Mr. Tony O'Brien:

It comes within the HSE Vote but is centrally held and allocated internally.

On staff reductions, members will have seen some illustrations as to what an across-the-board equivalent reduction of staff in existing categories would mean. This is not how we would expect it to turn out. There will be a natural rate of turnover, probably accounting for between 1,000 and 1,400 staff based on a typical cycle. Members will be aware that a voluntary exit scheme is being prepared, which will have an impact on the total numbers leaving. An exit of 4,000 will be required if we are to comply with our employment control framework and create the headroom for the additional posts we need to create. We will have to closely monitor this process, which is in its relatively early days. Some of the matters about which we spoke earlier will have an impact on it.

On Deputy Ó Caoláin's point regarding the difference between the €323 million and €383 million, the figure of €323 million is identified on page 3, table 2 of the service plan. It was an Estimates day issue. At the bottom of page 4, under community demand-led schemes it states: "The HSE board has made a decision to introduce additional cost reductions in PCRS beyond those specified in the Estimates. In so doing, the HSE will seek €60 million of further target reductions in expenditure through a range of efficiency measures detailed in table 5". We believe it is possible to reduce costs in areas such as medicines management and so on and have set a target of €60 million in this regard, which we believe is realisable. The €323 million essentially relates to the impact of the IPHA deal, various eligibility changes and the impact of the increase in co-payments, which impact on the cost rather than level of care provided. On the question of the impact on those aged over 70 years, a policy decision was made by the Government to reduce the income criteria for those aged over 70 years. While previously the qualifying income criteria for a single person was €700 per week and for a couple was €1,400, this has been reduced to €600 and €1,200 per week, respectively. That is how people aged over 70 years will be impacted.

I agree with Deputy Ó Caoláin that an eight month target, while a significant improvement on the two and three year wait evident up to two years ago, is still a lengthy waiting period. This is a target beyond those classified as clinically urgent. Such persons can, left untreated, have significant debilitating and life altering conditions. Clearly, this is another step towards reducing waiting times further. The primary target list which started out at 12 months was reduced to nine months and now stands at eight months. We hope to achieve this year's target and to use it as a platform for reducing the target further so that we get to a normative situation in due course whereby persons could expect to be treated within three or four months, as would be the case in neighbouring jurisdictions. I agree with the Deputy's points in this regard. While it may be classified as elective it does not mean it is in any sense trivial or non-urgent: it is. My colleague will address the Deputy's questions on medical cards.

In terms of mental health, Appendix 3 of the service plan, which is set out on page 3, details the level of expenditure and number of posts, totalling 477, to be allocated this year to different areas of mental health services. It is important to stress that while primarily due to the lag in recruitment last year the €35 million was not spent on development posts, that €35 million has been restored and added to by a further €35 million. As such, in-year additional resources for these developments is €70 million.