James Reilly (Dublin North, Fine Gael)

Has that been analysed? It seems a lot of money. I would have thought it was more like €500 million, but if the Minister has facts to show otherwise I would be delighted to hear them, because it makes our task in the future much easier.

We cannot have a debate on the health service today without acknowledging that we did not just arrive here out of the blue. The same Minister has been in place for the past number of years and we have had the same Government for the past 12 years. Under their auspices the HSE was set up. The service plan approved by the Minister in 2009 cannot deliver 2008 levels of services, as we now know. On top of €500 million worth of savings initially planned for 2009, an additional €600 million will need to be saved. In addition to the 500 hospital beds currently not in use, a further 600 are expected to be taken out of the system, which gives a total of 10% of the bed complement. Eleven accident and emergency departments will be rationalised, front-line staff will be cut, and critical overtime will stop. However, the reason overtime has become critical is that we do not have the manpower to allow the work to be done in ordinary time. I encourage the Minister to correct the overtime requirement. I do not believe it is safe for patients or doctors to work inordinate hours. However, patients must be served and doctors must be there to serve them.

Rather than tackling wasteful spending within the HSE and approving a redundancy programme, as mentioned by the Minister last year, to reduce management and administrative bureaucracy within the HSE, the Minster is more interested in withdrawing lifesaving HPV vaccines from young girls for a minimal saving of €9.7 million. Although a voluntary early retirement scheme for the HSE was announced last July, the Government has yet to decide on the detail. In fact, the Minister said in the House only a couple of weeks ago that it was now a matter for the Minister for Finance. Reading between the lines, I can conclude that no progress has been made.

Let us consider the existing cutbacks and mismanagement that have hurt patients and the taxpayer. We have seen the withdrawal of the automatic entitlement to a medical card for the over 70s — the generation that paid 60% tax and educated themselves. This caused unprecedented public outrage, and is still very much in people's minds. The Minister was on "Questions and Answers" with me last night, and a gentleman in the audience raised the issue yet again. When out canvassing I have been told by elderly people that when Fianna Fáil Deputies called around they would show them the medical cards they tried to take from them. The Minister tried to take the soft option in that case. Yet there has been no move in terms of achieving savings by using generic drugs. The withdrawal of the automatic entitlement to a medical card, which was supposed to save €100 million, has saved only €20 million.

Another issue on which there is still no clear direction is that of oral nutritional supplements. A group led by Dr. Michael Barry was to report to the Minister in this regard. We still do not know what supplements will be included in the proposed cuts, and rumours are rife.

In August 2008 the Minister approved the introduction of a vaccination programme against HPV, which can lead to cervical cancer. This was due to commence in September 2009. The programme was welcomed; HIQA recommended the vaccine and the National Immunisation Advisory Board welcomed it. We were told the vaccine would reduce the incidence of pre-cancer by 66% and that of cervical cancer by 50%, while deaths from cervical cancer would be reduced by 45%, the equivalent of 52 lives per year. The annual cost was estimated at €10 million, although I believe it could be lower. However, in November 2008, the Minister did a U-turn on the cervical vaccine notwithstanding a confirmation by the winner of the Nobel Prize, Dr. Harald zur Hausen, of the vaccine's efficacy. It is a mystery why we cannot find €10 million in an overall budget of €16 billion to protect our children.

In November 2008, the Minister announced a new private health insurance levy of €160 for each adult and €53 for each child under 18 on foot of a Supreme Court decision which found her risk equalisation to be ultra vires. She claimed that insurance premiums for older people would increase substantially by up to 60% with no evidence to back this up other than the assertions of the VHI, which is the dominant player in the market. If passed on fully, the health insurance levy will cost a family of two adults and three children almost €500 per year before whatever substantial increase in premiums is now in prospect. This is being introduced even though the VHI posted a profit of €112 million in 2007. Community rating continues to ensure that a person's age does not determine the level of premium he or she pays because the law clearly prohibits an insurance company from selectively deciding that certain age groups should pay more for insurance. This is, therefore, a revenue gathering exercise. As health insurance becomes less affordable, families will be forced out of the market.

My late arrival to the House, for which I apologise, is because I attended a meeting between the Committee on Health and Children and Age Action Ireland. I wanted to hear that organisation's view of the new annual nursing home fee of €190 per bed. Nursing homes with 40 to 50 beds will have to pay between €7,600 and €9,500 to HIQA. As it appears that individuals will be paid €85,000 or more to inspect nursing homes, the money will be spent on personnel. In fairness to HIQA, it had no part in devising this stealth tax. I do not doubt that it will be passed to the relevant consumers, namely, elderly patients. Costs will arise to the HSE for public nursing home beds and public patients in contracted private nursing home beds. If the Minister is determined to impose a charge, it should be double rather than triple digits. The maximum charge should be less than €50.

We do not know what the impact will be on HSE nursing homes in terms of how many homes will meet the standards and the amount of capital available to make the requisite improvements. I acknowledge that they will be permitted a six-year period to make these improvements but they are unlikely to get the funding they need. The ensuing closure of many of our public nursing home facilities will further the agenda of driving people into private health care. Bethany Home and St. Brigid's ward in St. Patrick's hospital, Waterford, closed because they did not meet the standards but there was no consultation or discussion locally in advance of their closure. Having visited both facilities, I am aware that a great deal of money has been raised for St. Brigid's ward. It meets all the health and safety regulations and the number of beds in the ward has been reduced. All that remains to be done is to spend a few bob on fire screens in the attic. We lack a national plan on future bed requirements. We are closing beds in rural communities whereas people are lying on beds in Dublin long after they have been medically discharged.

General cutbacks include a reduction of €18 million in the money promised for palliative care and a reduction of €50 million for mental health. Moneys intended for disabilities, diabetes and older people have been diverted to meet spending deficits in other areas. This afternoon, the Committee on Health and Children met representatives of Pavee Point, which is experiencing similar problems because the money set aside for Traveller health has been spirited away to meet day-to-day budget needs. This is especially frightening given the life expectancy for Travellers and the health issues they face. Budget 2009 saw a 50% increase in accident and emergency charges, a 14% increase in inpatient charges, a 20% increase in private and semi-private bed charges and a further increase in the threshold for the drugs payment scheme, which has increased by 80% since 2002.

Increasing charges and hurting patients is one way to stay within budget but what about addressing the waste over which the Minister has presided for the past four years? The HSE has spent €292 million on staff transport costs since 2005. Approximately €1 million was spent on consultants to advise on the deconstruction of the HSE. The Minister spends €1 million on special advisers, press officers and constituency staff. A total of 216,000 bed days were lost, which is the equivalent of Tallaght hospital remaining closed for one year. This represents an increase of 30% in the number of people who were not discharged from hospital because no investment was made in nursing home beds in Dublin and other urban areas. Nursing Homes Ireland has informed us that up to 300 beds in the greater Dublin area are available to be contracted in the next six months. Why are we continuing to spend €1,400 per day on the care of a person for whom medical treatment is complete instead of €1,400 per week? It is a nonsensical waste.

Over the past couple of years, 31,000 operations were cancelled. Money was spent on HSE bonuses and PPARs but the 320 people who are lying on trolleys today represent an increase of 25% on this time last year. I make no apology for pointing out problems and castigating the Minister on her failure to act, but I will also offer positive alternatives. Why are we not doing a better job of managing the hospital system to avoid lost bed days and cancelled operations? We should make better use of existing capacity. Community rehabilitation and diagnostics services could be improved. We should abolish the National Treatment Purchase Fund, thereby saving €110 million per year. A special delivery unit was established in the North of Ireland at a cost of €30 million and the waiting list there was cleared in 18 months. Unlike the NTPF, this investment did not recur annually.

Where is the promised HSE redundancy programme? Why is the Department of Health and Children not being streamlined? That Department has seen little reduction in its staff since the establishment of the HSE. Why does the Department need four junior Ministers? Their number should be halved at least. Savings could be made through generic and better prescribing and by teaching people how to use medicine properly.

Services have been withdrawn in the mid-west and the north east and cutbacks have been imposed in Portlaoise, Navan, Mercy Hospital in Cork, the orthopaedic service at Naas General Hospital and in dermatology departments. The hospitals in Galway and Blanchardstown have had to withdraw services in order to meet break-even pressures. A 12-bed orthopaedic unit in Letterkenny hospital closed and Mayo General Hospital's break even plans have led to the closure of a number of beds at weekends. Half of one wing remains empty in Mullingar hospital and Tullamore hospital is also half empty.

Following the North's example of getting rid of waiting lists will require direct action from the Minister. She will need to take responsibility for oversight on a daily basis. In the coming two weeks, Fine Gael will launch a new direction for health that will result in 10% efficiencies, rid us of our waiting lists and ensure fair and equitable access to health care, thus ending the long era of two-tier health care in this State. I hope that we will have a full debate on the health service once the Minister has completed her deliberations and the intended cuts are made public.

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