John Moloney (Laois-Offaly, Fianna Fail)

I thank Senators for the opportunity to conclude this debate. A number of the issues raised are specific to my Department, but I should respond to those raised in the past few minutes.

Senator Healy Eames made a case. Least of all, I must acknowledge her concerns. As we are all aware, all Departments, including the Department of Health and Children, are operating under budgetary constraints. It is important to point out that, although this is the case, safety and patient care must be to the forefront. As we approach the forthcoming budget, we are all aware that we are discussing a saving of €600 million within my Department. It is important to recognise that cuts and reductions apply across the regions, not just the west. I do not say this in a flippant manner, as I fully appreciate people's concerns. I cannot dispute the figure of 29,000 people because I am not aware of it, but I accept the bona fides of what has been mentioned.

Like the Senator has always done, I accept that the call for reducing the number of administrative staff, which is often made, is a popular one. I have never been one to believe in that call, given the obvious case for the importance of medical records and backup facilities. However, I must reiterate that the Government's intention is to maintain patient safety levels and present the best level of service.

I will refer to the specific points raised regarding the west and budgetary issues. At the end of July and based on a projected estimate to year end, the HSE identified a potential excess in HSE west of €65 million. It is important to point out that this has been represented as a substantial reduction on the excess of €133 million projected two months earlier. Obviously, continued management of expenditure is demanded.

I do not want to separate the concerns of people representing the west, but HSE west and the health sector unions signed a framework document at a Labour Relations Commission hearing in August agreeing to engage with one another in addressing the budget deficit while protecting services and jobs, which is the most important commitment. This agreement offers the best approach to meeting the health care demands of the people of that and all regions.

Notwithstanding the considerably difficult financial environment in which we live, the Government is determined to do everything possible to protect patient services. It is important that we respond to priority demographics and other needs and support ongoing reform of public services throughout the regions. Without co-operation and flexibility, services to patients cannot be protected. There is a responsibility on everyone concerned to live within our budgets and these are the budgets that have been allocated.

We should all work together to protect patient safety. While I am taken by Senator Healy Eames's reference to Dr. O'Keeffe, it is the Government's responsibility to protect patient safety. This must be the underlying commitment and all talks on funding and budgetary requirements will be based on it.

Points were raised about my area of responsibility, the disability sector and the withdrawal of respite care services. When the threat of withdrawal was visited on doors several months ago, I made it clear that it was never the Government's intention to cut respite care services. The notion of reducing funding and, potentially, services in the west was not dictated by the Government. The priority was to retain and support front-line services. Following the meetings held in May and June, I asked the director for disability services and local health managers to engage with all groups to ensure the threat of reduced funding would not lead directly to reduced services, including respite care. I will meet the national umbrella group tomorrow with a view to putting this in train.

The disability sector receives €1.6 billion in funding, rightly so. Hwever, the real challenge is to ensure the money is spent wisely. I put together a value for money process over a year ago - not because of the demonstrations which took place two months ago - to ensure money given to the disability sector was spent on front-line services. I am often challenged to explain what the value for money review group is doing. Essentially, its purpose is to ensure we provide front-line services and that money is well spent. The underlying commitment I have given on behalf of the Government is that whatever is saved through the review will be retained for the disability sector. In case somebody does not believe me, I have copper-fastened my commitment by nominating two people involved in the disability sector to the review group. The delivery of services in the disability sector is not reliant solely on the outcome of the value for money review. Before the end of the year I will also be presenting a paper to the Government on direct or individualised payments. I will also suggest the possibility of providing funding through fostering to allow a choice of services.

I hope I have put to bed the notion that the Government is withdrawing respite care services. As a result of the difficulties experienced several months ago, talks are ongoing with all the service providers and will culminate tomorrow.

Deputy Twomey has gone overboard in his comments about not trusting the HSE. The service cuts unfortunately required owing to budgetary restraints in all Departments will apply in Wexford as in the west or the constituency of Laois-Offaly. I presume the Deputy was referring to the capital programme for mental health services, as well as the reconfiguration of services.