Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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At the outset, I wish to use this opportunity to again convey my sympathy to the family of the late Mrs. Halappanavar. Perhaps it is too soon to give an answer but with the indication at this meeting of the change in membership of the investigation team, has there been a response from the legal representative of the late Mrs. Halappanavar's husband, Praveen, as to the acceptability of the new composition of the investigation team? I am anxious to learn what Mr. O'Brien has to say on that. It is very important to recognise the investigation team must be seen to be independent and must have the confidence of both the bereaved family, which is of significant importance, and the wider public and this must be addressed.

I have a number of questions. In response to my proposal that we might consider initiating address of some particular areas in the course of the Irish Presidency of the European Union next year, the Minister indicated two such areas. I welcome that the Minister does indeed intend to focus on particular areas. He mentioned autism and went on to speak of the impact on health of financial difficulties domestically and across Europe. While they may not be the exact words the Minister used, that roughly is the representation of it. I absolutely welcome this, particularly in respect of autism. I again ask the Minister to consider the area I had highlighted and to not allow it to fall off the table, that is, the issue of rare diseases. Ireland has more than its fair share of such diseases and per capita across a number of them, quite a high incidence on a comparative basis with other member states of the European Union. It would be very appropriate that Ireland would indeed take up the issue of rare diseases.

As for the second of the two points of which the Minister spoke, namely, the impact on health of financial difficulties, it is against a backdrop of reports that appeared both yesterday and over the weekend that further cuts are anticipated in the health budget, of the order of approximately €900 million. This is more than I had expected we would be obliged to face. Moreover, a further 3,231 staff are set to leave the service. Can the Minister confirm these figures? Can he comment on both these issues? Does he not agree these further cuts will have further devastating consequences on the impact of the delivery of services and on the impact on health of financial difficulties which he hopes to address in the course of Ireland's Presidency in the first six months of 2013?

As for some of the replies the Minister has given to the joint committee in response to various questions posed, I wish to address question No. 8 on the national bowel cancer screening programme. I am particularly concerned there is little hard evidence of readiness in respect of the roll-out, which is supposed to happen before the end of next month or that is what one had been led to believe. As the Minister indicated in his reply, it is anticipated that the first round will take up to three years to complete. Can the Minister outline in detail for members the proposed phases that will lead to full implementation? I again invite the Minister to comment on the case I have highlighted with him previously, with the support of the Irish Cancer Society, of the need to encompass a wider age group from the outset, that is, the 55 to 74 age group, to maximise the potential of this screening programme. In recognising that more than 2,000 cases are diagnosed annually and that this is the cause of approximately 950 deaths annually across this jurisdiction, everyone agrees early detection is hugely important. Moreover, earlier detection leads to more effective and less costly treatment. Can the Minister advise us precisely where the 15 candidate colonoscopy units will be located? The joint committee will understand if he cannot do so this afternoon but I ask him to circulate the information naming the aforementioned units to members. As for the symptomatic service, what state of readiness exists with regard to the anticipated 5% to 6% of those who go through the screening programme and who then will need to have ongoing referral? Can the Minister name the hospitals that are in a position to respond to this additional number of people who will require address of diagnosed issues in respect of bowel cancer?

Bowel cancer has the second highest cancer incidence and is also the second highest death-causing cancer. We can only expect with the advance of the screening programme polyps are going to be identified in an ever greater number of people. What state of readiness is the hospital system in to take this on?

Regarding staffing for mental health and acute psychiatric services, I note with concern that a minimum nursing staff floor, a bottom line, does not apply but ceilings do. The HSE stated in a reply to a parliamentary question to me that total agency staff in Dublin-mid-Leinster mental health services came to 7.5. I must correct that figure; it should be 16.5. Some 11% of the workforce in our mental health services are temporary or agency workers. There is a permanent staff of 465, 16.5 agency staff and 39 temporary staff in Dublin-mid-Leinster mental health services. With the further anticipated reductions in staff and the continuation of the recruitment embargo, will the HSE give us some certainty that it will have adequate staff to cater for future mental health needs in the region?

The €35 million earmarked for the creation of 414 posts in mental health services by the end of this year has been knocked on the head with only 17 posts filled, three in the child and adolescent mental health area and 14 in general adult mental health services. These are statistics I have taken from replies to parliamentary questions. It is a concern that we are not providing adequate staff to carry out these important roles in mental health services.