Colm Burke (Fine Gael)
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I welcome the Minister of State to the House.

Trevor Ó Clochartaigh (Sinn Fein)
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Sinn Féin opposes the further restriction of this scheme leading to thousands of older people losing their medical cards. This section will reduce the income threshold for assessment for an over 70s medical card from ¤700 per week to ¤600 per week for a single person, from ¤1,400 per week to ¤1,200 per week for a couple. Those in the ¤600 to ¤700 weekly income bracket will be assessed for an over 70s GP-visit card, which is a very different class of entitlement. We believe that this is a regressive move and we are opposed to it. We also believe that it is very short-sighted, because people will, having lost their medical card, now avoid accessing health care where they might once have been more willing to do so. This will likely mean poorer health outcomes and require more hospital visits, inpatient care and residential-nursing-home care, which will lead to increased costs to the State in the long run. We also know that it is not only the over 70s whose entitlements to medical cards are being scrutinised and cut back - it is happening right across the board, anywhere there is any question at all. It is the over 70s now, what will be the next category?

The Government is taking a very different approach to that which its parties took during the general election campaign. I ask the Minister of State to enlighten us on what progress we are making towards a universal health system. What progress are we making towards issues such as the commitment to ensure that access to primary care without fees would be extended in the first year to claimants of free drugs under the long-term illness scheme at a cost of ¤17 million? There was a commitment that access to primary care without fees would be extended in the second year to claimants of free drugs under the high-tech drugs scheme at a cost of ¤15 million, and that access to subsidised care would be extended to all in the next phase. No progress has been made in that regard.

John Gilroy (Labour)
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On a point of order-----

Colm Burke (Fine Gael)
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We are dealing with section 3 and there is no amendment in that section.

Trevor Ó Clochartaigh (Sinn Fein)
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I am opposing the section because it relates to the broader issues in the health sector.

Colm Burke (Fine Gael)
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The Senator should speak to section 3.

Trevor Ó Clochartaigh (Sinn Fein)
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Cuirim fáilte roimh an Aire Stáit. Ar ndóigh, táimid i Sinn Féin i gcoinne na hathruithe atá an Rialtas ag iarraidh a thabhairt isteach maidir leis na cartaí leighis. Is léir dúinn go bhfuil na ciorruithe breise atá an Rialtas ag cur i bhfeidhm éagórach agus mícheart. I have made the general point I intended to make. Sinn Féin opposes this section and also opposes the Bill in its totality. We have been consistent in calling for universal health care and this goes against that general principle of universal health care. We very much regret the Government's decision and will be opposing it.

Alex White (Dublin South, Labour)
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The Senator has not explained how he is of the view that the section goes against the principle of universal health care. He merely asserts it, as his colleagues have, without explaining it. If he reads the section he will see that it does not go against the principle of universal health care. As he has acknowledged - although he seems to fail to recognise the implication of his words - he correctly informed the House that persons who lose access to the full medical card will nevertheless have access to a GP-visit card. All such persons will have access to a GP-visit card. Therefore there is no consequence along the lines the Senator asserts.

The Senator then continues to make the argument - I am not sure I fully understand it - that it will mean that persons, who lose the full medical card under this legislation, will avoid accessing, for example, their GP. There is no basis to that argument which is completely fallacious because they will have the GP-visit card. In order to respond properly to the Senator I would need some clarity from him as to why he is making the assertions he is making. The GP-visit card will be there for all persons affected under this legislation by the changes to the eligibility limits the Senator has read out.

I addressed the issue of progress generally in respect of free GP care yesterday on Second Stage.

John Gilroy (Labour)
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Which was more appropriate.

Alex White (Dublin South, Labour)
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Today we have Committee Stage and of course questions of order are a matter for you, a Chathaoirligh, and not for me. However, I simply point out that I addressed that issue yesterday. It remains a commitment of the Government to extend free GP care to all in the community by the end of its term of office. I do not say that is necessarily a particularly easy task. I accept it is a big task for the Government. It is true that the particular route the Government agreed early on in the programme for Government - the long-term illness, LTI, then the high-tech followed by the subsidised GP care - has not in fact been taken to its ultimate end, which is to extend GP-visit cards to all in the community. However, it is being actively pursued by the Government and very actively pursued by me.

Trevor Ó Clochartaigh (Sinn Fein)
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I thank the Minister of State for his response, which does not surprise me. It is clear to those on the ground that those who do not have the full medical card are afraid of going to the doctor and the cost of going to doctors and the worries of the treatment that might have to follow is an issue for them.

John Gilroy (Labour)
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On a point of order, with the Chair's permission, may I try to ascertain what this speech has to do with the section under consideration?

Colm Burke (Fine Gael)
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Senator Ó Clochartaigh is entitled-----

John Gilroy (Labour)
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He is entitled to speak to the section.

Colm Burke (Fine Gael)
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He is entitled to respond to the Minister of State.

John Gilroy (Labour)
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Only to the section.

Trevor Ó Clochartaigh (Sinn Fein)
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I can understand how Senator Gilroy might not want us to raise these issues because they are issues of serious contention to the general public. Any curtailment of this, and the fact that the Minister is looking at those over 70 who worked hard over the years and taking away the medical card from them, is a retrograde step.

My party made pre-budget submissions about other choices that could have been made as opposed to these cutbacks. The Minister of State can dress it up as he likes, but this is a retrograde cutback and my party will oppose it wholeheartedly.

Marc MacSharry (Fianna Fail)
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My party will also oppose it.

As the Minister of State correctly stated, we made many of these points on Second Stage. I do not believe one should be so touchy about Senators making points on Committee Stage. The practice is that Senators can make points as often-----

John Gilroy (Labour)
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Perhaps it is the reason the House will be abolished, that we are not doing our job properly.

Marc MacSharry (Fianna Fail)
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I would say the attendance today would be more relevant to the abolition than the contribution.

Trevor Ó Clochartaigh (Sinn Fein)
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On a point of order, Senator Gilroy cast aspersions about the professionalism of statements that we are making in these Houses and I would ask him to retract them.

Colm Burke (Fine Gael)
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It is not a point of order.

Marc MacSharry (Fianna Fail)
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We made the points yesterday. The section is wrong. We did not table all the amendments my party tabled in the Dáil where they all were ruled out of order, which was regrettable. It will be on the sections we will speak and some of those points will be general.

The Bill is regressive. It creates a lot of fear for those who will lose the medical card. Some, arguably, will not go the doctor. On his experience as a medical doctor and in opposition, the Minister, Deputy Reilly's, own assertion was that basic increases of 50 cent on a prescription charge would potentially stop persons from going to the doctor to get drugs and medicines. That is the opinion of a physician, not somebody merely trying to score a political point, although he could certainly have been accused of that on many occasions. If the Minister will say we are taking away the medical card and one will have the drugs payment scheme, nevertheless, there has been a trebling in the cost per item that must be paid.

It would also seem that the Bill gives the Minister the power to decrease the criteria for eligibility without an Oireachtas vote.

Colm Burke (Fine Gael)
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This was clarified yesterday.

Marc MacSharry (Fianna Fail)
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I would like it clarified again, if that is okay. In section 7, we will be dealing with-----

Colm Burke (Fine Gael)
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We are confining ourselves to section 3 at this stage. If Senator MacSharry wants to comment on section 7, he can come back on it.

Marc MacSharry (Fianna Fail)
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We will be dealing with it shortly. The Minister of State can clarify that but my party will oppose the section.

John Gilroy (Labour)
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It is important that we act responsibly and the words we use are those of responsible Senators. There is no question that we are introducing fear of persons losing their medical cards in the sense that Senator MacSharry has casually mentioned there. This is a targeted measure aimed at those who have pension funds, perhaps to the value of ¤650,000, who will also benefit from GP only cards and the prescription scheme. It is important that the message does not go out of this House that we are removing medical cards from those who are in bad need and the most vulnerable sector of society.

Alex White (Dublin South, Labour)
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At the risk of my own colleagues wondering why I would put it this way, I will say it anyway because I believe it. There is fear across the community in society, not only in Ireland but internationally. Unfortunately, there is much basis and reason for fear. One should not create fallacious fear. The Senators here can read the Bill as well as anybody else can. We all are intelligent persons here. There is no point in Senator Ó Clochartaigh stating that those on the ground see it differently. If he will make points that are not true about the Bill, then they might see it differently.

Let me put it another way. There is plenty to criticise for the Opposition, for the Fianna Fáil Party and for the Sinn Féin Party, but they should not be criticising what is not there. They should stick to the criticisms that they can make because in a period of financial constraint and retrenchment, a Government does much that it would prefer not to have to do and is exposed to criticism in a democracy, and in Parliament. It is expected that such criticism would come from the Opposition and it is correct that it should but they should stick to the points that are factual. As I stated, there is plenty that they can find which is accurate and where there is a basis for criticism besides trying to find points that are not there.

It is not a question of me dressing something up. I am simply making the point, clearly and factually, that it is manifest in the Bill - this is not my interpretation or a general view - that persons who looses the full medical card will have a GP-only card and will have access to the drugs payment scheme, DPS. It means that the net loss, if I can put it that way, to somebody who is affected by this legislation would be ¤144 a month or approximately ¤36 euro a week because the system will pay for their drugs above that limit.

I would appeal to colleagues to stick to what is in the Bill rather than trying to create fears where none exist. Even though there may be a basis elsewhere for concern, there is no basis for concern on the part of Members in this House or others that persons will lose access to their GPs as a result of this legislation.

Sean Barrett (Independent)
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I move amendment No. 1:

In page 9, lines 47 and 48, to delete all words from and including "Insofar" in line 47 down to and including "Executive," in line 48.

It should be noted from this amendment that I am not seeking, in this subsection, the deletion of the following: "a choice of medical practitioner shall be offered under the general practitioner medical and surgical service made available under this section." This is a commitment that the House made, as the Minister acknowledged in debate yesterday, as a response to the IMF programme to open up the general medical service to new medical entrants. Yesterday I put on the record some numbers of persons earning ¤700,000 plus. We wanted to get new graduates, many of whom had to emigrate, to be allowed to practice as GPs. That was earlier recommended by the Competition Authority. It is the express wish of this House, in legislation, that such is what we wanted.

There is an absolute requirement that the Minister allows new graduates to take up their places. The Health (Provision of General Practitioner Services) Act 2012 opens up access to GMS contracts to all fully qualified and vocationally trained GPs, and there will be no limits on the number of contractors. Section 2 of that Act provides that the Health Service Executive will be entitled to enter into a GMS contract with any suitably qualified and vocationally trained general practitioner and will not be limited to granting contracts in cases where a GMS contract holder has died, retired or resigned or where the contract has otherwise been terminated. Section 5 of that Act, most importantly, provides that the HSE, when filling or creating a GP position, will not take account of the short-term or long-term economic viability of that or of other GP practices.

Why has this provision been included? These obligations are to be met in so far "as it is considered practicable by the Health Service Executive". While I have much less experience of the House than the Minister of State, Ministers have not stated in my time in the House that the Revenue Commissioners will collect tax, the Garda Commissioner will investigate crime or the Minister for Education and Skills will provide primary school places in so far as it is considered practicable to do so. The Health Service Executive was given obligations by the House as part of the agreement with the International Monetary Fund. A service must be provided from the wide range of new graduates, rather than by those on salaries of ¤700,000 per annum. I am not interested in whether the HSE considers this practicable or not as it has a duty that was imposed on it by Parliament.

We referred to legacy issues yesterday. Senator Crown's Bill on smoking disappeared into the Department and has not been heard of since. Similarly, his Bill on the practice of uninsured medicine has also disappeared. The Department lost a case on health insurance in the Supreme Court by a unanimous decision of the court and lost a case on the same issue in the European Court of Justice. I do not trust it when it states a choice of doctor will be available "insofar as it is considered practicable". This is the law and the Department must adhere to it. The Department has a record of showing disregard for the wishes of Parliament. This is a legacy issue rather than one that has arisen in the Minister of State's time in office.

I do not know the reason this provision has been included in the Bill as I have never seen another Minister invoke a similar provision. We decided, and it is internationally agreed, that there will be a general practitioner service with a choice of doctor. This is not at the discretion of the Health Service Executive or any official. I am worried generally about the extent to which officials dictate to the Government. Elected Members made a commitment in the House and it would not cost much to meet it, particularly when compared to the ¤700,000 or more we pay to certain general practitioners. I do not know why this subsection is in the Bill.

I supported the Government's position on the new income arrangements. Why should we seek to renege on a commitment by using the weasel words "insofar as it is considered practicable"? The HSE does not have a great record. Parliament should determine these matters and I hope the Minister of State will agree to remove the section. This is an obligation incurred as part of an international agreement and attempts to change it in this section come from a Department that does not have the happiest of relationships with the House. It is time the House asserted itself.

Alex White (Dublin South, Labour)
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I do not propose to accept the amendment. There is no intention to roll back or renege on the position as set out in the 2012 Act, nor will it be the effect of section 7(9). I understand and accept the argument Senator Barrett made yesterday on the opening up of the system. He made some compelling points with which I agree and which were properly dealt with through the legislation to which I referred. There is no question of that Act being rolled back or in any sense reversed by anything in this Bill.

The Senator is concerned that the section may, even inadvertently, repeal or roll back the 2012 measures. I understand his remarks to suggest that it is almost the intention to do so. I assure him that this does not constitute a backsliding from the measures taken in 2012 to open up general medical service contracts to any fully qualified general practitioners. The provisions of the Health (Provision of General Practitioner Services) Act 2012 are not affected by the subsection. As I stated, the 2012 Act opened up access to GMS contracts to all fully-qualified and vocationally-trained general practitioners, subject to general suitability criteria. No limits have been set on the number of GP contractors.

The Senator will be aware that previously there were three routes for entry into the GPS scheme. These were: where a vacancy arose due to the retirement, resignation or death of an existing GMS doctor; where a new GMS panel was created in response to an identified need for an additional doctor in an area; or where a GMS doctor obtained approval from the Health Service Executive for the creation of an assistant with a view to partnership within his or her practice. Previously the HSE was required, before filling a vacant GMS panel or creating a new panel, to take account of the potential viability of the panel and the viability of existing GP practices in the area in question. Under the 2012 legislation, new GMS contract holders are free to establish their practice in the location of their choice. There is a caveat that, once established, any GP contract holder who wishes to move location will only be able to do so with the prior approval of the HSE. This provision is designed simply to ensure continuity of GP care for patients. To date, 114 general practitioners have obtained a GMS contract under the Health (Provision of General Practitioner Services) Act 2012. There are in the region of 2,400 GPs with GMS contracts in total.

I understand the Competition Authority has expressed the view that the new arrangements are having a very positive effect. The authority is reported to have seen evidence of doctors advertising their services and prices, as well as greater moves in terms of innovation in pricing among GPs, which is also a positive change. The new open contractual arrangements between general practitioners in the GMS scheme are not affected by section 7(9). The subsection deals with the relationship between the patient and general practitioner. The language ensures that as far as practicable the HSE will arrange the general practitioner service with the GP of choice by the individual. However, we cannot guarantee that the individual will always get the GP of his or her choice. This is the reason for the provision. It could happen that the general practitioner of choice is unwilling to take on a new patient because he or she already has too many patients. In general, GPs are not supposed to have more than 2,000 GMS patients.

I am concerned that the Senator's amendment would inadvertently engender an inflexibility and impracticality in the delivery of general practitioner services by the Health Service Executive and general practitioners. It is for this reason alone that I do not propose to accept the amendment.

Paddy Burke (Fine Gael)
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Is the amendment being pressed?

Sean Barrett (Independent)
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I will seek, on Report Stage, to incorporate some measure to deal with the misgivings I have, which were echoed to some degree by the Minister of State. Choice is to be provided by the new graduates. I wish more than 114 doctors had joined the 2,400 doctors on the General Medical Services scheme because we hear stories about the emigration of young doctors. To take the Minister of State's example where a doctor X has 2,000 patients, surely another doctor would be available in such circumstances. The Minister of State referred to a choice and I am keen to preserve the principle of choice. The list showing that some general practitioners earn ¤500,000 or ¤700,000 per annum from the GMS scheme also indicates that some of the doctors in question employ two or three doctors. Why can these doctors not engage with patients in their own right? I am worried the Department is using the phrase "insofar as practicable" as a means of reneging on a commitment because that is, unfortunately, a tradition in the Department. The Chief Justice of the Supreme Court referred to a Department which sought to usurp the function of the Oireachtas. Choice is not expensive to provide in this case and it should be available. If a list is full, let us find another doctor. I will consider over the weekend whether I will be able to draft a Report Stage amendment to address this matter.

Paddy Burke (Fine Gael)
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I understand we are dealing with all Stages today.

Sean Barrett (Independent)
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I thank the Cathaoirleach for clarifying the matter. I will press the amendment because the track record of the Department in dealing with the House makes me reluctant to trust it to operate the provision. I do not know the reason it asked for it to be included.

Colm Burke (Fine Gael)
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One of the reasons it is in there is for situations where someone does not accept any medical service that is offered to them. This is to prevent a situation where someone expects a utopia that no Department or Minister can deliver. This arises in the education and health systems where people are not happy no matter what is offered to them.

Alex White (Dublin South, Labour)
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I understand the Senator's concerns but I respectfully suggest that they were addressed in the 2012 Act. The operation of that Act is beginning to bear fruit. Everything is related but the right of access into the system of newly trained GPs was addressed in the 2012 Act and this section is perhaps not the vehicle to address that issue. If the Senator was concerned the 2012 Act had not gone far enough or that undue restrictions remained on entry into the profession, or that the 2012 Act might benefit from further review in future, that would be the context in which to do that.

The duty imposed on the HSE by the Oireachtas in section 58 of the Health Act 1970 is to make available without charge a general practitioner, medical and surgical service. The duty imposed on the HSE by the Oireachtas is to provide a GP service, not a specific GP. We discussed legacy issues yesterday and people might be concerned but there is no question of disrespect being shown to the Houses of the Oireachtas here and that we are attempting through the use of phraseology such as "insofar as it is considered practicable" to give wriggle room to the HSE not to carry out its duties. That is not the case. If I thought it was a way to facilitate backsliding on statutory responsibilities, I would have a serious problem and would not present this legislation to the House.

We are addressing the Senator's concerns. We are all concerned about this as public representatives. We have addressed the issue of access to professionals in the 2012 Act, which is the correct vehicle for dealing with that issue and this does not represent any change or reneging on that commitment.

Sean Barrett (Independent)
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I appreciate what the Minister says but why is the Department looking for this? Why does it want to get out of a commitment on the grounds that it does not consider it practicable? I do not know what the difficulties are. I am worried about the way the smoking Bill disappeared and the practice of uninsured medicine Bill disappeared. The Department has serious cost overruns and it needs to improve its image. I would not like to give the Department any loophole that it can only give a person a choice of medical doctor "insofar as it is considered practicable". This is not something I want to see in the law because it could be availed of to deny people a service. It comes on top of a number of issues I have raised and I am not willing to give the HSE that sort of leeway.

Sean Barrett (Independent)
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I move amendment No. 2:

In page 10, subsection (3), line 24, after ?Commissioners.? to insert the following:?The Revenue Commissioners shall be the designated primary body for the conduct of means testing in the State.?.

I will not press the issue unduly but we all should look at administrative processes that lead to duplication and waste. We want the money to reach the target group and not to be spent on administration. Perhaps the Minister of State will relay to the Cabinet the view in the Seanad that we should streamline means testing and income declarations in a single facility using modern technology.

Trevor Ó Clochartaigh (Sinn Fein)
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I support Senator Barrett on this. It is not the first time he has brought a very good idea to the Seanad and his thoughts on this have a great deal of merit. We have seen other scenarios where people who are entitled to tax clearance certificates have difficult obtaining them. There should be a single Government body to carry out means tests and assess liabilities so other Departments can check with that body to see what category a person falls into. It is inherently logical and is a positive suggestion I commend. Senator Barrett often brings such fresh thinking to debates in the Seanad.

Marc MacSharry (Fianna Fail)
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I also support the amendment. The information is available and while it would require an amendment to the Data Protection Act to allow for the sharing of information, the fact there might be legal challenges to achieving such a system does not mean we should not have it as an objective.

To go off the point slightly, it is a suggestion that has merit when one considers the kind of backlogs for social welfare applications and people having to wait an inordinate amount of time for answers. I cannot imagine that the officials or anyone in the Civil Service would have any problem with it. In fact, it would probably make their jobs a lot more straightforward. Perhaps the Minister would embrace the spirit of the amendment and ensure that it is brought to Cabinet for consideration and report back to us on it at another stage.

John Gilroy (Labour)
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I support Senator Barrett?s aspiration to have such a measure included, although I cannot support the amendment. Senator MacSharry put it very well, that the replication of means testing is time consuming and wasteful of scarce resources. It is something the Minister could usefully bring back to Cabinet not in the context of the Bill, but as part of a wider legislative measure.

Colm Burke (Fine Gael)
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I support in principle the amendment tabled by Senator Barrett but it is a measure that requires further examination. It is not one that is suitable for incorporation in the Bill but it is certainly a good idea that is well thought out and we should examine it. We attended the launch of the healthy living campaign today. The big theme of the launch was Departments working together as opposed to working as separate units. This is a clear example of how Departments could work together. I am supportive of Senator Barrett?s proposal overall but it would need further examination before incorporating it in legislation. It promotes the notion of Departments working together and given the day that is in it the Minister of State could take the point on board.

Alex White (Dublin South, Labour)
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I certainly will take on board much of what has been said, both by Senator Barrett and his colleagues. For reasons I will indicate in a moment, I am not in a position to accept the amendment proposed but I very much acknowledge the context and argument proposed by him and supported by his colleagues. The amendment is in the general spirit of section 8, which refers to data exchange. These days people say data is king and very often that is the case. If data is available it is sometimes only available in one spot and it needs to be seen by another section or Department. What we provide for in section 8 is data exchange on a statutory basis, which is entirely in compliance with data protection principles and embeds the Data Protection Commissioner in the process by requiring the commissioner to approve any agreements for the sharing of data. The basic principle of data exchange and sharing is established but the protections Senators want to see in terms of privacy and other protections that are in place because of the data protection legislation which dates back to 1988 are also satisfied.

The point about centralising the process is also well made by Senator Barrett and others, where, for example, different activities are going on in different places that there is a strong argument that they should go on in one place or at least to reduce the number of places a particular activity is conducted. I am not an expert on the matter but, curiously, for all the work done by the Revenue Commissioners ? as we know they will do more ? I do not think it conducts means testing. I have not had an opportunity to definitively establish the fact but it strikes me that they are not involved in means testing so this would be a new activity for them. That is something to bear in mind when we examine the appropriate place for means testing to be centralised, were we to consider doing that.

From the point of view of the health Acts, the HSE is charged with legal responsibility to make decisions regarding the eligibility or otherwise of a person ordinarily resident in the State. This legal obligation would remain on the HSE even if the amendment were to be accepted. The HSE would still have to assess the eligibility under the health Acts. The Revenue Commissioners are not equipped at present ? I accept that people are talking about what might happen in the future ? to carry out an assessment of medical cards and GP visit cards as well as other services provided by the HSE.

There has not been universal support for the centralising of applications for medical cards. I consider it has been a great success. Nothing is perfect but there has been considerable success in dealing with the backlog, not without objection and sometimes from our own colleagues on all sides. People were worried about certain changes. The centralising of the processing of all new medical card applications and renewals at the primary care reimbursement service, PCRS, was done with effect from 1 July 2011. Significant progress was made on the national project to provide enhanced service delivery to clients and providing a consistent and equitable national assessment process on which everyone can depend.

The HSE processes in the region of 750,000 applications each year. It aims to have all medical card applications and renewals processed within 15 working days. The latest information, as at 18 March, shows that more than 95% of applications are processed within the target time. Different types of application are made. There is the basic application for a medical card, a GP visit card and it is also required to process applications for discretionary cards which often require a significant medical input. It is important to bear that in mind in the context of the assessment of eligibility. That requires a clinical panel to be put in place. One has recently been established for the processing of the discretionary applications. The medical or clinical dimension is another issue one would have to consider in the context of giving the task to another agency at some point in the future. There is also the emergency process provided by the HSE for a person who is terminally ill or in urgent need of medical attention who cannot afford to pay for it. In such cases a card is provided within 24 hours.

The suggestion that we centralise means testing in a particular agency is not without complication. I am not sure whether the Revenue is the place to do it. I very much accept the spirit in which the proposal has been made. Senator Barrett will be interested to hear about administrative costs and efficiency, as it is very much in line with the arguments he makes in debates, as highlighted by Senator Ó Clochartaigh. The administration costs of the primary care reimbursement service is approximately 0.5% of the cost of the medical card scheme, which is pretty good. Given the day that is in it the Senator might be willing to congratulate us on the fact, but perhaps not.

Sean Barrett (Independent)
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I wish the Minister a happy Easter. I thank the Minister of State. We are nearly there, or we are closer to it than we thought. In an appendix to the Mangan report it is estimated that the compatibility of the Revenue and the Department of Social Protection is approximately 89%, so we might be moving rapidly in that direction. It would be of benefit if we could free up resources for health by cutting the administrative burden, which is a lot more than in other areas. The fastest growing category of staff for many years in the health service was the administrative layers, as the Minister of State is aware. It does not make sense to perform the same functions in the areas of health, education through SUSI, social welfare and in the Revenue Commissioners. I agree with other speakers that it is a good goal for us, and a whole-of-Government goal, as we face the significant problem of the duplication of tasks. I thank Members from all sides who gave the Minister a strong opinion to bring back to his Cabinet colleagues that we would like to see action on that front because the goal of putting the money into education and health is one that everyone in the House shares.

I also thank the Minister of State for his generous response. I will not push the amendment but the idea is now out there. Ms Mangan was surprised herself at the fact that we are nearly there. People thought it was not possible to integrate child benefit and the tax system but it is now 89% done. That is a development which would allow us to get money into the front line. Once again, I thank the Minister of State for his response.