry into policing efforts at the Shell development in Bellanaboy.

The Taoiseach has very much clarified matters for his constituents, which is probably one of the reasons Fine Gael now has diminished representation on Mayo County Council. He seems to be very well versed with the propaganda of Shell, as is his colleague sitting in front of me, Deputy Grealish. Perhaps he got this information on his visit in February when he took time out to go to Shell and meet it on site. He has not shown the same enthusiasm to meet people in the area, such as Mrs. McGrath in whose kitchen he felt comfortable enough to make a cup of tea on a previous occasion. This woman, who is 73, was manhandled by 30 gardaí outside her pub in the early hours of the morning between 1 a.m. and 5 a.m. less than ten days ago.

A supplementary question please.

She was the subject of Garda manhandling. The Taoiseach told us previously that the acting Garda Commissioner represents a new police force. Will the Taoiseach make contact with this family, in whose kitchen he drank tea before he reached his elevated status, and ask them what happened? The man in the house had a stroke over what went on. He was in his bedroom listening to his wife being manhandled on the street by gardaí. Young gardaí jeered at him and made fun of him knowing about his health and asking him to come down.

We are over time.

Will the Taoiseach once and for all deal with these issues in the area? Will he tell us how this possibly represents a new Garda force? Is it not indicative of what we have been stating, that the force needs to be stood on its head if one is to get to the truth and have a proper police service which does not act as hired hands for a multinational company, which the Taoiseach prostituted himself in front of, but-----

I ask the Deputy to put her supplementary question, please.

-----instead serves constituents and residents?

Outrageous language.

I do not know whether the Deputy knows all of the people down there in the locality but I know most of them. The vast majority of those who caused all the trouble in Bellanaboy were not from the area. They were imported serial protesters who went out of their way to cause trouble-----

Who was there last Sunday?

-----and who cost the taxpayer €20 million to €25 million in Garda overtime costs, one of whom died in the middle of all this. I do not accept the Deputy's argument that all of this trouble is caused by people from the locality. I have been in many of their houses, and I went there recently to look at the standards employed and to speak to Irish engineers and environmental engineers whose careers depend on the standards and quality of work they have implemented. Deputy Daly would be welcome there to see the standards. I respect the difficulties faced by local families but the company has worked with local communities in many areas providing opportunities for young people through scholarships to fulfil their educational potential and other community issues and it has grown with the communities.

So all of the human rights organisations are wrong.

It has the worst human rights record in the world. The Taoiseach should go to Nigeria where Shell had somebody assassinated.

Are Archbishop Desmond Tutu and the UN wrong?

Deputies Daly and Halligan do not want to see the product of the Corrib field coming ashore.

Sorry, would you please remain silent? Thank you.

It had Ken Saro-Wiwa executed in Nigeria a few years ago.

Deputy Clare Daly should note I will welcome very much the day on which Corrib gas flows through to the terminal in Bellanaboy.

It has provided an economic lift and injection-----

A billion euro.

-----that in many ways has shielded that locality from the recession which has affected the rest of the country. On many occasions, up to 2,000 men were working around the clock in providing a terminal.

For the benefit of the people of Norway. They get the profit.

Deputy Daly and her fellow Deputies have never referred to how people have built their houses and paid off their mortgages or to the upskilling and training for young people not just to work on that plant, but on so many others. The benefits of this will be seen when the gas actually flows-----

Who will get the gas?

I will welcome the day on which it will flow because from my own experience, I can testify to the quality of the work that has gone in there, the standards that apply and the lessons that have been learned. Lessons have been learned, not least of which was-----

They were not learned last Sunday night.

Thank you, Taoiseach.

------that people from outside my own county travelled very long distances from outside the country-----

Nobody was there on Sunday night, except 30 gardaí.

-----to give vent to their professional protester hysterical screeches on the road outside Rossport.

That completes Leaders' Questions for today. Could I remind Deputies that it is extremely difficult to ask somebody to sit in this Chair and to try to be fair to everybody when a time limit has been imposed which obviously is not suitable? I appeal to them to change the rules in order that we can stay within the rules and not have me interfering and interrupting on an ongoing basis.

We now are nearly 20 minutes over time and this is not the way to do business. It does not suit me or my temperament to be interrupting people on a continuous basis. Moreover, to ignore the Chair is even worse, whoever is in it.

Deputies

Hear, hear.

We do not need any smart remarks either from the sidelines.

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