Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health when the Health Service Executive Service Plan 2014 is to be published; the reason it remained unpublished eight weeks after Budget 2014; if there are any substantial changes with regard to the composition of the €666 million savings target set out in Budget 2014; and if he will make a statement on the matter. [54386/13]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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2. To ask the Minister for Health the position regarding the 2014 Health Service Executive Service Plan [54128/13]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I seek clarification regarding a notification we received indicating that Questions Nos. 1 and 2 had been grouped.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Priority questions may not be grouped with ordinary questions but may be grouped together.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We did not ask that Questions Nos. 1 and 2 be grouped. We received a notification to that effect.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I have not received any such notification. I am sure the Minister will announce the position when he speaks.

Billy Kelleher (Cork North Central, Fianna Fail)
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My question was tabled on the assumption that the Health Service Executive service plan would be published this week. I am disappointed that we will not have an opportunity to discuss the plan before the end of the year. The inordinate delay in publishing the plan following the publication of the budget in October is unsatisfactory. Even if one tries to stretch credibility to the nth degree, the difficulty one has with the current HSE service plan is that it is again based on a series of assumptions and premises. When savings were identified in the original back-of-an-envelope estimate for the service plan announced by the Minister in October in the Estimates, it was evident that the Minister was again placing the health service on an unsustainable path in 2014. Officials in the Health Service Executive and the Department of Health have fought a rearguard action in the meantime and the Minister has pretended several times that he stood up to the Minister for Finance with great bravery. How can he expect to deliver health care without cutbacks to services?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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To respond to Deputy Ó Caoláin, I will raise the matter at the Committee on Procedure and Privileges this evening. According to Standing Orders, if questions are grouped, only the Deputy who tabled the first question in the group may introduce the subject.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In that case, the questions should be ungrouped. I am as entitled as Deputy Kelleher is to put my question.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I will deal with the issue this evening at a meeting of the Committee on Procedure and Privileges.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What about the questions before us?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I am not allowed to invite the Deputy to introduce his question.

James Reilly (Dublin North, Fine Gael)
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I have sympathy for Deputy Ó Caoláin. His question is as much a priority for him as Deputy Kelleher's question is for him.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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If the Minister does not wish to group Questions Nos. 1 and 2, he may answer them separately.

James Reilly (Dublin North, Fine Gael)
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I am more than happy to answer them seriatim.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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That is fine.

James Reilly (Dublin North, Fine Gael)
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To respond to Deputy Kelleher's comment on stretching credibility, I thought that was his party's forte. As for his comment about being on an unsustainable path, we have not only sustained the health service in the past 12 months but improved it, as demonstrated by the improvements in inpatient waiting times and the number of people who must endure long waits on trolleys. These figures are still too high and more needs to be done in that regard. I pay tribute again to the men and women who work in our health service on the extraordinary job they have done in the face of reductions of 20% in the budget and 10% in staff.

To respond directly to the question, the Health Service Executive-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Minister has 58 seconds left to reply.

James Reilly (Dublin North, Fine Gael)
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-----service plan will be laid before the Oireachtas at 10.15 a.m. In previous years, it was often presented at this time of year or later. The budget was announced earlier this year and while we face a challenging year in 2014 in terms of the finance available to us, we had very good news this morning when the ESRI issued its growth projections for the domestic economy. The country is looking forward with a real sense of hope, having emerged from the bailout. The health service can play its role in that regard.

I reject the assertion that we did not sustain a safe health service last year. Not only did we sustain the service but we made it better in terms of the impact it had on people and the long wait that many had to endure in the past. I again remind Deputy Kelleher that as recently as January 2011 there were 569 people on trolleys. The current figure is below 300 and we have achieved a 34% reduction in the number of people who endure long waits on trolleys.

Billy Kelleher (Cork North Central, Fianna Fail)
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There has been anything but a sustained improvement in the health service. For example, the number of people waiting for procedures has increased incrementally. The Minister referred to a 34% decrease in the number of people waiting on trolleys, and I accept that is the case, but he overlooks the fact that more than 380,000 are unable to see a consultant in a timely fashion. He informed me at the start of the year that he was not too concerned about this figure, as 380,000 people could be-----

James Reilly (Dublin North, Fine Gael)
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I did not say that. The Deputy should correct the record.

Billy Kelleher (Cork North Central, Fianna Fail)
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-----dealt with quickly given that more than 200,000 people are seen by consultants every month.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy should ask a supplementary question.

Billy Kelleher (Cork North Central, Fianna Fail)
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The problem is that there has been an alarming increase in the number of people waiting for consultants as those seeking to see consultants face inordinate delays. The Minister speaks of sustainable health services. He should acknowledge that inherent problems remain in the health services.

James Reilly (Dublin North, Fine Gael)
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The real problem is that the Deputy does not recognise the truth and engages in fantasy. I never said any of the words he uttered.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister said the figure was not a big deal.

James Reilly (Dublin North, Fine Gael)
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The Deputy should allow me to finish. We discovered that 380,000 people were on the waiting list. This is an issue that the Fianna Fáil Party in government ignored because it did not want to count the number waiting or tell people the truth. We were up-front in stating how many people were waiting.

I stated it was an awesome figure but that it had to be put in context because 200,000 outpatients were seen every month. We will deal with this matter in the same way as we dealt with that relating to inpatient waiting times, namely, by catering for those who have been waiting longest first. There are no longer 386,000 on the list. Since we first discovered this issue in March and counted and validated the numbers involved, there has been a huge reduction. We will be dealing with that issue in the context of a later question. I intend to deal with the service plan now.

The year ahead will be challenging. I am pleased that we were able to obtain some extra money during the course of the consideration of the validation process relating to some of the figures involved. This will reduce the need to examine the medical card issue. Frankly, I did not believe that was possible. I reassure Deputies that a figure of €23 million, not €133 million, will be sought on the probity side. This will allow people who are possession of medical cards to rest assured that those who are entitled to them will remain so entitled, that there will be no change to the eligibility criteria during the coming year and that the normal probity measures will be used when validating medical cards-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Minister must conclude. I will allow him to come back in.

James Reilly (Dublin North, Fine Gael)
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-----to ensure people have not left the country or moved on and that doctors are not being paid for services they are not delivering. I wish to make an important point.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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No, the Minister cannot do so. We are over time. I will allow him to come back in.

James Reilly (Dublin North, Fine Gael)
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I accept that, but this is a critical point.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I know it is, but the Minister can contribute again. There is a limit of one minute on these contributions.

Billy Kelleher (Cork North Central, Fianna Fail)
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As is the case each year, we are starting off by denying the reality. The Estimates relating to the two most recent budgets presented to this House were wholly unsustainable from the day they were published. I knew that, as did the Minister and everyone else. Obviously, however, those who operate the system were wandering around in a world of fantasy and pretence.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Perhaps the Deputy might ask a supplementary question.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the aftermath of drilling down, the Minister has accepted that €130 million in savings could not have been achieved on the probity side in the absence of the wholesale withdrawal of medical cards from swathes of vulnerable people. Now he is clapping himself on the back for reducing that figure. Either way, he must accept that from the beginning of 2014 he will be implementing cuts which will have a detrimental impact on front-line services and that a Supplementary Estimate will have to be introduced as some point. He is aware of that fact, even before 2014 begins.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Clocks were installed in the Chamber to allow Members to see how much time they had for their contributions.

James Reilly (Dublin North, Fine Gael)
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We had this discussion at a meeting of the select committee. The Deputy would like the world to believe that during his party's time in government no Supplementary Estimates were introduced in the area of health. Fianna Fáil-led Governments more than quadrupled the health budget between 1997 and 2009, but in 2010 the then Minister for Health and Children brought forward a whopping Supplementary Estimate of €595 million. The Deputy refers to Members on this side of the House engaging in fantasies. However, he has no sense of reality at all. What he is good at is the old Charlie Haughey trick, that "If I say it often enough, it becomes so." That is not reality.

Kathleen Lynch (Cork North Central, Labour)
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It is reminiscent of Pol Pot. History begins now.

James Reilly (Dublin North, Fine Gael)
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Exactly. The reality is that we are facing a very challenging year. The economy is recovering, but we must continue to consider ways in which we can operate more efficiently. I again congratulate the people who work in the health service on the great job they are doing and acknowledge that waiting times have been reduced. Hundreds of thousands of people had been awaiting inpatient treatment for longer than one year when I entered office. By the end of the year, it is hoped no one will be obliged to wait longer than eight months for such treatment. We will deal with this matter again later.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Minister accept that it is absolutely objectionable-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Will the Deputy introduce question No. 2? It is a separate question.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am dealing with question No. 2. Will the Minister accept that it is most unacceptable that Opposition spokespersons are dependent on purposeful leaks through the media in order to obtain some sense of the detail contained in the national service plan? I presume that detail will be formally announced later this morning. We do not have access to the relevant information. Such information should have been shared immediately on sign-off, particularly in view of the fact that it was leaked to the media yesterday in order that it might appear on the front pages of the newspapers this morning. We most certainly should have been made aware of the detail of what was contained in the plan. Does the Minister accept that to be the case and that the detail of the HSE's national service plan should have been announced in this Chamber?

The Minister has confirmed that €133 million, not €113 million-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy can come back in when the Minister has replied.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----and, therefore, that-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The 30 seconds allocated is for Deputies to introduce their questions rather than to make speeches.

James Reilly (Dublin North, Fine Gael)
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The HSE's national service plan will be placed before the Oireachtas, as required, at 10.15 a.m.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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After it was leaked to the newspapers and "Morning Ireland".

James Reilly (Dublin North, Fine Gael)
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The plan took quite some time to prepare on foot of the challenges we faced. However, we have managed to address many of the main issues of concern. This does not mean that we are going to have an easy year. In fact, it is going to be a very difficult year, but we will continue to work hard to implement the plan. I reiterate that I do not wish services to be cut; rather, I wish to see the cost of services being reduced. That is what the Government is about.

In the context of question No. 2, the service plan is comprehensive. I am prepared to offer those in opposition a briefing on it by the HSE. Obviously, the HSE will be briefing its own staff on it today.

As regards the plan, we have done as good a job as possible in protecting existing services and developing new ones. I look forward to implementing the plan which is heavy on reform during the course of the coming year. We are using the good offices of the HSE to bring forward many of the reforms on an administrative basis in order that the legislative process will have an opportunity to catch up. In addition, we will be in a position to learn from the administrative side about some of the fine tuning which may be necessary in the context of the legislation we will ultimately introduce.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The director general of the HSE, Mr. Tony O'Brien, has calculated that 225,000 medical cards equates to €44 million in cuts under the so-called probity heading. If one extrapolates from this on the basis that the Minister had adhered to the €133 million cut, some 675,000 medical cards would be taken back in 2014. The reality is that on the basis of the director general's calculation and the figure of €23 million, there will be a reduction of between 112,000 and 115,000 medical cards next year. What I am saying is based on figures contained in the director general's letter to the Minister. How can the Minister state what is being done is a success? The people involved are already suffering. I am aware of this as a result of individual cases on which I have made representations. The Minister cannot take any comfort from the fact that there is going to be untold suffering, of which evidence is already emerging, in this area. Regardless of what the eventual figure might be, what are the prospects for the people involved in 2014? What can he say that will offer them any comfort as they face the loss of their medical cards in the coming year?

James Reilly (Dublin North, Fine Gael)
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I do not know whether there is something wrong with the air filtration system in the House. Again, a Deputy opposite is stating I referred to something as being a success. I never used that word; rather, I stated it was going to be a very challenging and difficult year. I never described anything as a success.

Billy Kelleher (Cork North Central, Fianna Fail)
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The word was on the tip of the Minister's tongue.

James Reilly (Dublin North, Fine Gael)
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If, in the context of the substantive question posed by Deputy Caoimghín Ó Caoláin, one averages out the cost of a medical card at €1,000 and if one is purely going to remove medical cards on that basis, it might not be unreasonable to assume that 113,000, 115,000 or 133,000 medical cards might be taken back. Of course, there will be many other factors involved when the implementation process takes place. As I have stated elsewhere, I know what probity means and I am aware that it does not involve changes to policy or eligibility.

Probity means ensuring that those who are entitled to medical cards have them and that those who are not entitled or are no longer entitled to them do not have them. It also means ensuring that the fees claimed by doctors, pharmacists and dentists are appropriate, right and proper.

I expressed concern at the outset about the possibility of achieving that level of saving with just a probity measure, and I made it very clear that there would not be a policy change. I can stand here and, with absolute certainty, reassure people who have medical cards, which is nearly 2 million people, that they have nothing to worry about.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Minister is over time.

James Reilly (Dublin North, Fine Gael)
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The normal probity measures will continue in terms of regular checks. If we did not do that, we would be held to account for it in the Committee of Public Accounts.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Does the Minister not accept that it is unacceptable that the opposition spokespersons on health will not have the opportunity to address the detail of the national service plan until after its introduction and implementation from 1 January next? The plan is for the calendar year of 2014.

With regard to provision for the roll-out of the bilateral cochlear implant programme, speculation in the media this morning cites a figure of just over €3 million. Is that not on the low side, given the possible cost of introducing the bilateral programme? How many young people will be seen in the course of 2014, given that the window for young people who are challenged by hearing loss is limited as time passes? There is provision of approximately €500,000 in respect of narcolepsy and the victims of Pandemrix. What services will that provide?

To conclude, it is really unacceptable that the Minister is circulating this plan at 10.15 this morning. We should have had the plan at 10.15 p.m. last night, at the latest, to prepare for detailed questions to the Minister.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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As for the Minister's claim of success, he should read the newspapers. He does not have to say it when his spin doctors are suggesting that this was a victory for the Minister over the Labour Party-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This is Question Time, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----with that party claiming, in turn, that it was a victory over the Minister. The Minister should look to his colleagues beside him who are quoted in the newspapers this morning.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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From now on I will strictly adhere to the rules. It is unfair to other Deputies if somebody takes up all the time. We have spent 22 minutes on two questions, and we are supposed to spend six minutes on each question. The Minister has two minutes to answer and there is one minute for a supplementary question by a Member after the reply. That is the rule. Otherwise, it is unfair to other Deputies whose questions are not reached. The Minister has one minute to respond.

James Reilly (Dublin North, Fine Gael)
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With regard to the last point raised by the Deputy, who manages to work himself up into a great state of indignation, both parties are very concerned about any distress being caused to medical card holders regarding uncertainty about their cards, and both parties were eager to address this. I sought the validation process, as the line Minister, because I am closest to it and understood that there would be real difficulty in achieving the type of saving that was apportioned. Following a validation and examination by the Department of the Taoiseach and the Department of Public Expenditure and Reform, with my colleague, Deputy Howlin, we concluded that this would not achieve the types of saving mentioned, so we have approached it from a different point of view. There is no question of victory of one over the other. This Government is here to serve the people. It is not about trying to score points.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We will move to Question No. 3 from Deputy Maureen O'Sullivan.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What about the bilateral cochlear implant programme? Is the Minister in a position to answer that?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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No, he is not. Deputy Maureen O'Sullivan has been called.