Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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6. To ask the Minister for Health when the Health Service Executive service plan for 2014 will be published; and if he will make a statement on the matter. [48067/13]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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When will the HSE service plan for 2014 be published? Will it include a breakdown of the so-called saving of €113 million on medical cards under the heading "probity"? Can the Minister tell us exactly what this means, how this very considerable sum will be achieved, how he intends to realise this so-called saving and how it was calculated for budget 2014 purposes? What is the correct figure for the estimated cut in the health budget for 2014? The budget document says it is €666 million but there has been speculation that the real figure is closer to €1 billion.

James Reilly (Dublin North, Fine Gael)
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Under the Health Act 2004, the HSE has a 21-day period from the publication of the Estimates for supply services on budget day to submit its 2014 national service plan for my consideration. This would have required the HSE to finalise and submit its service plan for next year by Tuesday of last week - 5 November. The Act does, however, allow me as Minister for Health to provide the HSE with any such other period that I may wish to allow in this regard. In view of the very challenging nature of this year's budget and the fact that it has come early, I have written to the HSE and advised it that I have allowed it another ten days until 15 November to adopt and submit its 2014 service plan for my consideration. I must wait and see if that is possible given the challenges it faces. It may need a further extension which I will consider if that is the case.

This extended period also recognises the earlier than usual presentation of the 2014 budget. Clearly, there are huge challenges in addressing the budgetary figures we have been given this year. My priority, as I made very clear at all times, is patient safety followed by having patients seen in as timely a fashion as possible. As everybody in this House knows, if somebody's inpatient elective or planned procedure is cancelled and delayed for too long, they end up presenting as an emergency, which is more expensive to the State but much more worryingly, outcomes from emergency surgery are never as good as outcomes from elective surgery when they are considered in statistical fashion. That is not necessarily true for the individual but is true overall.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister spoke about of the delay in the presentation of the national service plan. I ask him to address the other issues I made reference to because they are integral to the entire business of the national service plan. Will the Minister clarify the conflicting situation between the €666 million and the figure of €1 billion cited more frequently at this point in time? Can he also advise if the service plan will show a breakdown of the €113 million designated as so-called savings under the medical card heading over the course of 2014? How will that incredible sum be realised, what steps will be taken to do so and who are the targets who will lose their medical cards as a consequence?

I will conclude with my next point. I encourage the provision in the national service plan of the required funding to allow for the fitting of bilateral cochlear implants to get underway in 2014. I believe all views in this House share a belief in this as a target for the coming year.

James Reilly (Dublin North, Fine Gael)
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In respect of the latter point, I have made it very clear in this House that this is a priority of mine. Obviously, I am not going to discuss the service plan and specifics around it here today before I have had a chance to see what is in the service plan and to present it to my Cabinet colleagues. The Deputy asked a question about the figure of €666 million versus the figure of €1 billion mentioned by Mr. Tony O'Brien, the director general of the HSE at the Oireachtas Committee on Health and Children. The figure of €666 million is the budget target savings we must make and which were given to us by the Department of Public Expenditure and Reform. The figure of €1 billion alluded to by Mr. O'Brien included all sorts of other issues, pressures and developments that might take place. What he was alluding to is the swing of €1 billion so I hope that explains the difference between the two figures.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Not certainly, however, in respect of the €113 million, surely we do not need to wait on the national service plan to get an indication of how that figure was computed. What is the basis of it and what is the Minister's target area in respect of current medical cardholders to realise such a so-called saving over the course of 2014? It is a time of great worry for many medical cardholders and surely they are entitled to some clarity in respect of the Minister's intent in this regard.

In respect of bilateral cochlear implants, we know that an initial allocation of some €12 million might be required but it will be a considerably smaller sum in future years once the bilateral programme is up and running. There is no question that it can be programmatised so let us hope that at least that can be looked forward to.

I spoke to the Minister privately about my final point yesterday. I would like to take the opportunity to say it to him publicly two and a half years after he and the Minister of State at the Department of the Environment, Community and Local Government, Deputy Jan O'Sullivan, as Opposition spokespersons on health gave a commitment as did I regarding the outstanding cases relating to the case of Michael Neary at Our Lady of Lourdes Hospital in Drogheda. We shared a platform together on this matter. I welcome the Minister's statement this week that women over 40 will be included in a form of payment in recognition of the barbarity to which they were subjected to and the suffering they have endured. I commend that decision.

James Reilly (Dublin North, Fine Gael)
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I am glad that this is the case. It was only right and proper that this arrangement should be reached. It was a very arbitrary decision to exclude women purely on the basis of their date of birth when they suffered the same harm and damage by the aforementioned Dr. Neary.

In respect of medical cardholders, both the Deputy and I have a responsibility not to cause alarm among people unnecessarily. I made it very clear and the Minister of State has already alluded to the fact that we have put in place a communication strategy to communicate with people to reassure them that their entitlements are not changing in terms of the medical card. If they are legally entitled to a medical card, they will get it and if they have one, they will keep it. There will be no question of people losing their medical cards because of a change in policy. There is no change in policy and it is very important to state that it was never the case that any particular medical condition gave a right to a medical card. What was the case was that medical conditions could lead to particular financial hardship, which was a ground for giving discretionary medical cards and that remains the case. Last year, I asked the HSE to formulate a panel of doctors to ensure that even more latitude and compassion would be in the system to deal with those difficult cases.