Darragh O'Brien (Fianna Fail)

I welcome the Minister. I do not think I have had an opportunity before now to congratulate him publicly, although I have done so personally, on his elevation, as one north County Dublin man to another. He now understands how difficult it is to be Minister for Health and perhaps he has some sympathy for his predecessor, Mary Harney, on whom he was particularly hard from time to time, although it was sometimes justified. He should always bear this in mind.

I have some questions for the Minister. However, I would like to start on a positive note. I very much welcome the additional €35 million and 400 staff in the mental health sector, an issue we discussed with the Minister of State, Deputy Kathleen Lynch. This is crucially important. I am glad to say that, as the Minister will agree, the former Minister of State, John Moloney, did good work in this regard; it is important to highlight this fact. There is also €20 million for primary care services and €15 million to continue the GP visit card system which is a good initiative, as well as €25 million for further progression of the national clinical programmes. These are positive steps. I understand the Minister's job is a difficult one, as there is no silver bullet for the health service.

The Minister has mentioned the €750 million reduction in his budget and that the number of retirements from September up to the end of this month will total 4,000. He has said he will reassess the position at the end of February, which is probably the right thing to do, but I am concerned about the effect on front-line services. We must consider being more targeted in protecting front-line services, although I know the Croke Park agreement does not allow this. It was the Minister's mantra when he was in opposition - I consider that he was correct - but I would like to see more action from him in government.

One striking aspect of the Minister's statement is the lack of a mention of private hospital consultants and the issue of consultants' fees. That is a nettle that needs to be grasped. The lack of 24 hour, seven day a week coverage in hospitals is the elephant in the room. The Minister and I both know the number who remain in our local hospital, Beaumont Hospital, at the weekend because there is not enough cover to allow them through the system. The special delivery unit will deal with only one element of the problem, the accident and emergency unit side. If we are treating the health service seriously, as we all are, we must grapple with the issue of hospital consultants' fees and, more generally, the issue of private fees.

I fundamentally disagree with the Minister on the issue of a universal health system - not necessarily with what he is trying to do but with what is being achieved. Effectively, middle Ireland can no longer afford private health insurance. We all know this and the figures bear it out. We will have a one tier system much sooner than the Minister might believe. We all aspire to this, but we will have a one tier system on the basis of the thousands of people who continue to leave the private health system. I put it to the Minister that the public health system is not fit for purpose in taking on the additional procedures. I would like to hear his view on how we will manage this. More than 140,000 people who cannot afford private health insurance are moving away from that system. How will the public health system deal with this?

We previously considered matters such as elective surgery. The Minister has said much about the SDU and I agree it has done good work on the issue of trolleys, but the NTPF previously had an average waiting time of three months for elective surgeries and that is now being pushed out to nine months under the service plan.

What was the difference between the service plan the Minister rejected on 5 January and this service plan? Were there fundamental differences? Fergal Bowers might have been a little unkind in describing it as somebody writing a letter to themselves to complain about themselves when commenting of the rejection of the service plan on 5 January, but we need to know if there were fundamental differences in the plans.

The Minister has given a commitment time and again that the smaller community hospitals will remain. Throughout the country, however, there is a different sense about what is happening. Under the plan a maximum of 898 beds could be closed this year in community nursing homes. That is an 11% cut in public residential beds. We need more clarity on this. Every week, another figure is blowing around.

I know the Minister is aware of the issue but I am also concerned about the further downgrading of HSE nursing homes and the services they provide. Specifically, there is a proposal that all cooking facilities will be off-site at Lusk nursing home. Food will be delivered the day before for elderly patients and reheated in the nursing home. This is a grave concern. The Minister, as a doctor, is aware of the importance of nutrition for sick and elderly people. I hope this proposal is not the thin end of the wedge with regard to moving food preparation and cookery services out of HSE nursing homes altogether and centralising them through mass-produced products. I do not expect the Minister to comment specifically on that today but I ask him to use his good offices to assist in the case of Lusk nursing home.

It appears we are facing another 100,000 applications for medical cards over the next year or so. It is a fact - and none of us believes the HSE - that the applications are not being processed within eight weeks. The system is not working and we know it. I was sick to my back teeth asking the previous Minister about this. The review and renewal of medical cards is absolute nonsense. People have ailments that everybody knows will not be cured, yet in many instances their medical cards are being reviewed every 12 months. That is adding to the paperwork within the section. It makes no sense and is slowing down the approval of new medical cards. There have been some awful cases, and I am sure the Minister has encountered some in his constituency office and has views in that regard. Can he confirm whether he believes the HSE's claim of a four to six week turnaround on new medical card applications? It is not happening.