Catherine Murphy (Kildare North, Independent)

There are several things at which we are very bad in this country, one being the building of institutions. We have no history of doing so and we inherited our education, local government and health systems. When the latter was reformed, it was not really reformed. What happened is that the HSE was lobbed in on top of the health board system, and the oversight role of councillors was removed. There was never any real reform. Reform presents a big challenge, which I fully acknowledge. The challenge has been inherited by the Government at a very difficult time.

There are very many excellent people working in the HSE who are going way beyond the call of duty. Let us not put everybody into the one basket and engage in a blame game because doing so is unfair, demoralising and counter-productive.

Let me refer to the service plan. People are appalled at the lack of targeting in the downsizing approach. There is some very blunt language in the document. I have been saying for the past few months that it does not make sense to make staff redundant through early retirement and then recruit others. This does not result in a saving; it shows a lack of certainty in the Government's approach. This is not helpful at all and it could end up being very costly in the long run, or more costly than is necessary.

We are told much efficiency has been achieved and that it is not possible to protect services from reductions in 2012. There are some very serious developments on the way. The plan states "hospital budgets will drop on average by 4.4% of last year's allocation". When deficits are taken into consideration, this is closer to 8%.

The document indicates how threadbare and unbalanced the system is. It states the western hospitals are particularly challenged. Some services, such as speech and language services, are monumentally better in some parts of the country than in others. Why should one's address determine the quality of the service one receives?

We are told the reorganisation of the ambulance service is required, yet we are told there will be no additional funding in 2012 and that our ability to address the newly agreed national targets will be challenging. The phrase "will be challenging" is seen throughout the document. "Challenging" means very little or nothing will happen.

I have a number of concerns. The approach involving keeping elderly people at home is good but there is to be a major change in regard to home help for personal and non-personal care. I refer to home helps who call to people to see whether they are okay. Has there been an actuarial assessment in the past year of the income that might derive from the fair deal scheme?

With regard to mental health, which is the responsibility of the Minister of State, Deputy Kathleen Lynch, the sum of €35 million is very welcome, but there is a considerable drop in the number of psychiatric nurses owing to the retirement scheme. It has been said to me several times, and to the Minister of State, that if we took mental illness and suicide as seriously as we take road safety, it would be beneficial. The Road Safety Authority's statement, which I examined today, refers to a sum of €48 million. The authority has been doing an excellent job in this regard.

If we were to consider the effect of a really targeted approach in the area of suicide prevention, we would consider changes in the institutional provision of mental health services, given that the money is not be shoved towards another service. I am sure there will be good oversight on the part of the Minister of State.

The HSE has been allocated €40 million each year for ICT projects. This is a lot of money and it is very welcome but there needs to be institutional architecture if a proper ICT system is to be built. Without this, computers and systems will not talk to one another and one will end up wasting money and with incredibly wasteful systems such as PPARS. It is essential that we see the institutional architecture before we commence. We will have to have oversight. There are savings that can be made and greater efficiencies to be achieved in our approach but let us not proceed in a haphazard way. Let us put a health system together that is integrated.

There are many points in the plan about which I am very critical but if I were to elaborate on them I would be told off by my colleague, Deputy Maureen O'Sullivan, for taking up her time. I am sure she will cover some of the other aspects.

See this speech in context