Brian Cowen (Laois-Offaly, Fianna Fail)

I would like to speak about the private assessment of where we stand. The amount of money invested in the public capital investment programme is the amount of capital that the Government believes to be available in the context of its various budgetary requirements, such as the need to maintain growth in competitiveness, job creation and revenue. The Government decides on its priorities across all Departments. Nobody has argued that it is wrong that the Department of Health and Children has been one of the major recipients of capital funding.

When one examines the role of private sector investment in enhancing all sectors of the health service, one has to strike a balance between the potential benefit of such investment to a prospective investor and its possible wider benefit for the community. Such wider benefits can accrue if private capital is invested in areas of social and economic priority, as identified by the Government. Certain schemes are put in place by the Government, from the available Exchequer resources, to enhance and supplement the public capital programme. Demands are placed on Exchequer funds when services are provided across the full gamut of Government activity.

The Government has to make a judgment when striking the balance I have mentioned — it is not an exact science. People can have honest disagreements when making such decisions. When one has the responsibilities of a member of the Government, for example as Minister for Finance, one operates on the basis of one's judgment and one defends one's judgment. I do not expect unanimous approval when the House discusses the decisions I have made. That is too much to expect even when I am right, and I am never 100% right. One has to defend the judgments one makes.

Deputy Ó Caoláin spoke about the state of the health service. I have acknowledged that we need to address some structural issues if we are to deal with some of the difficulties in the service. We should not talk about a status quo plus model as if that would help to bring about visible and incremental improvements in some of the service pressures we have discussed, because that is not the case. Real improvements are taking place. The number of people who have been on a waiting list for over 12 months has decreased significantly. When the Government took office, 45% of adults had to wait more than 12 months for surgery. Some 80% of patients now wait less than 12 months for surgery — 37% of them have to wait for between three and six months and 43% have to wait for between six and 12 months. While I do not suggest that the problem of waiting lists has been solved, the major reduction in waiting times should be acknowledged.

The total number of discharges in 2004 represented an increase of 35% on the figure in 1997. In other words, the throughput has grown by one third. The number of day case patients doubled between 1997 and 2004. The number of consultant posts has increased by almost 50%. I could speak about the increase in numbers of front-line staff, such as speech and language therapists and physiotherapists, who provide real services which offer additional value to citizens.

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