Richard Bruton (Dublin North Central, Fine Gael)
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Question 58: To ask the Minister for Finance if he is satisfied that the extra tax collected in the past seven years is delivering value for money through the spending increases they were used to finance. [30128/04]

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Government has more than doubled total spending on public services between 1997 and 2004 to over €41 billion. As provided for in the Abridged Estimates Volume published last week, the Government will add a further €2.5 billion to this in 2005 on a pre-budget basis to fund day-to-day spending on public services. Priority has been given to expenditure on social welfare, health, education and investment. Gross current spending on health has increased by 176% to €9.6 billion in 2004, spending on social welfare has increased by 97% to €11.3 billion while expenditure on education has increased by 103% to €6.1 billion. Capital spending to address the country's infrastructural deficit has increased by 178%. The general Government debt ratio has decreased from 65% of gross domestic product, GDP, in 1997 to an expected ratio of less than 32% by the end of this year. In addition almost €10.5 billion has been set aside for long-term pension and social security costs by investing in the national pensions reserve fund.

This level of spending has been achieved in tandem with the preservation of a stable budgetary position and major reductions in personal taxation. It has resulted in significant improvements in public services across the board but issues concerning individual programmes or projects should be raised by the Deputy with the relevant Ministers.

Richard Bruton (Dublin North Central, Fine Gael)
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The Minister admits that the tax take has doubled in the past seven years and that tax as a proportion of gross national product, GNP, has also increased. Do people ask him, in the same way as they ask me, what we get for all this extra money? Have we made an impact? For example, do they ask him about the trebling of spending in the health area which appears to have produced only a few hundred extra hospital beds and a decrease in accident and emergency services while there is chaos in the health service and fewer are eligible for medical cards than were seven years ago? Do people ask him why things went so wrong? Why does the Minister think there has been a preference for recruiting to administration and management tasks instead of to frontline services? This view has been supported by the Comptroller and Auditor General in his report on the health services. What changes does he believe are necessary if we are to get better value from spending on this scale given that these golden years will not last forever? Since we are not delivering, what changes does the Minister advocate making to obtain better delivery?

Brian Cowen (Laois-Offaly, Fianna Fail)
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I do not accept the continuous contention of the Opposition that there has been no improvement in the health service in the past seven years. That is patently absurd.

Richard Bruton (Dublin North Central, Fine Gael)
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There has been no commensurate improvement.

Brian Cowen (Laois-Offaly, Fianna Fail)
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That is patently absurd. It suggests that 35,000 extra employees are going to work every day and doing nothing which is also patently absurd. I can give a simple example of the improvements in the health service. When I became Minister for Health and Children in June 1997, the Government of which the Deputy was a member left a situation where the intellectual disability provision was €1 million for that year which did not even cover emergencies. We have had subsequent multi-annual investment in that area, in which I was involved, for three years of more than €18 million. This meant increases in residential places for more than 1,700 people with intellectual disability and more than 3,000 new day care places. That is just one subhead of activity and there are many more where there have been real improvements. There is no suggestion of a completed agenda but real improvements for ordinary people in respect of the increased provision in the health service.

On the question of frontline staff, there are an extra 6,500 nurses in the service and 8,500 in the medical, dental and health and social care professional grades. We then hear the facile idea that support services are a waste. For frontline staff to do their job properly, they need good support staff behind them. I do not think consultants should be engaged in surgeries and all that type of detailed work and that they should work out their appointments for next week and send out the letters themselves. While there is the superficial attraction of the Deputy's argument which is meant to have a wider populist appeal, there are many in the support services that help frontline staff to do their job better.

Richard Bruton (Dublin North Central, Fine Gael)
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May I ask the Minister——

Brian Cowen (Laois-Offaly, Fianna Fail)
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In regard to the future, it is not simply a question of more resources, although they are important because this is a people-centred service. It is also about getting better value and implementing the required reforms which are a major challenge to the system. They have been devised as a result of the widest consultative process that has ever taken place in the health service.

Richard Bruton (Dublin North Central, Fine Gael)
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The Minister is trying to attack a straw man. Does he agree it was the Comptroller and Auditor General who reported that the increase in administrative staff at a rate of 90% dwarfed the increase in frontline staff medical staff which was only 20%? He has drawn the attention of the Oireachtas to this imbalance. Does the Minister agree significant new layers of bureaucracy have been created in the health service? In the Dublin area alone, three new health boards were created which did not deliver improved service. Will the Minister admit any mistakes in regard to the way in which these matters have been handled? Will he admit they have made serious blunders in regard to cost overruns? Will he admit when benchmarking arose, which was a golden opportunity for reform to be brought forward as an issue, the Government paid the money without any reform being negotiated? I will not even deal with waste of the scale of Punchestown.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Some 6,500 nurses and 8,500 people in medical, dental and health and social care professional grades, such as physiotherapists or social workers dealing with community care problems, are frontline staff. I do not know what the Comptroller and Auditor General calls them but I know they are frontline staff.

Richard Bruton (Dublin North Central, Fine Gael)
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The Minister ought to at least brief himself before he speaks. He should read the audit he has done and not pretend the problems do not exist.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputy's problem is that he wants to answer his own questions.

Richard Bruton (Dublin North Central, Fine Gael)
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It is for the Minister to answer them. It is for me to state the problems——

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am giving my opinion which happens to differ from that of the Deputy. I am sorry if I have a different opinion.

Richard Bruton (Dublin North Central, Fine Gael)
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No, the Minister is distorting the facts.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The truth born out of experience is not of any relevance to the Deputy. To suggest that 90% of the increase of 35,000 are down to paper pushers in the health service——

Richard Bruton (Dublin North Central, Fine Gael)
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That is not what the Comptroller and Auditor General said and it is not what I said. The Minister is deliberately misinterpreting what I said.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am not. The Deputy is trying to give a false impression——

Richard Bruton (Dublin North Central, Fine Gael)
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The increase in the number of administrative staff——

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputy has been trying to give a false impression for months.