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All children with cancer should be granted medical cards – Ó Caoláin

9 October, 2013 - by Caoimhghín Ó Caoláin TD


Sinn Féin Health spokesperson Caoimhghín Ó Caoláin has described the refusal of Minister Reilly to ensure that all children with cancer get medical cards as most cruel, illogical and medically highly questionable.

Deputy Ó Caoláin was speaking in the Dáil this evening on a private members motion on discretionary medical cards.

During the course of the speech Deputy Ó Caoláin said successive Health Ministers including Mícheál Martin failed to address the recurring junior hospital doctors’ crisis, resulting in the industrial action taking place at hospitals across the state today.

The following is the full transcript of his speech:

Private Members Business 8/10/13 - Medical Cards
Caoimhghín Ó Caoláin TD, Sinn Féin Health & Children spokesperson

It is hard to believe that this Government has actually promised in its Programme to provide free GP care for all. Its actions have all been in the opposite direction – it has increased the cost of primary care for people on medical cards by increasing prescription fees and for non-medical card holders by raising the drug payment scheme threshold. And, as this motion points out, it has reduced the number of discretionary medical cards issued.

The Government repeatedly points out that the overall number of medical cards, issued on the basis of income, has increased. That is correct but that is not an indicator of this Government’s commitment to primary care: it is, rather, an indicator of the dismal economic failure of this and the previous Government in driving masses of people down to the low levels of income which qualify for a full medical card or a GP visit-only card.

I have repeatedly raised the issue of medical card restrictions. I have done so  Health Minister James Reilly, and with junior Ministers Alex White and Kathleen Lynch, both in Dáil chamber and in Committee. I have also met and lobbied the central medical card administration in Finglas.

It speaks volumes of the lack of real planning and real substance in this Government’s plans for universal healthcare based on the private insurance model that they fell at the very first hurdle with regard to GP care. The proposal to begin the roll-out of free GP care for all with people in the Long-Term Illness Scheme has been abandoned. Why was it proposed to proceed in that way in the first place? Why was false hope given to people on this Scheme?

Let us be very clear. Sinn Féin has for long advocated GP care free at the point of delivery for all, funded by fair and reformed general taxation, the funding basis for the truly reformed universal health service that we advocate. We have long advocated also commencing free GP care with children. It seems now that the Government may be considering extending free GP care to children under 5. We have included that proposal in our alternative budget proposals published today and we hope that the Government does indeed proceed in that way, as a first step.

They are more than welcome to use any – and preferably all - of our proposals, rather than continuing with an austerity strategy that is shredding the health service, as well as other public services.

The specific focus of this motion is the discretionary medical card. We asked the Minister for Health about this matter recently. We urged him to ensure that all children diagnosed with cancer are granted, or allowed to retain, medical cards.

This matter arose because it was reported to us and, I am sure, to other Deputies, that whereas previously the granting of discretionary medical cards to children with cancer had been virtually automatic, in recent times some parents were experiencing refusal or delay. This was contrary to previous experience and to legitimate expectation.

Health Minister James Reilly, questioned on this issue by me at the Dáil Health Committee last July admitted that discretionary cards are no longer being granted to cancer patients in the same way as previously. I pointed to the irony that this Government is promising to extend free GP care to all while at the same time cutting medical cards for some of those who need them most.

Medical card assessments need to be carried out with appropriate discretion and compassion and not simply on the basis of the very low income threshold. This is clearly a requirement where applicants have life-limiting conditions, including cancer.

The HSE has claimed that there has been no change in criteria for discretionary medical cards but has also admitted that the number of people on discretionary medical cards has indeed decreased, as the figures cited in the motion demonstrate.

It does not take much imagination to see the great distress all this causes to already traumatised parents of children with cancer.

That distress for parents would be compounded by a reading of the Minister’s reply to our recent Dáil question urging him to ensure that all children with cancer get medical cards. He pointed out that other than on the grounds of income and “undue hardship” there is no provision for the automatic granting of discretionary medical cards to children with cancer – unless they are terminally ill.

That is a most cruel position. It is also illogical and medically highly questionable. In very many cases no-one can tell whether a cancer will prove terminal or not; it depends on a number of critical factors, including how the patient responds to treatment. And what parent wants to provide medical evidence that their child’s cancer is terminal in order to qualify for a discretionary medical card that is valid for six months?

This only goes to show the inequities and, indeed in some cases, the cruelties, that arise when the principle of universal care on the basis of medical need and medical need alone is not adhered to.

The reality is that Minister Reilly, like Minister Harney before him, is shredding our public health services with his regime of cuts and patients are suffering as a result.

A Budget over-run on health spending is predicted again this year. That is no surprise. We have had successive years of health cutbacks since 2007 with our public health system unable to cope.

Cuts of €781 million in Health were imposed by Minister Reilly for 2013.  

When Fine Gael & Labour cut over €750 million out of Health for 2012, on top of the €1 billion cut in 2011, we said it was unsustainable and would cause huge damage to the health services.

They then cut a further €130 million in August 2012.  And at the end of 2012 Minister Reilly had to ask the Dáil for an additional €360 million supplementary estimate to prevent services collapsing before the end of the year. That is no way to fund and run our public health services.

As we made clear at our Alternative Budget launch today we would discontinue the futile austerity policy. We would address the deficit by redistributing the burden away from those on low and middle incomes and taking a greater contribution from the highest earners and from wealth.

This is the only approach that can prevent further cuts to health and other public services.

Look at what has happened to health over the summer.

In July we saw further restrictions on discretionary medical cards, the focus of this motion.  

We found out during the summer that hundreds of young people with severe disabilities who have finished school are to be denied the day services they need due to Coalition Government cutbacks. Cutting the allocation from almost €10 million in 2012 to €4 million in 2013 can only be described as callous in the extreme.

We had Minister Kathleen Lynch signalling that the Government intends to bring in means testing for home care and other services for older people and people with disabilities. This has been denied subsequently but in the language of the reply to me from the Minister there is wriggle room for means testing to be sneaked in by the back door.

We had the cuts to services for people with disabilities at Stewart’s Hospital in Palmerstown.

We had the decision to close the 22-bed mental health unit at St. Brigid’s, Ballinasloe.

We have had the cuts to services provided by St. Michael’s House, one of the largest providers of services to people with disabilities – over 2,000 service users.

In a Dáil reply to me Minister Reilly has stated that in 2012, 121 HSE executives earned in excess of €100,000 and between them, total remuneration, including allowances and arrears, amounted to €14.6m. He said that a high-level analysis of annualised payroll data from May 2013 indicates that at that time, the number of executives on annual remuneration in excess of €100,000 has risen to 129.

This is scandalous, particularly in light of the cuts imposed on health services, the impact of which are having a devastating effect on the lives of many thousands of vulnerable citizens on a daily basis. Frontline services, acute and community care, medical cards, disability and mental health services have all been cut while those at the very top of the HSE are rewarded time and again.

Minister Reilly has failed to deliver the level of savings possible from the State’s drugs bill. We estimate that an additional saving of over €300 million in 2014 is achievable.

The Minister and his predecessors back to Mícheál Martin have failed to address the recurring junior hospital doctors’ crisis, resulting in the industrial action which we have seen taking place at hospitals across the State today. That action was inevitable given the length of time this failure to implement the Working Time Directive has gone on. It is long past time to implement the directive in full and bring in the root and branch reform of hospital medical staffing and training that is required.

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