Billy Kelleher (Cork North Central, Fianna Fail)
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I move:

That Dáil Éireann:

— noting that the Health Estimate in Budget 2012 was misleading given the fact that it was based on assumptions and targets that were not deliverable by the Minister for Health;

— highlighting that enabling legislation for measures announced in the 2012 Health Estimate have not been published 7 months after being announced and therefore will impact greatly on the sector's ability to meet its budget targets;

— agreeing that, 14 months after abolishing the Health Service Executive (HSE) board, the Minister has failed to take any legislative or other action in relation to governance in the HSE and that this has exacerbated the deficit;

— acknowledging that the income streams or expected savings from:

— the cost of public beds being charged to insurance companies;

— drug pricing; and

— reducing agency costs;

will not now be achieved;

resolves that the resulting €500 million overspend in the health budget will not have an impact on front line services and patient care; and

rejects any moves to close wards, theatres or hospitals as a result of the failure to properly plan the health budget.

The purpose of this motion is to ascertain the purpose of the budgetary Estimate last year and to consider how it has been implemented. If we consider the statements of the Minister for Health and other Ministers last year in the context of the formulation of the budget, they accepted there were challenging and difficult times ahead. At the time, we highlighted that we were very concerned about the budgetary process, the number of leaks and the intimidatory statements made by Ministers to their colleagues that Armageddon would arrive if they did not get their way at Cabinet.

It is clear now, seven months on from that budget, that much of what was said in terms of the health Estimate was a tissue of lies. It has transpired the health budget was based on false premises. For example, the programme for Government stated the restructuring of the HSE was a priority. This was to be one of the first acts of the Minister for Health. He was like Wyatt Earp going down to the OK corral, looking for a fight. He found the board of the HSE and summarily dismissed it and replaced it with an interim board. We asked at the time what was the purpose of dismissing the board and the Minister replied that he wanted to be a hands-on Minister, one who would roll up his sleeves and take charge of everything. Unfortunately, we are still waiting to see that legislation on governance of the HSE come to the Dáil.

This lack has created huge difficulties and there is now paralysis in the HSE and the Department of Health. Nobody is quite sure who is in charge. The Minister says he is in charge and is responsible, but he has abdicated his responsibilities. The CEO, Cathal Magee, was before an Oireachtas committee recently and he outlined clearly that there is no way the HSE will achieve the savings outlined in the budget last year. Therefore, the savings outlined last year were just figments of imagination. This has transpired to be the case and the service is already running at a budget deficit of over €280 million. Huge changes will be required and catastrophic damage will be done to services if the Department is to come in on target. We have highlighted this every month since February and have pointed out that the budgetary figures provided last year were not achievable. Later this year, we will see huge damage to services. We will see the closure of operating theatres and the downgrading of wards. The CEO, Cathal Magee, said at the Oireachtas committee that the HSE could envision the potential closure of hospitals to bring the HSE in on budget. This motion notes that the health Estimate in budget 2012 was misleading, given that it was based on assumptions and targets that were not deliverable by the Minister for Health.

Another key area in which there was a promise of huge savings was in reference pricing and generic drug substitution and figures were provided for these savings. However, nothing has happened and no effort has been made to bring forward legislation to enable generic drug pricing and reference pricing. This again was a stated priority in the budget, in order to bring about the savings required to bring the HSE in on target. Clearly, this is another priority on which the Government has failed. It has failed to ensure it had a budget over which it can stand. The Government also proposed to make significant savings in the area of private health insurance and planned to charge people the full cost of public beds. However, there has been no enabling legislation and no change. By failing in these two areas the health budget will be down €200 million. The Government committed in the House last year to ensuring the HSE would have an adequate budget to deliver services, but what will happen now is that we will have fire brigade action from September onwards. It will be a slash and burn policy, all because the Government was incapable of delivering on the priorities and policies outlined by the Ministers for Health and Finance in the budget last December.

It is now July and the HSE remains in a state of flux. The CEO is the Accounting Officer, the Minister claims he is in charge and the board is made up primarily of people appointed from the Department of Health. The Department says the HSE is responsible, but the CEO is the Accounting Officer, with the board. This state of affairs has caused damage and dislocation, particularly with regard to bringing forward policy, enacting it and ensuring services are provided.

With regard to the HSE service plans, last January we had more smoke and mirrors from the Minister when he sent back the service plan because he was not happy with it. Surely, he should have been involved in drafting the service plan as he has claimed that he is the one ultimately responsible. The HSE and the board signed off on a plan, but the Minister took a look at it and sent it back to the board saying he wanted substantial changes. What substantial changes did he want? As far as I am aware, no changes were made. That was just another spin by the Minister to show he was flexing his muscle in terms of being in charge. Unfortunately, he has not stood up to the responsibility of ensuring the HSE brings in its budget on time and within limit.

The fundamental issue is the delivery of services to the people. We have already begun to see hospital managers under huge stress and pressure. We have heard claims that trolleys are being moved to wards in order to reduce the trolley count. We have eminent consultants saying that lives are now being put at risk. Front line health service providers and nurses are stating that they are working in areas that are not fit for purpose in terms of delivery of emergency care. These issues are being raised continually, but that is nothing new. They were raised last December also. We have highlighted these issues regularly, but the Minister seems to be incapable of understanding or acting on these warnings. It is time for him to act because the CEO of the HSE has said that it cannot come in on budget unless there is massive dislocation to health services throughout the country. This is just the seventh month of 2012, but huge adjustments are required if the HSE is to come in on target.

The adjustments required will, unfortunately, affect vulnerable people most. We had a situation not long ago when incontinence pads being provided for patients in a nursing home in Kilkenny were being counted out to them. At the same time as this is happening, the Minister has failed to make the savings in the areas he proposed, agency staff, generic substitution and price referencing. He identified massive savings in these areas, but the CEO has stated that these savings have not been realised at all. I understand the challenges are difficult and we are all aware of the reality of the situation we face. However, the least the Minister should do is to try to bring forward the legislation that will allow him to make savings, that will allow him to substitute brand drugs with generic drugs and allow him to price reference and address the agency issue. More importantly, he must bring about proper corporate governance and ensure accountability at the highest levels to ensure Government policy is enacted. That is not happening now.

On the issue of community nursing homes, the Minister has stated that the most important issue with regard to acute hospital services is to ensure a throughput of patients and to ensure that people do not remain in intensive care or high maintenance units in hospitals when they could be in community nursing homes. At the same time, the service plan he rejected initially and then sought to implement has proposed closures of over 800 community nursing home beds in one year. Without any stretch of the imagination, that is contradictory to what the Minister is trying to achieve, namely, to move people who should not be in hospitals into the community setting. I never come into this House and question anybody's integrity but other Deputies have raised the issue of conflicts of interest in terms of private nursing homes and support for them and a slash and burn of our community nursing homes without any logical explanation as to why they should be closed. The Health Information and Quality Authority was used as a reason for closing them in some cases while in others, other reasons were used. However, there is a fundamental question we must all ask. What is the logical reason for closing community nursing homes which we all accept provide the highest standard of care to our elderly people in the community setting and which benefit, in every way, the transfer of people from the hospital setting to the community one which, as the Minister says, is stated policy and yet he reverts to type and closes them without any consideration for the residents or the community?

I refer to other areas causing huge dislocation. The Minister placed great store on his special delivery unit. This was the answer to all his difficulties and would resolve all the problems he faced. The special delivery unit is spending an awful lot of time dealing with people who are waiting more than one year for procedures. However, it is benefiting from the fact that people cannot get to see a consultant to be assessed and to find out whether they need to become inpatients. Hundreds of thousands of people are waiting to see consultants to be assessed but they are not being allowed into the system. I know of a woman in her 90s who is waiting more than four years for an audiology assessment. People are waiting ages for orthodontic services. What is happening to orthodontic services is shameful, in particular in regard to our young people who simply cannot get to see an orthodontist.

We must be honest with ourselves. The Government has failed to bring forward the legislation which would allow it to deliver the services our people need. I do not know the reason but the Minister promised three pieces of legislation. He also promised with great fanfare some time ago that he would renegotiate consultants' contracts but he has just thrown that aside. He said he might get more productivity out of them. At the same time, some consultants are continually in breach of their 80:20 public-private mix. There are contracts with a 70:30 mix but some consultants are even in breach of that. Nobody is taking them on. When he was on this side of the House, the Minister promised he would do the devil and all when he moved to the other side. He has moved to that side of the House but everything has almost stopped.

The Minister of State, Deputy Shortall, is as accountable as the Minister because she is representing the Government in this Chamber and in this debate on the budgetary process. The Government has quite clearly failed. When it is closing hospital wards, hospital theatres and nursing homes in the future, it might reflect on the fact that if it had been active in the legislative area to bring about the savings identified in the budget, we would not have to take the drastic action we may yet have to take. What exactly will the Government do at this late stage with one week remaining in this session to bring forward legislation to allow it to at least effect some savings between now and the end of December so that we will not have the dislocation of services which will inevitably happen if we continue on this path?

I refer to the issue of accountability and the HSE. We must find out once and for all to whom we speak. Is it the Minister, the Secretary General of the Department or the CEO or all three - the three wise men? At committees, I see the Secretary General of the Department, the Minister and the CEO of the HSE all defer to each other. The Minister must take a hands on approach at some stage.

I refer to the other commitments in the programme for Government. I only have 20 minutes to speak so it would be wrong of me to take up more time than that but we will have to revisit the issue of primary care. The Minister promised at the Irish Medical Organisation conference that he would transfer money from the hospital budget to the primary care setting. Has that happened? This is a key question to which we must know the answer. The Government cannot continue to spin its way out of this. The fact is that services are continually being downgraded by stealth and people will be waiting for longer periods, not necessarily on hospital trolleys, to see a consultant. People cannot get to see consultants for assessment.

This motion is an opportunity for us to highlight the Government's abject failure to address the budgetary problems which have been evident since early January. This was highlighted in the context of private health insurance and the fact that charges for public beds has not happened. The CEO of the HSE said last week that this did not transpire. In one fell swoop, the Government has lost millions of euro through inactivity on the legislative front and, as I said, people will suffer because of that.

I refer to the issue of agency staff. We highlighted the fact the Government did not have a plan for retirements on 29 February. The more I look at this the more I see that it is by pure accident rather than design that we have not had worse dislocation of health services. We have an issue in regard to agency staff and the Temporary Agency Workers Directive. A key component of the budget was to address the reliance on agency staff which would save more than 50%. The Government has made no effort to do that. The recent figures from the HSE, the Minister or the Department - I am not quite sure from where they came, although I presume they are accurate - state that the agency bill has increased. We are becoming more reliant on agency staff even though it is the Department of Health's stated policy, and it was stated in last year's budget, that this issue would be tackled and that the Government would address the issue of agency staff once and for all.

I hate to say it but after a short period time, the Government has driven the health services to the brink because of inactivity. It is not always about a lack of funding but rather inactivity and a deficit of ideas and action. That is the situation we face. When people must wait long periods of time to be assessed, to get medical cards and to get orthodontic treatment and when someone of 90 years of age must wait four years for audiology services, the Government can consider its abject failure to bring forward the legislation it promised the people and the Dáil when it passed the budget last year. I am convinced - it was said at the time - that it was aspirational at best or dishonest at worst. The jury is still out that particular issue. It gives me no joy to say - let it be conveyed to the Minister - that it is a very serious breach of trust when a Government passes a budget and fails abjectly to bring forward the legislative measures which would bring about savings so that people who require services will not have to carry the burden due to inactivity and its failure on the legislative front.

Barry Cowen (Laois-Offaly, Fianna Fail)
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The health service has been used to taking a battering in this House over the years. Some of it has been justified but some of it has not been. Before the HSE was set up, not a day went by without an issue in one of the 11 health boards being raised or debated. The whole aim of setting up the HSE was that patients wherever they lived had access to the same type of service and that health outcomes would be the same whether one lived in Carndonagh or Cahirciveen. When the previous Government set up the HSE, it was actually welcomed by the Labour Party and Fine Gael. Obviously, since going into government both parties, as is the norm, found themselves to have short memories.

I am not saying the HSE did not have a very difficult start. I admit it took a while to bed all of the changes down but it must be acknowledged that the health service is one of the biggest employers in the State, has thousands of sites and numerous grades and different professions, so it was bound to take time to settle. Any expert in change management would tell one that. Let us take primary care, for instance. The Minister and Minister of State, Deputies Reilly and O'Sullivan never miss an opportunity to say nothing was done in this area before they came into office, even though on their own Department's website an update on progress on primary care teams that was posted in March 2011 tells a very different story. It outlines how there were 348 teams at an advanced functioning stage, that is, holding meetings on patients. A further 171 teams were in development. There were at that stage over 2,500 health care professionals on primary care teams. This illustrates that an enormous amount of work was done by the previous Government. Any objective commentator would confirm that. I wonder do the Minister and Minister of State agree.

What baffles me most is the audacity of the present Government. When elected, members of the Government made a conscious decision to rubbish all previous health policy as it was seen to be tarnished in some way. The mantra of universal health insurance was the answer to all our woes, nothing would be right until it was introduced. However, the Dutch model is no longer mentioned as it was found to increase the number of administrative staff and to cost the Dutch taxpayer more. It is now 16 months since the election and a White Paper on universal health insurance has not even been introduced. The Minister has said it is unlikely that it will be introduced in the lifetime of the Government, however long that will be.

In the meantime, insurance costs for families who can afford it have gone through the roof and an increasingly rapid number of people are leaving insurance schemes as they simply cannot afford them. Waiting times for processing medical cards are at a historic high, and not just for first time applicants. We all remember the story of Regina Kennedy who last December, at 29 years of age and battling chronic renal failure, said she could not afford life-saving medication while her medical card re-application was being considered. Even though she had a chronic illness and the date on her original medical card had expired she would have to wait months and pay for medication in the meantime. This is far from the Utopia of universal health insurance. The Minister is not in charge of his Department or the HSE. He is too busy pontificating and relabelling policies so that he can call them his own. This is not fooling anyone working in the health service and it is certainly not fooling the public.

The National Treatment Purchase Fund, which had treated more than 200,000 patients over the previous ten years was a real success story and, when surveyed, patients who had used it gave it a more than 95% satisfaction rate. Waiting times were considerably down, with the vast majority of procedures being done within a three month waiting period. Within a few months of taking office, the Minister, Deputy Reilly, dismissed the NTPF and set up the special delivery units, SDUs. The SDUs are now busy relabelling trolleys and waiting rooms in the country's hospitals so numbers in accident and emergency departments look better on paper.

As we speak tonight, there are 2,451 beds closed in our public hospital system and 277 patients on trolleys. While the Minister is taking praise for treating the longest waiters on the waiting list, very few people have copped that these are the least number of patients being treated compared to when the NTPF was in charge. Obviously, the spin of treating those waiting longest was the priority rather than the substance of comparing the total numbers being treated. The Minster is not being open and honest about the SDUs. I was surprised to see reports that two of his advisers on the SDU are paid through the UK and do not appear to pay tax in Ireland. If these reports are inaccurate they should be corrected immediately.

The Minister is also facing major challenges to ensure that his health Estimates are correct and in order. Indications so far do not lend any confidence. It is hard to ascertain the exact budget correction the health service is facing. It seems to be in a shambles.

The Minister got rid of the board of the HSE, an exercise in optics, and shamelessly has yet to bring forward legislation to replace it. This cynical exercise has led to this mess and brings with it a total lack of accountability. The Minister put Department of Health officials on the interim board of the HSE but when they met last week with the CEO of the HSE to discuss exact budget deficit figures they could not agree on them. This is farcical. It is like a pantomime. The deficit could be anything from €250 million to €300 million but as there is no functioning governing board the Minister will have to become directly involved himself to sort out this mess.

The Minister for Public Expenditure and Reform, Deputy Howlin, has recognised this. Ten days ago, he asked the Minister for Health to get personally involved, but there are no signs of this happening yet. Deputy Howlin even wrote to Deputy Reilly and outlined his concerns over the budget over-runs in a four page letter and added that he was concerned about the lack of governance structures. This is like a bad episode of "Killinaskully".

While the Minister pontificates about his universal health insurance plan, without producing any real plan, the health service as we knew it is falling apart, bit by bit. Morale is extremely low amongst staff, the service is facing massive cutbacks but the Minister is not even being honest about that. The CEO of the HSE is calling for direction. The Minister's own Department is saying the HSE is to blame. It is like a vicious circle of financial madness.

The Minister has only three Bills on the legislative list, not one of which has been published in this session. The first is on generic drugs where there were to be substantial savings, but to no avail. The second is to amend the Health and Social Health Care Professionals Act 2005, hardly a complex piece of legislation, but nothing has been done. The last is the HSE governance Bill. Despite repeated requests from Deputy Kelleher and many others on this side of the House, nothing has been produced. The Minister needs to take charge and to act now to prevent further damage being done to front line services. He is in danger of becoming the emperor with no clothes.

Time, patience and excuses are not enough. The Minister for Health, Deputy Reilly, and the Ministers of State are no longer acceptable. Labour and Fine Gael have been in office for 16 months. It is time for them to walk the walk. We have spent too long listening to them talking the talk, but there seems to be no cohesion, direction or control. The situation is spiralling out of control while the prospect of a €500 million over-run can only spell disaster for front line services.

John Browne (Wexford, Fianna Fail)
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I am pleased to have an opportunity to speak on the motion tabled by the Fianna Fáil spokesperson on health, Deputy Billy Kelleher, and to express my concern about the health services.

Before the last general election, Deputy Reilly had all the answers. He travelled the country, visited every county and constituency and made every possible promise that could be made. In my own county of Wexford, he promised many changes to the health services, improvements to Wexford hospital and better mental health services. He undertook to deal with just about every issue on the cards at the time. He was the expert in the health service area and had all the answers and solutions.

The Minister's promises have not been fulfilled. The health service is on course to run a deficit of €500 million this year. This is due to the Minister's failure to prepare a proper budget. He presented a false Estimate last December, failed to implement necessary legislation on drug pricing and bed designation and his other targets were never achievable. He got rid of the HSE board, to great fanfare, and we now do not know who is running the health service. When he got rid of the HSE board I understood the Minister would take over complete control of the HSE. That is why I was amazed when, last week, he made an attack on the HSE and told it to get its house in order, even though a significant number of directors of the HSE are officials of his own Department and the Department of Children and Youth Affairs. Do these officials not follow the same philosophy and ideals as their Ministers? That cannot be the case, as the Minister is criticising them and asking them to get their house in order.

Savings of €124 million in drug payments were envisaged through a new pricing agreement with the industry but pharmacists, doctors and consultants did not think the target was achievable. The Minister spoke about replacing expensive drugs with generic medicine but I recently read that generic drugs are almost the same price as their branded equivalents. Perhaps he will clarify how he plans to save €124 million with cheaper drugs because it does not seem to be happening. He also proposed to increase private income by €144 million, of which €75 million would come from private patients in public beds. As Deputy Kelleher has pointed out, however, the CEO of the HSE, Mr. Cathal Magee, has indicated that it will not be possible to deliver on this target. Clearly the Minister was pulling figures out of the sky. Agency costs were to be reduced by 50% but, again, Mr. Magee has stated that the target is completely unrealistic. When the Minister and his departmental officials presented their budget last December they put forward figures that nobody in the health service believed could be achieved.

People are waiting as long as five years to see a consultant in Waterford and Wexford general hospitals. The orthodontic service is a shambles and people are waiting years just to be assessed for hip operations, let alone be admitted to Ardkeen or Kilcreene. There are also significant waiting lists for eye operations.

The medical card system is a disaster and Deputies spend a large proportion of their time trying to secure people's rights to cards. People who are below the income threshold or who previously held cards are now finding it impossible to get medical cards. In fairness to the staff in the medical cards unit, they are very helpful and respond promptly to our inquiries. Whether because of a lack of staff or delaying tactics on the part of the Minister, however, medical cards are taking too long to process. I suspect the delaying tactics come from a desire to save money.

I recognise that mental health services are dear to the heart the Minister of State at the Department of Health, Deputy Kathleen Lynch, and she has been helpful to my own county in providing funding for services. I ask her whether the €35 million budgeted for mental health services continues to be ring-fenced for this area. I have been informed by sources within the HSE that it has been suggested in recent days that part of the €35 million investment in mental health services should be diverted to offset overruns in other areas. I ask her to confirm that the 414 staff promised for mental health services will be recruited at the earliest opportunity. From what I have been hearing about mental health services in my region, I am concerned that money may be siphoned off for other parts of the health service. That would be disastrous because, as the Minister of State will be aware, the service has changed significantly in recent years and people have moved with the reforms recommended at national level. It is important that the process of change is maintained. The closure of St. Senan's hospital in Enniscorthy became an emotive issue but the ancillary services that have since been put in place are excellent. We need additional services for the south-east region and, I am sure, the rest of the country. Mental health services in Waterford need to be upgraded because they are now serving the entire south-east region. I am sure the Minister of State will fight to ensure the money is ring-fenced.

The Minister has spoken about the importance of the fair deal scheme for the elderly in our communities. I recently received a letter from a nursing home in Wexford which has not admitted a single patient through the fair deal scheme. It now has seven empty beds but it has been informed by hospital management in Wexford that the funds required to release patients to nursing home care are not available, even though a considerable number have been approved for funding. This is another broken promise from the Minister. The fair deal scheme is not working in the south east because the funds have not been made available for it. The old subvention system worked reasonably well but the fair deal scheme was to be the answer to all the problems in terms of caring for the elderly. We must continue to fight for the rights of elderly people because the lack of funding has been a bone of contention in the south east for the past two years. Between eight and ten patients in Wexford hospital could be transferred to nursing homes with vacant beds rather than holding up beds through no fault of their own. Gorey hospital had eight long stay beds for older people but they are now being transferred to St. John's hospital in Enniscorthy. St. John's is a new hospital with excellent facilities but it is already overcrowded and the transfer of patients from Gorey means there will be no room for fair deal patients.

There are many difficulties in the health service at present and it is important that the Minister comes clean on the issues that have arisen. The estimates he gave in the budget are clearly incorrect and will never meet the needs of the health service. He needs to fully explain the reason his budget was underfunded and what he is going to do to provide additional funding. The Minister for Public Expenditure and Reform is calling for cuts in the running costs of the health service but this can only mean the closure of wards and reductions of services. In this day and age, that is not good enough. I ask the Minister to come clean and deal with the issues as quickly as possible.

Róisín Shortall (Dublin North West, Labour)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"— noting that the Health Service Executive (HSE) is facing a significant challenge in 2012 given the need to set expenditure levels within the parameters of the National Recovery Plan;

— acknowledging the significant reductions which the health sector has experienced over the last three years, both budgetary and staffing;

— further noting that the HSE has operated the Croke Park Agreement very effectively, with over 3,500 staff redeployed, and a reduction in overall numbers of over 6,000;

— further acknowledging that a range of measures are being actively progressed during 2012 to enhance income collection;

— commends the Minister for Health for managing within this difficult environment, and at the same time achieving;

— a 7% increase in in-patient discharges and a 6% increase in emergency department admissions;

— in relation to a basket of 24 procedures, the national target of 75% of cases treated as day cases;

— significant improvements in hospital waiting times, with 9,100 fewer patients waiting on trolleys when compared to the same period in 2011, which equates to a 19% year-on-year improvement;

— implementation of clinical programmes which saved 70,000 bed days last year, thereby allowing for more patients to be treated more efficiently;

— cost reductions within the health sector which are impressive by international standards, particularly within the hospital sector;

— 1.8 million people now with medical cards, and 130,000 with GP visit cards;

— the passing of legislation to abolish restrictions on GPs wishing to become contractors under the General Medical Services scheme which is now in place;

— progress on the preparation of legislation to allow for the extension of free GP care to persons with long term illnesses;

— progress in building primary care capacity and in chronic disease management, particularly for the management of diabetes;

— significant advances in mental health services in the implementation of A Vision for Change, in particular improved child and adolescent mental health services;

— advances in the care of older people, with almost 23,000 clients now supported under the Fair Deal scheme; and

— accelerating the type of service delivery reforms that will move to models of care across all service or care groups which treat patients at the lowest level of complexity and provide services at the best possible unit cost; and

— welcomes the determination of the Minister and Government to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent 'money follows the patient' system of funding that will be supported ultimately by Universal Health Insurance."

I welcome the opportunity to speak on this motion. As the Minister for Public Expenditure and Reform indicated on the publication of the Estimates, the Government has a significant fiscal deficit which needs to be closed. Our country has suffered the greatest economic crisis in living memory leading to a large fall in Exchequer revenues. I am sure I do not have to remind the Fianna Fáil Members opposite of the reason that is the case.

It is in this challenging context that expenditure plans for 2012 were set and the health sector, as with other sectors, incurred a reduction in the resources allocated to it. The health service budget has been reduced by €2.5 billion over the last three years. The number of health service staff has fallen from a peak of 111,000 in 2007 to less than 103,000 now.

As we are all too well aware, the country still faces serious challenges in respect of the public finances. In order to meet the targets agreed with the troika, there will be further reductions in the level of resources allocated to the health sector.

The Government faced difficult choices in setting the health Estimate and set, as its priority, the aim to maintain services to the greatest extent possible within the reduced resources available. The HSE's national service plan was prepared in the context of the challenges faced by the health services this year in terms of reduced staffing levels and a reduced budget, combined with increasing demand for services.

It also took account of additional funding being invested this year to critically change the models of care we are providing in areas such as mental health services, primary care, the national clinical care programmes and children's services. It is not enough to reduce services in order to meet budgets; we must also commit to the radical programme of reform that is set out in the programme for Government. We can no longer continue with business as usual. That is simply not a sustainable position.

It is clear that the savings targets set for the health service are ambitious, particularly in light of the fact that significant numbers of staff retired under the grace period. Budget reductions pose a major challenge to the system's ability to maintain services at an acceptable level. In the six months to the end of February this year, almost 5,000 staff members retired from the health service. All key services, including maternity, critical care, neonatal and essential social services were maintained without interruption. That is a significant achievement on behalf of the HSE. This was facilitated to a large degree by the flexibility provisions in the public service agreement. In some respects, the response and co-operation of staff went far beyond the terms of the agreement. I commend and welcome the flexibility and adaptability staff showed during this difficult period.

This agreement is a key tool in enabling the health service to respond to these staffing reductions. Since its inception in 2010, the agreement has helped the health sector to manage the reduction of staff numbers by over 6,000.

Another significant success of the Croke Park agreement in the health sector has been the redeployment, to date, of some 3,500 staff within the services. This number is exclusive of 1,000 staff who transferred to the Department of Social Protection. Other achievements include an extended working day in hospital laboratory and radiography services, the ongoing revision of rosters at local level and co-operation with clinical care changes in hospitals.

It is also clear, however, that further change is required, and at a faster pace, if we are to be able to reduce the impact on front line services. Therefore the 2012 health sector action plan contains a demanding and relevant set of measures. These include a comprehensive review of rosters, changes in skill-mix, productivity improvements and a focused approach to reducing sick leave levels.

The motion specifically addresses the issue of the drugs bill. Drugs spending represents 17% of total health expenditure and, clearly, this is not sustainable. The comparable figure in the UK is 9%. I would like to set out some of the work that has been under way in this regard. Significant savings on the drugs budget have already been made in recent years. Changes in wholesale mark-up paid on medicines, and the introduction of a common sliding dispensing fee across all schemes, along with the reduction of the retail mark-up paid on a number of schemes, resulted in on-going annual savings of approximately €120 million.

The Health Professionals (Reduction of Payments to Community Pharmacy Contractors) Regulations 2011 reduced certain payments made by the HSE to community pharmacy contractors with effect from 20 June 2011, with a further saving of over €34 million. This included a reduction in wholesale mark-up on drug items from 10% to 8%. These reforms have contributed to savings in the drugs budget this year along with changes to the threshold of the drugs payment scheme.

An interim agreement with the Irish Pharmaceutical Healthcare Association, IPHA, provides €10 million in savings in 2012 through reductions in the price of off-patent medicines. This agreement is in advance of more substantive discussions to deliver a new agreement and significant price reductions. It is intended to bring these discussions to a conclusion shortly.

I am glad to report to the House that further savings will be achieved later this year through the introduction of the health (pricing and supply of medical goods) Bill 2012, to which Deputy Kelleher and others have referred. This Bill was approved by the Cabinet this morning and will be published in the coming days. The Bill was promised a number of years ago, during the term of the last Government, by the then Minister, Mary Harney, but unfortunately little or no progress was made in this regard.

The Bill will provide for the introduction of a system of reference pricing and generic substitution for prescribed drugs and medicines, which will lead to savings for taxpayers and patients. This is a significant development and in the coming years we look forward to making savings in the overall medicines bill and also for individual patients.

In addition, a national task force is being established to deal with the prescribing and dispensing of existing medicines. It will address this from the perspective of quality and patient safety primarily, but it can be anticipated that significant cost savings will result. By addressing the issue from the perspective of quality and safety, and by working with the leadership of the medical, pharmaceutical and other professions, we have the best means of securing a sustainable means of improving value for money from the State's significant expenditure on prescribed medicines.

The task force will be made up of a number of key leaders from the healthcare system and will be chaired by the chief medical officer of the Department of Health. Its terms of reference will require it to oversee and direct analysis of the extensive information that is held on prescribing patterns through the HSE's primary care reimbursement service. It will use this information to establish priorities to be addressed concerning quality and patient safety prescribing and to allow that to inform decisions on the nature and scale of interventions that should be undertaken. These can range from providing advice, guidance and support to prescribers and dispensers to help them to improve prescribing practice, to assessing the suitability of maintaining a supply of certain items with limited efficacy where more appropriate items are available. The work of this task force will be based primarily on evidence. The criteria that underpin these decisions will be clear and explicit to everybody working in this area.

I understand a preliminary meeting of the group will take place next week and that it is anticipated an executive office to support the very important work of this group will be established as a priority in the HSE so that the committee can be fully functioning before the end of September.

I anticipate that the Minister, Deputy Reilly, will in his closing statement to the House tomorrow evening speak about developments in hospital waiting times, the work of the special delivery unit and other issues. My colleague, the Minister of State, Deputy Lynch, will speak about the ongoing development of specialised care services and the work under way to improve client experiences in mental health and disability services and care of older people.

For my part, I want to report on progress in primary care. If we are to achieve savings in health spending while also reforming and improving the health services we provide, we must develop new models of care. As I stated earlier, business as usual is not acceptable. It is particularly not acceptable in the current climate when there is such pressure on budgets. We want to ensure that primary care can meet 90-95% of people's health needs and so we must move away from the old hospital-centric model where health care was episodic, reactive, fragmented and expensive. Through modern and strengthened primary care, we can achieve much better health outcomes and much better value for money.

I can assure the House that front line services in the primary care area will not be cut. I hope Deputy Kelleher heard that. Primary care services will be significantly strengthened in the coming months. We recognise the importance of primary care and of switching the focus and orientation away from hospitals to the primary care setting. An allocation of €20 million set aside in the budget will enable us to recruit some 300 people in the primary care area, including public health nurses, RGNs, occupational, physio and speech and language therapists. These posts will be allocated to the areas of greatest need, using an objective resource allocation model. Full details of this allocation will be announced next week.

In January, I established the Universal Primary Care Project team to drive implementation of primary care reform. The projects overseen by the UPC team include policy, planning, costing and legislative preparation for the extension of free GP care, preparation of legislation in respect of which is at an advanced stage; development of implementation plans for chronic disease management in primary care - last week I approved the recruitment of 17 diabetic nurse specialists to commence the roll-out of the diabetes programme; development of a detailed programme of capital investment in primary care centres; preparation for a new GP contract to reflect the programme for Government commitment to universal free GP care and intensive chronic disease management; and preparation of new governance and funding arrangements for primary care, which is well under way. I assure Members opposite that a great deal of work has been done on preparation for the development of the new directorate within the HSE. Work on identification of the cohort of staff who will be working under the new directorate and, crucially, on separating out those budgets is ongoing. For the first time ever, there is a commitment to the establishment of a primary care fund which will enable us to meet the commitment to strengthen primary care.

Our health services are essential to the functioning of our society. Our citizens expect and demand a modern, high quality, safe single-tier health service which guarantees access to care based on need not on ability to pay. They expect a health service that is continually evolving and improving and delivering services more efficiently, effectively and with fewer staff. The programme for Government sets out a clear pathway for the future development and strengthening of our services, notwithstanding the enormous financial challenges that this Government inherited. Despite the challenges posed by reducing resources, this Government has already made significant advances in improving services and delivering on the commitments made in the programme for Government.

I urge the House to reject the Opposition's motion and to support the Government as it deals with the challenges it faces by supporting its amendment.

Patrick O'Donovan (Limerick, Fine Gael)
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I welcome the opportunity to speak on this motion. I also welcome the contribution made by the Minister of State, Deputy Shortall and welcome her colleague, the Minister of State, Deputy Lynch, to the House. The Department of Health is not the prettiest to be assigned to. I wish to put on the record my admiration for those people who serve in the health services, HSE or Department of health, be that in a political, administrative, departmental, front line, nursing, domestic or other capacity. It is probably the most stressful place to work from a political or service delivery point of view.

There is no doubt but that Deputy John Browne is correct. There is a lot wrong with our health service. However, I take issue with him and with Deputies Cowen and Kelleher on one issue. The problems in the health services in Ireland did not commence last February 12 months. They have been around for a long time. Despite 40 minutes of uninterrupted contributions from the Opposition benches they did not offer a single solution, which says a great deal about where Fianna Fáil as a political party is placing itself on its road to redemption. All they did was crib and moan. I know that Fianna Fáil is in a race to the bottom with the political party sitting to its right. However, as a party trying to restructure itself on the political landscape in Ireland it should, rather than continually whinging from the sideline take some responsibility for what it did to the health services, admit it was wrong and be supportive of Government which is trying to fix the problem.

I wish to raise two issues with the Minister of State. I am glad both Ministers of State are in the House because this issue is relevant to both. The first issue relates to young adults with an intellectual disability who have been receiving letters during the past couple of days in regard to whether they have school places going forward. I am sure every Member of this House has received representations on this issue in the recent past. I was visited at my clinic last Saturday by parents of a child with an intellectual disability who are concerned about who will care for her when they are gone. I urge and implore the Ministers of State and Minister to engage with the voluntary bodies charged with providing services for young intellectually challenged adults to ensure there are places for them when the school year recommences next September.

I have previously stated in this House when speaking on education issues that I believe now is the time for this country to engage in a new model of social partnership. By this I mean not the model of social partnership that involves calling people in late at night to Government Buildings and asking them how much of the cake they want but the model of calling in all of the stakeholders, be they nurses, domestic staff, parents, service providers in the voluntary sector, HSE or Department of Health officials, and informing them of the amount which has been voted through by the Oireachtas for the next year for, say, education, health, defence or justice and asking them how they propose to spend it, what they see as the priorities in their area and, more important, the areas where potential savings could be made. I agree with the Minister of State that we cannot continue with business as usual. We have a depleting budget going forward. I implore officials in the Department of Health, together with their colleagues in the Department of Education and Skills and the voluntary service providers, to sit down together over the next six weeks to ensure young intellectually challenged adults of 18 years are not discharged from school, leaving their parents, many of whom are elderly, wondering who will look after them when they are gone. I compliment all of the work already done in this area. The brother of one Deputy once referred to the Department of Health as "Angola", on which I would probably agree with him. I applaud anybody who is trying to deliver real change in the health services, including the nurses at the side of the bed or the Ministers of State present this evening. Their hearts are in the right place and I compliment them on the work they have done. However, I urge them to engage, for God's sake, with the service providers and stakeholders at all levels of the health service in order to achieve better value.

Olivia Mitchell (Dublin South, Fine Gael)
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I appreciate the opportunity to speak on this issue, which is of intense interest and importance to every citizen. An overrun in the HSE budget is nothing new, but this one is disturbing for us all. While I welcome the opportunity to debate the issue, I am disappointed in the wording of the motion which raises a very legitimate issue but offers no solution. It takes the easy option of demanding that services be maintained regardless of the overrun. All of us wish that services could be maintained but the issue is achieving it. The clear absence of any management structure when setting up the HSE was disastrous and it has dogged it ever since. It merely introduced a layer of management on top of the layer of management that existed for the health boards. It has struggled ever since as a result of that fateful decision. To this day governance in the HSE is problematic as is administration. Legislative change in the past few months, as mentioned in the motion, was not going to prevent a deficit emerging right now. Despite putting enormous amounts of taxpayers' money into the health system there is widespread dissatisfaction with delivery and regardless of what is often said about it outcomes are not up to international norms except in very limited areas.

A lack of money is not the problem nor is it the quality of personnel in the system. However, the management is a major problem. Management of something as vast, pervasive and complex as a health service is highly problematic and requires a management system with a clear line of command and responsibility that is second to none and we just do not have that. Most of the money goes into the hospital and that is where the problem is particularly obvious. I recently had occasion to visit a patient in what is regarded as one of our top hospitals. My observation of procedures and practices - medical and otherwise - were more than disturbing. In one example I observed a patient in a bed being moved to a different ward so the area had to be cleaned. On a Saturday afternoon I sat there and watched as three different cleaners came to clean the area - they all did exactly the same work and left again. While it is a very small thing it reflects the absence of anybody in charge and taking responsibility for management at ward level. Nobody is responsible for cost containment. As that was a Saturday afternoon, I presume the cleaners were not on normal rates of pay but on a higher rate. I do not blame the cleaners but management. How could that happen in a hospital where budgets were stretched?

I will not go into the other inappropriate and wasteful use of devices and the ordering policy. The point is that hospitals absorb a huge amount of budgets and without really strong management in hospitals we will continue to have these problems. I will not go into the issue of consultants and the management of patient care, which is also of concern.

Another area of concern is the area of medicines. Approximately €2 billion is spent annually on medicines and this is rising at an alarming 9%. While some reduction has been achieved the pharmaceutical industry must do better and come to the table in order to provide savings to the State, just as the State has responded to its concerns that we would support innovation and purchase of new and expensive drugs. The reduced prescription charges introduced by the two pharmacy groups is very welcome and I hope the competitive pressure will see this trend continuing and secure further savings for the State and private citizens.

I raised the issue of disabled school-leavers some months ago and I realised that it would only become obvious at this time of year. As able-bodied school-leavers are moving on and looking forward to new educational opportunities, holidays and trips abroad, disabled school-leavers are being sent letters to be informed that there is probably no service for many of them. I understand there is less money for everything but it cannot be that there is no money for some of these children. Every one of these children is entitled to some kind of service plan. Their parents who have done everything for them up to the age of 18 are getting old themselves and are beginning to worry about the future. They see other children having every opportunity while they have none. We cannot throw these children on the scrapheap of life now. I will not stand by silently if every one of these children leaving school at 18 is not provided with a day-care plan.

Kathleen Lynch (Cork North Central, Labour)
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I support the sentiments of the Minister of State, Deputy Shortall, that it would be wonderful to be in this Department at a time of full and plenty with the country awash with money. God knows, there were times when the Government was hard-pressed to know what to do with it. We are in an entirely different space now and we are trying to ensure the front-line health services both within the acute hospitals and in the community are delivered in a more efficient and effective manner. That the country is virtually bankrupt is not and never was as a result of people needing a health service but of gross mismanagement by the previous Government, and Opposition Deputies should keep that in mind.

The Health Service Executive's national service plan for 2012 acknowledges that there will be an inevitable and unavoidable reduction in services this year because of the scale of the financial and staffing challenges facing the health service. However, it also outlines the various actions that will be taken to mitigate as far as possible the impact the budget and staff cuts would otherwise have on services. In framing the plan, the HSE was asked to avoid across-the-board cuts in budgets and to ensure that reductions in budgets should not lead to a corresponding reduction in services. This is in line with the objectives of the Government's health reform programme to prioritise our services in a way that supports those in greatest need.

I wish to address the areas of the health sector for which I have responsibility, namely disability, mental health and older people services. In excess of €1.4 billion will be spent on specialist disability services in 2012. The national service plan provides for a 3.7% reduction in budgets, but makes it clear that there is scope for achieving efficiencies of 2% or more through measures such as consolidation and rationalisation of back-office costs. That is not as easy as it sounds. Some organisations have already introduced all those efficiencies, as we are well aware. It is not something that can be said in a glib or off-hand manner. Organisations delivering disability services have done an exceptional job this year.

I wish to answer some of the points about school-leavers made by many contributors, including the last contributor. We started off with a figure of approximately 700 school-leavers - young men and women who happen to have a disability.

The number in this respect has not settled but we estimate that 180 people will be in need of a day place. I congratulate the disability services in the HSE and the organisations which have made room and managed to find space to provide for people who needed a service without it costing the Government any additional money. There will be no additional money in terms of provision having regard to demographics but we must ensure, and I am not certain that it can be done by way of threat, that people who are most vulnerable and in greatest need will have a service and we will continue to work on that on a daily basis.

Deputy Browne asked me the other day if I still had the €35 million allocation for mental health services. I would love to think that I had it personally but we have that funding. The posts which will be necessary to bring mental health services into the community and to strengthen the community mental health teams will be put in place this September. I congratulate the people in the Deputy's constituency of Wexford and the people of Waterford on the tremendous job they have done in driving that service forward and being courageous in doing that under some pressure. We have had the assistance of the Minister, Deputy Brendan Howlin, who insisted on the retention of the €35 million allocation, and there is also the promise in the programme for the Government's in regard to mental health.

We will publish a carer's strategy next week to provide not only for older people because carers comes in all shapes and sizes; sometimes they are very young and sometimes they are elderly. We will publish a dementia strategy in 2013. The review group and public consultation on that is being put together as we speak.

The allocation of €1.4 billion for the fair deal scheme is ring-fenced. I was amazed to hear there are difficulties in some areas because I inquired about the scheme only this morning and was told there was no waiting list. How we treat our elderly people cannot be only about nursing home or long-stay provision; it must be about far more than that. It must be about ensuring that we all live and die where we wish to be, namely, in our own communities.

Michael Kitt (Galway East, Fianna Fail)
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The next speaker is Deputy Ó Caoláin and I note he is sharing his time with Deputy Colreavy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Yes. Go raibh maith agat.

I hope the Minister for Health, Deputy James Reilly, takes the opportunity tomorrow or on Thursday to come into the Dáil to address the very serious questions that have been raised concerning his involvement in the private nursing home sector. That involvement raises issues of conflict of interest and his suitability to take decisions regarding public and private nursing home care. This is directly relevant to the motion before us and the issue of health care funding and health care services.

Between January and May this year, 296 public residential care beds were shut by the Government and the Department of Health does not have a way of identifying the number of beds opened or closed in the private sector in the same period. There are more than 600 public hospital beds occupied by people whose treatment is complete but whose discharge is delayed, mainly because they are older people and there are no care home places or step-down facilities for them. With care home beds being closed and acute hospital beds also closed - more than 2,400 at present - the system is being contracted at both ends. Clearly, the Minister, Deputy Reilly, and his colleagues are continuing the failure of their predecessors and are driving the health service into deeper crisis.

It would be laughable if it were not so tragic that at this mid-point of 2012 we have a renewed panic within Government about the so-called spending over-run in the health budget. This was utterly predictable because the amount of money cut from the health budget for 2012 was totally unsustainable. We are told that the over-run for the year to the end of May 2012 was €280 million. It is no surprise that the HSE has exceeded its 2012 budget to this extent because, as we and many others have warned, the cuts imposed on health spending in budget 2012 simply cannot be sustained without the virtual collapse of services.

Some €750 million was taken out of health in the Fine Gael-Labour Party coalition Government's budget 2012. Now the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, is predicting that the over-run for 2012 will be €500 million. A total of €1 billion was taken out of health spending in 2011 and the Department of Health is talking about an overall reduction of €2 billion up to 2014. This is totally unsustainable without devastating already struggling front line services.

Last month we had the leaked correspondence from the Minister, Deputy Howlin, to the Minister, Deputy Reilly, on the over-run in health spending, apparently a public airing of the usual pre-budget manoeuvring within Government. We also had attempts to link the health funding crisis with the Croke Park agreement. The funding crisis in the public health services has its source in fundamentally flawed Government policy and not in the Croke Park agreement. We are seeing an effort to target the pay of people working in the health services as part of the austerity drive. If implemented, such pay cuts would be imposed alongside cuts in services for patients, not instead of them as the Minister, Deputy Reilly, has pretended.

The continuing recruitment embargo is a false economy as it has led to increased use of expensive agency staff and to more overtime working by existing staff. The Croke Park agreement provides for flexible working and this should be used to the maximum. Due to the continuing cuts and the recruitment embargo, staff are under severe pressure but have shown flexibility. One of the main drivers of costs in the health services is not the Croke Park agreement but the consultants' contracts, which keep pay for top earners in the health service at excessive levels and perpetuates the two-tier system with many consultants continuing to benefit from both the public and private sectors.

Alongside the reports of the €280 million over-run last weekend, we had speculation that the €35 million allocation for mental health services this year would be targeted to fill gaps elsewhere. Any such move would be scandalous and should be strongly resisted, and I depend on the Minister of State, Deputy Lynch, to do that. Only last week, on 4 July in this Chamber, she told us: "I listened to Deputy asking where was the €35 million and metaphorically, it is in my back pocket. [The Minister of State will remember saying that and I remember her saying that very well.] I still have the money, it still exists and it remains within the Department." I would ask her to give it a tap to make sure it is still there. I hope the Minister of State and her Cabinet colleagues ensure that funding remains in place and that it is allocated as agreed and as promised for mental health services in this State where it is so badly needed.

As we address this latest funding crisis in health, we are still in the dark about the Government's plans for major health care reform. The Minister, Deputy Reilly, and his colleagues have repeatedly told us that they are moving towards universal health insurance and a "money follows the patient" model of funding, but beyond these endlessly repeated headlines we have been given little detail of how these far-reaching changes are going to be achieved and how exactly they will work. One thing is certain, this system will not be based on the public service model of health care delivery. The emphasis will be on the purchase of services in both the private and the public health sector by health insurance companies. There is nothing to indicate that the two-tier public-private system will be dismantled.

The Minister has spoken of a single waiting list but, again, we have no detail about how this will work. For example, will hospital consultants still be able to work in and profit handsomely from both the public and the private systems? If not, then new consultants' contracts will be required. If there is to be a new and better way of working for consultants, and there certainly should be, then work on the new contracts would need to begin now to prepare for the throughput of new consultants coming into the system in the years ahead. We have also been told that hospitals will be grouped and that hospital trusts will be formed. Again, we have been given no detail. What guarantee do we have that this will not be yet more bureaucratic change?

At last month's quarterly meeting of the Joint Committee on Health and Children with the Minister and the CEO of the HSE, both of them painted a bleak picture of a health service in the midst of a deep economic recession. Billions of euros are being taken out of the health service budget. I have described this as austerity in action. One cannot take €2.5 billion out of the health service budget in the last three years and not seriously affect front line care of patients. This is admitted in the HSE 2012 service plan. This is the result of the fundamentally flawed economic strategy of this Government. At the Joint Committee on Health and Children I asked about the Minister's intention to take more billions out of the health budget. The Department of Health statement of strategy 2011-2014 states:

...total current expenditure for the public health service is being reduced by nearly €1.1 billion in nominal terms over the period 2011-2014 under the National Recovery Plan. However, in order to meet unavoidable pressures and Government commitments, in excess of €2 billion will have to be taken out of the health budget over the same period.

As my questions were not answered at the committee, I ask the Minister again, or any Minister who cares to respond in the course of this debate tonight and tomorrow night, for clarity on these figures.

The Minister stated that €2.5 billion was taken out over the past three years. His Department's strategy speaks of €1.1 billion in nominal terms, 2011 to 2014 and in excess of €2 billion over the same period. How does this translate in terms of 2013 and 2014? It is a very confusing picture. How many more billions of euro have to be taken out to meet what the strategy calls, "Government commitments"? I have to understand those Government commitments to mean bank bondholders' losses and other debts not incurred by the people. The Minister has repeatedly spoken of maximising the use of resources, including the skills and the time of health professionals. How does he reconcile this with the type of so-called savings being made now? For example, in Cavan General Hospital in my constituency, it is proposed to run the operating theatre on a week-on, week-off basis. Staff believe this will not make the targeted savings because it will mean more work done out of hours during the theatre's working week and that it will increase waiting lists. Undoubtedly it will. A fully equipped operating theatre will only be used at 50% of capacity, apart from emergencies. How does that make sense? I call on the Minister again to intervene to put a stop to this regressive and counter-productive cut.

Savings can be made in our health services by charging the real cost for the use of private beds in public hospitals, by targeting the excessive salaries of the highest earners in the health sector and by reducing the cost of medicines, where little progress has been made. This is recognised in the motion and Sinn Féin will support the motion in the name of the Fianna Fáil Deputies. However, it has to be recognised that, overall, the crisis in health spending is a product of the failed austerity strategy of the Fine Gael-Labour coalition and it cannot and will not be fully and properly addressed until that futile strategy is changed. I am under no illusion that this futile strategy is fully supported by Fianna Fáil and so its promotion of this motion is an example of double-standards.

Michael Colreavy (Sligo-North Leitrim, Sinn Fein)
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I welcome the motion but I, too, took a double take when I saw who was proposing it, given it was Fianna Fáil and the Progressive Democrats which were first to take a very sharp scalpel to the health services. I have notes for my contribution but I will ignore them. I will start instead with some good news. The endoscopy unit at Sligo Regional Hospital has achieved level one accreditation from the Royal College of Physicians in London. This is an excellent achievement and I commend the staff and everyone involved with that achievement. It shows what can be done if a staff and a good hospital are given half a chance. Sligo Regional Hospital is only the second hospital in the country to receive this level of achievement. It demonstrates the standard of excellence for patients in the endoscopy department of the hospital.

I wish to contrast this achievement and the pride of the staff in that achievement with the situation of breast cancer services. Before the election, this Government promised the breast cancer services would be restored to Sligo. The service was taken away by the Fianna Fáil-PD Government and it has not been restored. Promises have not been kept. A bus to Galway was provided in place of the restoration of breast cancer services.

A specialist stroke unit is badly needed in Sligo Regional Hospital, including a catheterisation laboratory but there has been nothing yet. A previous speaker from this side of the House said there was no suggestion made as to how matters could be improved within the current straitened economic situation. The Government needs to look at how much potential productive time, particularly of surgeons who are well-paid consultants, is not being used in theatre because there are not sufficient theatre staff. Lists are growing longer and well-paid consultants are not working, I would argue, to anything near their full productive potential. This situation needs to be examined urgently.

It seems to me that in this House we are engaged in an unspoken process of slimming down health services to make them a more attractive proposition for some form of privatisation. I do not know what that form is but I am very suspicious of it.

A man came to me yesterday. He said he had an appointment in St. Vincent's hospital in Dublin for a post-operative check-up. He had previously travelled on a HSE bus from Sligo to the clinic in Dublin and back again to Sligo. He was told on Friday when he rang to inquire about the bus time that the bus had been withdrawn. He had no knowledge of the withdrawal prior to his call. He would have to make his own way to Dublin but this was a man who had never set foot in Dublin apart from walking from the minibus to the hospital for his surgery. I rang St. Vincent's hospital and they were excellent. They arranged a later appointment for him. I took him to Dublin and brought him to St. Vincent's where he was treated in the outpatients' department. I took him to the station and ensured he got on the train for Sligo. This was his first time on a train. It is disgraceful that this man did not know until he made an inquiry last Friday that his mode of transport had been withdrawn.

Maureen O'Sullivan (Dublin Central, Independent)
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I acknowledge the parts of the Government amendment to the motion which highlight the improvements that have been made in the health services and the challenges being faced in the health area. I will devote my short speaking time to one particular aspect which is also of importance to the Minister of State, the mental health sector. I refer to the startling statistics about the number of people with mental health issues and the very insignificant level of funding in this area. Last week, the cross-party group on mental health raised a Topical Issue Matter on mental health with the Minister of State. We raised three questions, on the status of the €35 million that had been committed for community mental health services; the date of the appointment of a director; and the commitment on the ring-fencing of staff numbers. It was a good debate and we had a good engagement with the Minister of State. She referred to the gap analysis which she had been seeking to indicate the posts needed such as social workers, psychologists, psychiatrists and the location of the nursing posts. She gave the impression there would be positive moves. We did not get an answer on the question about the director but the Minister of State provided information on the posts and the funding of €35 million. It was alarming to read in the newspapers that health spending is facing big cuts as the financial deficit hits €280 million, possibly €500 million and that there would be a review of expenditure across all headings. Most alarming is the suggestion that parts of the €35 million for mental health services would be used to offset the overruns. I ask the Minister of State to assure me on this point. There is a dire need to move on A Vision for Change so that it becomes a reality. I refer to my recent parliamentary question to the Minister of State on the matter of the parents of an 18 year-old son with intellectual disability who relies on services from the HSE through the Brothers of Charity and these have been affected by the cuts. There is a need for appropriate services for people with intellectual disabilities who leave school. The HSE has identified approximately 650 school-leavers who will require services in 2012.

The issue of drugs made the headlines at the weekend because of events in the Phoenix Park. We know the problems of polydrug use and alcohol and yet the funding is being cut to the drugs task force projects and they are left in dire straits when dealing with those issues.

Mattie McGrath (Tipperary South, Independent)
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I am delighted to contribute to this debate. I welcome the Minister of State, Deputy Kathleen Lynch. I compliment Deputy Kelleher for tabling this motion. Some have regarded this motion as a bit of a cheek coming from Fianna Fáil. This Government is almost 18 months in office and we have nothing but broken promises. I do not blame the Minister of State, Deputy Kathleen Lynch, because she has made a decent effort to ring-fence the money in the mental health area and to do other things. However, there has been one broken promise after another. I did not even read the Government's proposed amendment to the motion because it is not worth the paper on which it is written. It is nothing but blunder and bluster from the Minister. He promised so much and made so many commitments, in writing and otherwise. He had experience. He negotiated the Irish Medical Organisation, IMO, contract with the former Minister, former Deputy Mary Harney. He is a medical doctor and as a medical professional is more qualified and eminent to speak on medical matters than me. Other than that, however, he is a cowboy acting as if the rest of us are Indians. I mean that and I hope it is not offensive language. He is just a chancer as far as I am concerned with regard to what is happening in the health sector.

Michael Kitt (Galway East, Fianna Fail)
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The Deputy should use parliamentary language.

Mattie McGrath (Tipperary South, Independent)
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The Leas-Cheann Comhairle can wince as much as he likes, but it is time to call a halt to this. We have been under siege. What Deputy Colreavy described is happening throughout the country. Unfortunate people from rural areas and elsewhere are being thrown to the wolves by a system that is out of control, that is not fit for purpose and which the Minister said he would dismantle. The former taoisigh, former Deputy Bertie Ahern and former Deputy Brian Cowen, and the former Minister, former Deputy Dermot Ahern, agreed, as I know from being involved with the party at the time, that the HSE should be disbanded because it was out of control. That was a few years ago.

The Minister took away duties from the board but the board is still there and still making demands. I and Deputy Seamus Healy had a Topical Issue debate recently in the House about the waiting list in Clonmel but the only response I received was jargon about bed managers, ward managers and other managers. When there were matrons in the hospitals there were none of these managers and we had clean healthy hospitals that were accessible. Now we have hoards of pen pushers and people with letters after their names. It is a system of self-serving people, rather than a system that serves the public. These people have big wages and big job titles but many of them are doing nothing aside from adding to the problems and creating more problems. Nobody can touch them or take them on. Somebody needs to call time on those people.

The front-line services are being attacked and are under siege. The self-serving people that are in charge are destroying the health service we had, such as the accountability the ordinary members had on the health boards. It is time we got back to serving and looking after people with dignity and respect, not leaving them on corridors, removing services from them and frightening them from making complaints. It is outrageous.

Michael Kitt (Galway East, Fianna Fail)
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I ask the Deputy to move the adjournment of the debate.

Mattie McGrath (Tipperary South, Independent)
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We need something to move this mountain of bureaucracy. It must be undermined. The Minister would be better off being here in the House instead of in Cyprus and dealing with the problems rather than running away from them.