Mary Harney (Dublin Mid West, Progressive Democrats)

The possibility of a pay pause because of the economic situation was mentioned. There is a pay pause in the public sector. An 11-month pay pause was agreed as part of the national partnership talks. However, as we are all aware, the economic situation has deteriorated rapidly since that agreement. Every possible option for the public finances should be on the table. The more that can be saved on pay, the more there will be for services. Most reasonable people take the view that we must examine redundancy proposals. The Taoiseach established a task force to examine public sector reform. I understand it will submit a report in the coming weeks which will form the basis of a reform agenda for the public sector during 2009. The Minister for Finance is the Minister with responsibility for the public sector, however as many are aware I am open to making changes in public sector numbers to facilitate scope for services to the public.

The issue of drugs is a matter for clinicians to advise. Dr. Michael Barry, head of the National Centre for Pharmaco-economics, St. James's Hospital and Trinity College Dublin, was appointed to a group, including clinicians, to make recommendations. The group will report to me by 1 December next. The group and I had a long meeting yesterday. Dr. Barry is positive about the scope for considerable savings on this matter, as are many pharmacists.

I refer to Senator Quinn's question. Much work in Ireland in recent years has involved providing support at home for older people. There are 10,000 older people supported at home with the clinical home care package. This support package includes the provision of public health, nursing, physiotherapy, occupational therapy and so on. In the past these services had to be provided in hospitals. The emphasis of rolling out primary care teams is on providing support in the community outside of hospitals, which are the most unfriendly places for the provision of services. The same applies to home help hours. Some 53,000 people receive home help support, many of whom are older people. We wish to continue to maintain as many of these packages as possible. The option was to leave the medical card schemes as they are or tear to pieces home help services and home care packages and forget the strategy of gearing up. It was not a question of taking the action just for the sake of it.

We examined many choices. There was an option involving prescription charges. Some doctors suggested the possibility of a small prescription charge. We took the view that it would be wrong to charge for essential medicines, especially for poorest people, although several general practitioners suggested it was a good idea and such schemes operate in many other countries. We examined the option of changing the long-term illness scheme. This involves a card given to people with certain illnesses regardless of means. It would apply to people with very serious illnesses. The cost of this scheme amounts to €160 million and we took the view that we should not interfere with it. This decision was taken after much debate and discussion at many Cabinet meetings.

I refer to the question on frontline services. When people discuss frontline services the assumption is that there should be no change in staff ratios. There is a very high nurse to patient ratio in Ireland. It is twice the nurse to patient ratio in France and we do not have appropriate staff to patient ratios. Consider the cost of changing staff ratios in health care. Some 80% of the cost of health care is wages, which we could not touch next year. Therefore, any reduction to the €700 million to which I referred must come from the remaining 20%. That is why it appears the change in plans for the human papilloma virus, HPV, vaccine is one such proposal. That is the reason such changes appear very severe. However, I must cut €700 million from 20% of health spending and this involves making tough decisions, which I accept.

Health issues are a daily part of the national debate. Following the decision on the provision of the HPV vaccine announced yesterday, there was an implication in the other House this morning that the timing of the announcement was because of the election in the United States of America. However, it was announced yesterday because Deputy James Reilly asked a question and the RTE health correspondent made phone calls on the matter. We wanted to be honest. It was not a question of hiding the fact that it was going to happen. There are two companies involved with great public relations machines and the matter would not have gone under the radar. I say this in case there is an assumption that the announcement was related to the USA elections.

We will not change the structure of the HSE. Consistency of support is one of the reasons the HSE is important as a national organisation. Senator McFadden mentioned public health nurses dealing with ulcers. In some places they only deal with leg ulcers if the patient has a medical card. There is a view in other places that such treatment should be dealt with on the basis of need. We seek services based on the needs of the patient, especially given the new primary care strategy. The HSE must change the way in which it is managed and there must be clear lines. This point surfaced in the Fitzgerald report on the Midlands Regional Hospital, Portlaoise. There must be clear lines of accountability, which is possible in a unified organisation. This is the process Professor Brendan Drumm, to be fair to him, has undertaken in the past year through significant internal organisational efforts, the likes of which never before happened in the country on such a scale. Professor Drumm made announcements on this matter which will be put into effect in the coming months.