It was trollies at dawn in the Dáil yesterday when a well documented medical difficulty returned for further examination.

The issue of non-discretionary medical cards has been exercising the Fianna Fáil leader for some months now. Time and again, Micheál Martin has brought his complaint to Leaders’ Questions, only to be told by Enda that there’s nothing wrong.

“I just can’t understand you’re getting up here every day and saying there hasn’t been a change in policy,” cried a pained Micheál, after he had outlined two more cases of children with serious medical conditions losing their cards.

Whenever he thunders in brandishing further evidence of James Reilly’s “probity” crusade, the Taoiseach sends him home with an instruction to keep taking the tablets and stop imagining things.

Yet Micheál’s list of people denied medical cards continues to grow. Yesterday, it was the cases of Katie and Ronan – young children with chronic health problems.

He reminded the Taoiseach that Ronan’s mother protested about her son’s plight outside the recent Fine Gael conference, and while he agreed to meet her, he failed to follow through on the promise.

“Nobody told me the person involved wanted to meet me,” Enda replied.

Actually, it seems he was told about her by reporters at the time.

But the Taoiseach probably forgot this, what with Micheál getting so angry with him over the allocation of these discretionary cards.

It was one story he didn’t get to tell the Dáil about, the things people tell him when he’s on his travels.

He's allowed to do that sort of thing. The Opposition most certainly is not.

Hard cases
Enda nearly blew a gasket when Micheál arrived in with his latest batch of hard cases.

The Taoiseach’s argument is that nobody is automatically entitled to a medical card. “Issues such as income and discretion” must also come into play.

Micheál Martin’s argument is that the discretionary element is now being ignored in favour of a crude financial bottom line.

But Enda is full square behind his health minister’s probity drive. And to prove his point, he tossed one of his stories into the mix.

“I had a case last week of a claim for a medical card which was €7,000 over the limit every week – not just every year, but every week.”

That fairly stopped everyone in their tracks.

On the other hand, he’d had “a number of sensitive cases myself” over the past few months and was glad to say they were sorted out with the proper application of discretion.

However, due to all these stories being brought to his attention by Micheál and others, the Taoiseach has been instrumental in getting the HSE to put together “a communications system to deal with sensitive cases”.

Why did he do this? “I was getting a bit sick and tired, I have to say, of information floating around without reality.”

Richard Boyd-Barrett offered some more.

A sick man from Castlebar
"I'd a sick man from Castlebar talking to me today, Taoiseach," he shouted, with added reality. "A sick man from Castlebar!"

Whatever Enda said, Micheál Martin could not be convinced there had not been a change of policy in the medical card system.

Micheál brandished a sheet of paper containing figures supporting his argument. He thumped the ledge in front of him. His voice rose higher until he began to sound like Roy Keane on a rant.

Then he brought up one other case concerning a child with a condition so rare that fewer than 10 people in the world have it.

“What, in the name of God, what kind of system do we have, or Government, that takes a card from a child like that?”

And in a big finish, he made a passionate plea for cards to be restored to sick children and people with multiple complaints.

It was quite the performance.

And it was matched by Enda. The Taoiseach began with a short pause, for dramatic effect.

Then: “Well. Bravo, Deputy Martin. Bravo. Bravo.”

His chief whip, sitting in the pew behind, joined in. "Bravo. Bravo," repeated Paul Kehoe.

“Big talk,” drawled Enda, hand on hip, voice dripping sarcasm. “Strong talk from Deputy Martin . . .”

He proceeded to lambaste the Fianna Fáil leader for “his gross incompetence and neglect of his business” when he was minister for health.

As a man who left “an unholy mess” behind in his department, it ill behoved him to criticise the Government’s attempt to put matters right.

As for the stories of hardship that Micheál kept bringing before the Dáil, the Taoiseach was adamant there had to be a particular reason why the HSE refused full medical cards.

“Wave all the paper you like!” Enda told him. “Wave all the paper you like!” But he would not be deviating from his belief that the medical card policy hadn’t changed.

The Opposition wasn’t buying that line.

"It is a fact that long-term medical card policy has been changed," said Gerry Adams. "Very sick citizens, including very sick children, should have the right, without equivocation, to medical cards."

But he left it at that as he wanted to address “legacy issues from the conflict” in the North.

“There is no single voice across the victim community, ” he said, referring to “the totality of narratives”

The victim community.

That’s a new one.