Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I welcome our guests. The service plan invites such a broad set of responses and covers such a vast area that I will try to focus in on a few issues and seek clarification on them. We have noted the signalled cut of €721 million to the budget for 2013 and the composite figure of €3.3 billion in cuts since 2008. I note that in the presentation the witnesses indicated a reduction of €383 million in primary care schemes. However, if I recall correctly, the breakdown of the €721 million, when it was first signalled, contained a figure for the reduction in primary care expenditure of €323 million. There seems to be an additional €60 million here. Is my recall muddied or is there an explanation for that? Am I correct in pointing up the difference in those figures? Perhaps I have missed something in the intervening period but it seems that €323 million has grown to €383 million in terms of cuts to primary care schemes. That must cause serious concern to our friends from the primary care reimbursement service.

The witnesses also spoke of the composite figure of a €3.3 billion reduction in budget provision as representing a cut of 22%. They went on to talk about the fact that staff levels have reduced by more than 10,000 whole-time equivalents since 2009, but that obviously does not include the further reduction of 4,000 in the current year. If we are going to spell it out in terms of the euro and cent impact, we should also have the composite figure expected to apply in the course of this year with regard to staffing. A 14,000 reduction in whole-time equivalents is alarming. Is that the full situation? I ask the witnesses to clarify that point.

I understand the specific targets that have been set out and hope they are all realisable. I hope that in looking at this again in 12 months time, we will be looking back and ticking all the boxes, noting that the targets have been achieved. We only have to put ourselves in the shoes of those awaiting elective procedures to accept that a waiting time of no more than eight months is desirable. There is a sense that elective procedures are non-emergency procedures. However, I do not have to go far to come up with real people who were in real pain and anguish but whose treatment was categorised as elective. It is a fact of life and we are talking about human beings. Even the eight month guarantee for elective procedures is too long for someone in protracted agony, and I hope that we can do even better than that. That is not to say I am not mindful of the reality with which the service is contending at this point. I hope all of these targets are achievable but I believe we should be going much further.

On the issue of medical cards, I wish to record the fact that Ms McGuinness had a difficult enough meeting with us on Tuesday, following on from the non-consultant hospital doctors, and I would like to share something positive with her. I acknowledge the continued accessibility and reasonableness of people working in the primary care reimbursement service. While I will not take off on the Minister's statistics, as read into the record of the Dáil yesterday, Ms McGuinness might like to clarify the position. The Minister said, with a smile on his face, that there were only nine outstanding medical card applications in the real, quantifiable backlog category. I am not sure that could be the case because, if it is, they must all be in my back yard and the applicants must all have come to my office. However, I am not slating the effort because I know people are working very hard to cope. The Minister has cited, or put on the record, data that do not link up with what we, as elected representatives, know.

Of the 40,000 people who are signalled to lose their medical cards in the current year, the witnesses have indicated that a certain cohort will be people over 70 years of age. Will the witnesses explain the criteria and what particular body of people over 70 will lose their entitlement to a medical card? I presume it is on the basis of income calculations and perhaps the witnesses would elaborate on that. Will they give us the detail and explain who else, apart from those in the over 70 cohort with a certain income stream, will lose their entitlement to a medical card in the current year? We need that clarification on the alleged, so-called saving of €20 million.

My last point relates to the famous €35 million that has popped up again, which somebody pinched out of the back pocket, as it were, of the Minister of State, Deputy Kathleen Lynch, last year. The €35 million is back again and Mr. O'Brien has indicated to us that 307 of the 414 posts have now been filled between the end of 2012 and the beginning of 2013. Could he indicate what posts he is talking about and give us a breakdown of the roles, responsibilities and so forth? What service providers are we talking about in the profile of the 307 posts? On the €35 million which we all hope will be spent in realising the best prospects for the delivery of A Vision for Change, is that money only for additional posts or is some part of it to be used in some other regard vis-à-vis the roll-out of A Vision for Change?