Health Services: Motion

I move:

That Dáil Éireann:

— recognising that since 1997 life expectancy has risen by 5.3 years for men to 78.7 years, and 4.5 years for women to 83.2 years;

— confirming that between 1997 and 2011 major advances in tackling cancer were achieved with survival rates being improved dramatically and that death rates from cardiovascular disease had fallen massively;

— acknowledging that there were more than 170,000 patients treated by the National Treatment Purchase Fund (NTPF) up to 2010 and waiting times had been reduced;

— further acknowledging that the World Health Organisation ranked Ireland 19th in the world for its health system in 2010, ahead of countries like Germany, Belgium, Switzerland and Sweden;

— calls on the Government to immediately put proper governance structures in place in the Health Service Executive (HSE);

— condemns the €750 million in cuts to the health service contained in the HSE's National Service Plan 2012 for its detrimental effect on patient safety and front-line services as already detailed in the HSE South and HSE Dublin North East Regional Plans, and expected in the other regional plans;

— denounces closures to acute hospital beds and operating theatres as outlined in the Regional Service Plans;

— condemns the Government for:

— failing to halt increasing medical card waiting times, particularly where the entitlement to the card is not in question, which directly hits the sick, the old and the most vulnerable people; and

— introducing the insurance levy and extra costs to the health insurance industry which has directly resulted in people paying up to and over 50% more for their plans, causing them to leave the private system, and resulting in extra pressures on the public system;

— denies that front-line services are being protected or patient safety guaranteed, particularly when the CEO of the HSE has admitted that the critical impediment to the safe delivery of services in 2012 is the availability of adequate numbers of appropriate staff;

— confirms that the implementation of the early retirement scheme, which will result in 4,200 staff leaving at the end of this month, has been mishandled and is causing anxiety to patients and their families;

— calls on the Government to publish their contingency plans, inclusive of any proposed bed closures, to manage the outflow of front-line staff, especially acute, midwifery, 211 and community services staff such as home help staff;

— calls on the Government to lift the recruitment embargo for critical front-line posts particularly in the clinical area;

— condemns the announced closure of Community Nursing Hospitals in Abbeyleix and Shaen in Laois, and Crooksling in Dublin, especially given the distress caused to patients and their families, and calls on the Government to halt plans to close other community nursing hospitals which will remove 898 beds from the public system;

— calls on the Government to ensure adequate funding is provided this year to fund the fair deal scheme;

— condemns the Government for its decision to close the 24-hour Accident and Emergency Department in Roscommon Hospital and for breaking its election promises to keep it open;

— calls for the NTPF to be reinstated fully and separately from the special delivery unit so that waiting times and numbers of patients being treated can be accurately and transparently measured;

— opposes the introduction of reconstituted not-for-profit hospital trusts given their potential to reduce funding to smaller hospitals; and

— rejects the Minister for Health, Deputy James Reilly's plans for universal health insurance given it will massively increase costs to the Exchequer and to families, and that there is no evidence that it would improve outcomes.

I wish to share time with my colleagues.

I welcome the opportunity to speak on this motion. It gives us an opportunity not only to discuss broader health issues but to analyse the policies of the Government and the commitments made in the run up to last year's general election and to assess what has flowed from them in terms of output and policy. Any perusal of the facts suggests that there have been many failings in the delivery of services. When one considers what was said this time last year and where we are now a year on, it is clear that some of the policies held up as being the answer to the major difficulties facing us in the delivery of health care, are failing and failing very rapidly.

The Minister held up the special delivery unit as a central plank of his policy for dealing with waiting lists. Any analysis of that unit suggests it is failing rapidly when one considers the number of people waiting for day procedures and inpatient procedures. The number has climbed to more than 60,000 for people who have been on waiting lists for more than six months. Clearly, there is a difficulty.

When one analyses the Minister's quotes and commentary when in Opposition on the protection of front-line services and the capacity of hospitals and emergency medicine to deal with inpatient and outpatient procedures, it is clear that if there is a reduction in capacity, there is a corresponding increase in the number of people on waiting lists and in the time that it takes to deal with procedures for people. The special delivery unit is not functioning as outlined.

Another issue has been the raiding of the National Treatment Purchase Fund. That fund was an effective way of dealing with waiting lists. Some 170,000 procedures were carried out under it. That fund was getting to grips with reducing the waiting lists that had existed for some time. Any analysis of that fund in recent years would show that we were getting on top of that issue. We now find that the special delivery unit, since its inception last July, is beginning to run out of steam. Even the recent figures, as shown by the HSE, indicate that as time passes, the number of people on waiting lists for six months and more will increase dramatically if the current trends continue. The special delivery unit was established to deal with the number of people waiting to be treated on trolleys in accident and emergency departments. Some 420 people are waiting to be treated on trolleys on 21 February 2012. That is an indication that the special delivery unit is not functioning as outlined.

A broader issue is the responsibility with which the special delivery unit has been charged. This issue has been raised on a few occasions. We have to get to the bottom of it in terms of the base figure of people who were on waiting lists for more than 12 months and the disparity between the HSE and the Department of Health and the special delivery unit in the numbers and the base guideline that was outlined by the Minister in the House recently . There is quite definitely a discrepancy in the original number of people on waiting lists. The Minister said yesterday that the reason there was an increase in the number of people on waiting lists was that he had been dealing with people who have been on waiting lists for 12 months or more and that they were the priority. That does not explain why there is now more than 60,000 people who have been on waiting lists for six months or more when we spoke about a few hundred people on waiting lists for 12 months or more. We need to get clarity on this. There is a smokescreen exercise here with regard to the figures and number of people who were originally waiting 12 months or more and what the special delivery unit has achieved to date.

Ms Sara Burke exposed the fact that Dr. Martin Connor, the Minister's key adviser, spends a considerable amount of time out of this country. He is the Minister's four star general and he is on a salary of €160,000. I am not questioning his ability or capability when dealing with issues but the Minister would be apoplectic with rage if the previous Minister announced that her top adviser was not in the country on a full-time basis dealing with the serious issue of waiting lists. That issue is a cental tenet of the Minister's policy. We need to get clarity on the amount of time Dr. Connor spends in the country and, more importantly, what the special delivery unit is now charged with in terms of waiting lists because to date it seems to be failing quite rapidly.

Another issue is the waiting times to process medical card applications. The medical card application system was centralised. The need for coherency to be brought to bear on the way in which medical card applications are analysed was raised on a few occasions last June or July. Unfortunately, appalling cases have been raised by Deputies, day in and day out, and even by members of the medical profession. Some doctors in the north east are withdrawing their service and support because they are so concerned about the chaos in the application system for medical cards. This issue was raised at the Committee of Public Accounts last week and clarity was provided in the context of the number of people waiting for processing of medical card applications and renewal applications. It is unacceptable. There is a policy deep down in the Department of Health, of which the Minister is the head, to slow down the processing of medical card applications as a money-saving exercise. People who are terminally ill are waiting for their medical card to be renewed for months on end. That is unacceptable.

The Minister will be aware of a case I brought to the attention of the House last week. It is unacceptable that a person who is terminally ill was asked for further medical evidence.

The Deputy said that the person was refused a renewal. That is an entirely different matter.

The report I got from the Department states that the process was not correct in requesting further information. That is one of many such cases. We have heard of case after case from Deputies who consistently raise the issue of medical cards not being processed in time. People who are ill and who received medical cards because of their illness have to wait for a long time before renewal and in the meantime have to pay for their own medicines. This is a cost-saving measure by stealth and it is unacceptable. The delay in processing medical card renewal forms is an attack on the most vulnerable.

The Minister promised he would address the fair deal scheme. There are inordinate delays in processing applications under the scheme. This issue was raised last July and the Minister said he would get to grips with it but unfortunately people have to wait an inordinate length of time for their applications to be processed. This is unacceptable in the current climate in the context of the service plans announced by the HSE and regional plans flowing from that, given that the Minister will announce the closure of up 900 community and residential long-stay beds. If that goes ahead, the Minister will face a major difficulty in acute hospital settings because he will not be able to move people on. He said in Opposition that it was fundamentally important to have long-stay and step- down facilities in order that people could be moved from acute hospitals into long-stay and residential care. Now in the same breath he is saying that we can work without up to 900 beds in residential and community care. It is unacceptable. The way this policy was handled to date has caused difficulties, as the Minister will be aware from the difficulties in Laois and concerns in Dublin and in Louth. What is proposed is perceived as almost an attack on communities. There is also the matter of the way it was announced and handled. People had to go to court to protect what they considered to be their home. The Minister deep down would oppose what is being proposed vehemently if he was on this side of the House. All I am doing is raising these issues. Dismissing legitimate concerns of Members of this House is unacceptable when people are genuinely trying to be proactive in highlighting the inadequacies of the health service.

Front-line services are a key component. The Minister was strong and vocal on this issue in the past. He was quoted as having said it is not always about balancing the budget; front-line services are the most important vehicle for the delivery of medical care in this country. There is a fundamental attack on front-line services. The Minister knows full well that on 29 February there will be a major void in the capability of the health services to deliver emergency and maternity care. All of his statements that he has a plan simply do not add up. If he had a plan, I am quite sure it would have been announced and published at this stage, along with a photo opportunity, but we have not seen one to date. I ask him to ease the fears not only of those who may be dependent on the health services but, more importantly, of those who are working on the front line and are expressing grave concern. The Minister has dismissed the comments of some senior obstetricians and professors of gynaecology and obstetrics, but if he talks to maternity nurses, he will find they are very concerned about 1 March.

I have done. Has Deputy Kelleher?

Yes, I have. They are highlighting this continually. They are afraid of what will happen on 1 March because they have not seen a detailed plan themselves. These are the people the Minister expects to deliver front-line services on that day. If the Minister has a plan, will he publish it? He should consult the key providers of front-line services in emergency medicine, especially in maternity services. From all the conversations I have had, and e-mails from those on the front line, I know they are gravely concerned. The Minister says in the House that he has a plan, and the Taoiseach says: "Trust us." The bottom line is that it is difficult to trust the Government in light of what it has said previously and what it is delivering now.

Reference has been made to the insurance levy. This time last year, the Minister clearly stated that any increase in the insurance levy would have a devastating impact on insurance premiums and that it would be the final kick in the teeth for families. What he has done since constitutes a major attack on people who are trying as best they can to provide their own health care cover. The fact that he has increased the insurance levy by 40% and changed the way private health cover is charged in public hospitals has had a devastating impact on the cost of private health insurance. Families are being put to the pin of their collar.

I raise these four or five issues in the context of what the Minister said he would do this time last year and what has happened subsequently. This time last year, he was traipsing around the countryside and, wherever he could find a microphone, he was willing to make promises with wild abandon.

I think the Deputy is mixing me up with Deputy Martin.

I refer to Roscommon County Hospital or St. Mary's Orthopaedic Hospital in Cork, for which he promised a new hospital building. It is difficult for us to accept his words when we see that his recent actions are completely to the contrary of what he said previously.

I do not expect that this motion will be carried in the House, but I do expect Deputies opposite to say honestly in the Chamber that they are not satisfied with the performance of this Government and with the commitments that were made and reneged on time and again, particularly in the areas of waiting lists, medical card applications, the fair deal scheme, the attack on community and residential long-stay nursing homes, and the increase in the insurance levy.

The Minister spoke bravely last year about taking on the consultants. Now they are clearly riding roughshod over him, even in the context of the ratio of bed allocation in some hospitals. This is a serious issue. The Minister said he was going to reduce their salaries and obtain higher productivity, but he has done neither. They are driving a coach and four through the guidelines on the allocation of designated beds at a ratio of 20:80 or 30:70.

Fianna Fáil had a free rein for 14 years.

Deputy Feighan is a brave man to sit next to the Minister. I do not want to get personal on this issue-----

The Deputy should go to Roscommon hospital and he will see exactly what is happening.

One just has to have the courage of one's convictions.

-----but all I have to do is mention the fact that the Minister made a faithful promise to the people of Roscommon.

The Taoiseach then said Fine Gael would maintain and even enhance all the services in Roscommon.

We said that under Fine Gael, Roscommon hospital would have a safe future, and it does. I stand by that 100%.

That is just another broken promise. We are one year in and there have been many broken promises.

We are all pleased that the senior Minister in the Department of Health is present. It is important that, when an important motion such as this is before the House, he is present to listen and respond when his time comes.

The removal of €750 million from the health budget for the coming 12 months will have profound implications for the health service. When Fine Gael was in opposition, its members excoriated the outgoing Minister for Health and Children for cutbacks and adjustments that were made in previous budgets. Now, however, another €750 million will be taken out of the budget, which will have a serious effect on the level of service that can be provided.

On the issue of retirements, we accept that a programme was implemented to take a certain number of people out of the public service to adjust the fiscal position, but if more than 4,000 staff leave the health service, it will have serious implications for front-line staff in one of the most important Departments.

It was decided to centralise the processing of medical cards to one centre in Finglas in north Dublin. There is a major problem with this. I am sure the Minister, who represents the neighbouring constituency, is well aware of the difficulties people are encountering in having their medical card applications processed.

The Fianna Fáil Government did it.

I ask the Minister to listen to the point I am going to make. Surely, at a minimum, we should have telephone contact with the office in order that I or Deputy Kelleher or the Minister himself, as public representatives, can call someone in customer service in the medical card centre in Finglas to ask about the current position of an application for a person at the back of the Cooley mountains, in Cork, or wherever. At a minimum, it will take much of the frustration out of the system. The requests for additional information or clarification can be dealt with over the phone. If it is a matter of placing additional administrative staff, I ask the Minister to do this urgently. I believe this would remove much frustration from the system, and I am not asking him to spend additional money on it.

I will become parochial. Just down the road from the Minister are the Cottage Hospital, Drogheda, and St. Joseph's Hospital in Ardee. There are bed reductions at St. Oliver Plunkett Hospital, Dundalk, and St. Mary's Hospital, Drogheda. The smallest county in the country, Louth, has 12,500 people over the age of 65, of whom approximately 5% will require residential care at some stage. The number of beds and facilities that are being taken out of the service is horrendous. I ask the Minister, genuinely, to reconsider the decision.

I will start with St. Joseph's in Ardee. Fortunately, the HSE has a considerable block of land immediately around the hospital, which has three floors. I accept that in this day and age, we have to change the way in which services are provided, having regard to what HIQA may say from time to time. An intensification of services - not necessarily services for the elderly - in that premises, in addition to a sheltered housing development on the adjoining land, is an ideal scenario. It is an ideal place for the establishment of a retirement village and community hospital on one site. Indeed, there is a day care centre at the other end of the land, a mere 100 yards away from the existing hospital. The Cottage Hospital is on the north side of Drogheda town, right in the middle of the population of that side. Many families live within walking distance of the hospital. An intensification of services - palliative, step-down or other services - to increase usage would result in a positive change in the economics of the operation of these hospitals. I ask the Minister for Health to consider what I am saying to him. I ask him, not in a negative way but in a positive way, to examine my suggestions for both sites because of their locations and the strategic importance of the delivery of residential nursing home care. Let us reconsider any decision to close either institution.

I welcome the opportunity to contribute to this debate and I thank my colleague, Deputy Billy Kelleher, for putting forward this motion, which covers a variety of issues in the health area. They are issues of concern for the majority of people.

Every household interacts with the health service over the course of the year, whether it is at local level with the general practitioner, accident and emergency unit or local hospital or if people are obliged to travel further afield to get specialised treatment. Most families also interact with the HSE. A large number of them have medical cards, and there is a great deal of interaction with the HSE in the course of applying for them. I will discuss that issue further.

However, I wish to refer in the first instance to the Dublin - mid-Leinster service plan which was announced this afternoon and was published on the HSE website. It is shocking reading for people in the midlands, and particularly those in Laois-Offaly. There is no provision for major capital expenditure in the Laois-Offaly region, although there is some for other parts of the Dublin - mid-Leinster region. Nothing is provided in the service plan under the various headings in the area of primary care. A number of new primary care teams are required in the area, as well as a number of new primary care centres. There is no provision for capital investment in the acute hospitals in Portlaoise and Tullamore, or for investment in facilities for older people. Shockingly, no capital investment is provided for mental health facilities. In those four key areas, the plan writes off an entire area of the country in terms of capital investment even though there is significant investment funding available to the HSE and the Department of Health. To take a couple of counties out of the plan, as if they do not exist, is totally unsatisfactory. The management in the Dublin - mid-Leinster service area should re-examine this.

Medical cards were mentioned by earlier speakers and will probably be mentioned in this debate by speakers from all sides of the House. I have a single question for the Minister about what is happening with medical cards in the centralised facility in Finglas. I might be in a minority but, personally, I believe that if the Department of Social Protection can handle applications centrally, the HSE should be able to match it. However, it is not doing the job. It might need outside assistance because it has not previously operated on a national basis in the provision of a service such as this to 1.5 million people. Perhaps some staff could be seconded from the Department of Social Protection given that they are used to administering nationwide schemes from centralised locations.

I am not familiar with the building in Finglas; I have never visited or seen it. However, when I ring and occasionally get through to the staff on the telephone, the staff, who must be on the first or second floor, tell me that when they send the file to the fourth floor it gets lost. If the Minister does nothing else this week, he might visit the fourth floor of the building in Finglas. I do not know what is in it but other staff in the building tell me that files get lost there. I appeal to him to find out what happens there. Letters come from there dealing with meaningless issues. I accept that staff must make various requests for the supply of information, but when people are obliged to call to my office to scan a copy of their car registration certificate to send to the HSE to verify whether a member of the household has a car, we are pushing the boat out too far. What is being done about the excessive red tape in that department?

Cathal Magee, the chief executive officer of the HSE, has said he will examine this matter and try to ensure the files dealing with renewals are put into a different queuing channel so they do not clog up the new applications channel. New applications inevitably take more time. Where the person is elderly or has had a medical card for a few years and it is a straightforward renewal, there should be a separate queue to deal with that. Renewals could then be dealt with quickly and with the minimum of fuss. However, they seem to get caught up in the main system which involves starting the entire process again.

The waiting list for orthodontic treatment for children in the midland area is two to 2.5 years. It is a nationwide issue. Certainly, it is embarrassing to get a reply from the HSE, on foot of a parliamentary question to the Minister on orthodontic treatment, stating that the waiting list is in excess of two years. That reply came in writing from the Minister's staff.

The Minister is familiar with Portlaoise hospital. It is an active and busy maternity hospital as well as having a number of other very good departments. It is a maternity hospital for Laois, parts of Offaly, much of Kildare, parts of west Wicklow and part of north Tipperary. It is a regional maternity hospital at this stage. It has a very good pediatric and child care unit. Sometimes one tends to think that a hospital in a certain county only serves that county, but this is a regional facility and not just within the traditional midland health board regional boundaries. It serves other parts of the Leinster area and even north Munster. I urge the Minister to ensure there will be sufficient front-line staff in the maternity ward next month to replace the staff that are due to retire between now and the end of this month. The problem is that some of the staff have already left HSE employment. When they gave in their notice they might have had a month of leave left over from last year or holiday leave was carried forward, so they were obliged to leave almost on the day they handed in their notice or they would forfeit that leave.

The main issue I wish to highlight is contained in the Dublin - mid-Leinster service plan published today. I have an extract from the 2012 plan dealing with financial information, which is on page 123, and the corresponding page from the 2011 service plan. The horrific figures in this are under the heading for community care for the midland region. This refers to community hospitals for older people, and the Minister is aware I will refer to Abbeyleix and the community hospital in Shane. The figure for last year was €295 million, while the figure in the plan produced this afternoon is €275 million. That is a cut of €20 million. It is the biggest cut in any section or department or in any of the hospitals in the Dublin - mid-Leinster area.

This €20 million cut means, in effect, that a decision has already been made by some people to close those hospitals, and it is the wrong decision. If there must be a cut of €20 million, it can only be based on a serious number of beds being cut. There is provision for cuts but they are falling disproportionately on the Abbeyleix and Shane areas. The Minister met the Abbeyleix representatives some time ago. I was with the delegation and the people were happy with that meeting. However, a commitment was given that night that representatives of the HSE would meet with the committee to scope the decision and deal with the terms of reference for how the decision was made to close Abbeyleix community hospital.

The Minister stopped that decision in its tracks because the staff in the HSE did not know the legal position. They had announced the closure before giving the required six months' notice. The meeting between the HSE and the Abbeyleix committee has not yet happened. I am sure my colleague from County Laois has referred this to the Minister on various occasions as well. We are anxious that it happen. We are told the consultation period will commence next month. That simply means the HSE, which made the wrong decision in the first place, will now make the same decision but ensure it does not get tripped up by using incorrect procedures.

In addition, three beds in Abbeyleix community hospital are currently empty and could be utilised. People in Portlaoise hospital could transferred there. It is costing the HSE approximately €21,000 per week to keep the patients in Portlaoise hospital while keeping the three beds idle in Abbeyleix. That is false economy and false budgeting. It is utterly unfair. I do not believe there is proper management in this area.

I submitted a freedom of information request and received a response to it at the end of January. It stated the information I received was discussed in the Department of Health in July last year. In a letter dated 4 July 2011 from the area manager, whom I will not name, he stated with regard to Abbeyleix that "the physical infrastructure at the hospital is totally unsuitable and a complete rebuild would be necessary to meet HIQA standards". This is clearly untrue. I am very pleased that the Minister visited the hospital, in his low key way, over the Christmas period. There was no fanfare or people gathering at the gates. I believe that was not the Minister's view of that building. It meets HIQA standards at present and with some improvements it could be brought up to the proper standard not for 33 patients but for 50.

The entire decision process that worked its way up to the Minister's desk was based on an untrue assessment of the HIQA report by the regional manager, who said the required renovation could not be completed to meet HIQA standards. That was wrong and untrue. It was an assertion by the regional manager.

I cannot blame the Minister, although politically I would like to do so, for allowing that decision to be implemented. He took what was presented to him at face value. If he looks at the letter of 4 July 2011, which is in the Freedom of Information file I received, he will see the decision was based on an inaccurate, improper, untrue and unfair reading of the HIQA report. I ask the Minister to revisit this matter and to use his sense of fairness as a doctor in doing so. I understand the Minister was impressed by the facility. I ask him to do the same for the hospital in Shane.

I commend my party colleague, Deputy Kelleher, for bringing forward this motion on the issue of health, one of the most important issues we could discuss in the Dáil and the first priority in terms of protection at this difficult time. Whatever one might have to go without, one cannot go without a health service.

A little over a year ago, I was a member of Donegal County Council and the Minister for Health was standing roughly where I am standing now. Listening to him from that distance I could have believed he would do the devil and all for the health service. He was a swashbuckling spokesperson who was going to reform the health service and deal with all its ills. It seemed as if, were it not for his colleagues holding him back, he would have been immediately across the Chamber to act. He has not needed too many people holding him back in the past year because we have seen very little of the action he consistently talked about from this side of the House since he took responsibility for the Department of Health.

The Minister who promised he would bring health insurance to everyone in the country is now overseeing 5,000 people per month ceasing to pay for private health insurance and losing their cover. After one year in Government, 60,000 more people are without health insurance and dependent on the public health service, from which the Minister is draining funds. Why are these people having to give up private health insurance? It is largely because of the policies of the Minister himself. At the beginning of January, the Minister increased the levy on health insurers by 40%. He assured us the increase would be absorbed by health insurers and would not lead to an increase in premiums. However, the Voluntary Health Insurance Board, which the measure was most designed to assist, subsequently increased premiums by up to 12.5% for older people, the very people the levy was supposed to protect. This is what we have seen from the Minister so far.

The Minister promised to reform the Health Service Executive. One day, with a wave of his hand, he dismissed the board of the HSE. We have not seen much since then. In the HSE annual service plan, which was introduced in the middle of January, some €750 million has been taken out of the health budget. This means fewer treatments, which hits the most vulnerable, and longer waiting times, leaving people to wait longer in pain.

When the health service plan was delivered to the Minister he sent it back to the HSE. As one media commentator said at the time, this was like writing a note to oneself to complain about oneself. At least the Minister was in tune with people across the country, because many people were critical of what the report contained. It was the end of January before the HSE service plan for the country was approved.

Now, in the middle of February, the regional health service plans for this year are coming forward. In these there are further cuts. The service plan for HSE West, which was published last Friday, promises cuts across a range of services. In County Donegal, the Minister has decided to close Lifford Community Hospital, although he and his party gave assurances during the general election campaign that this would not happen. This is consistent with his policy in other areas, the decision regarding the emergency department at Roscommon General Hospital being the most famous case.

It is still open. I was in it yesterday. It has been downgraded to an urgent care centre but it is still open.

The health service plan also shows that the Minister is looking for a €12.5 million cut in the budget of Letterkenny General Hospital, from €105 million in 2011 to €93.5 million this year.

I wonder why? Would it have something to do with the Deputy's Government?

The Minister wants a cut in spending of 11% in one year.

What about the billions that were wasted?

The Minister has sought this cut at the end of the second month of year in which the cut is to be made. Is this the type of health service the Minister, the great swashbuckler, said he would deliver last year? We have seen nothing of what he promised.

Most of the Minister's recent public utterances have been to explain why he is rowing back on promises he made this time last year. He has had to explain why waiting lists are increasing. He has explained why he got rid of the National Treatment Purchase Fund which people could access after three months. He announced a new policy that people will wait no longer than six months for treatment, as if this was a gift he was bearing when it actually means that waiting lists continue to lengthen.

During the general election campaign, the Minister said it would take ten years to implement his policy of universal health insurance. Considering the number of people who have lost insurance in the meantime and considering the progress he has made in the past year, I am sure it will take longer. How long before we hear the Minister say it will take 15 years to do that job? It is time we saw health services protected and the Minister's promises fulfilled.

I thank Deputy Charlie McConalogue for allowing me some of his speaking time and I acknowledge the work of Deputy Billy Kelleher in bringing forward this motion.

The Minister promised the sun, moon and stars when he was on this side of the House.

I do not remember promising any of those.

They are about the only things the Minister did not promise. He promised everything else.

There is a lot the Minister does not remember.

We all have to deal with people who are waiting to have their medical cards processed. We had a system that worked very well when medical cards were processed locally but it has now been centralised. People with long-term illnesses are no longer automatically entitled to a medical card. Instead they are kept waiting. When the clock is ticking and a person's days are numbered, it is dreadful to have to wait while a medical card is processed. It is scandalous.

The Minister presided over a mass exodus from private health insurance, putting unbearable pressure on our public services at a time when they are not able to cater for this additional burden. The Minister has been totally inept in the manner he and his Government colleagues have dealt with the number of staff retiring from the health service. The objective was to save money, but the Minister is saying he will give them a lump sum of money, pay them a pension and then rehire them. I ask him to hire nurses, not agency nurses, to give full-time jobs to our young people who are highly trained and want to work in the system. I also ask him to remove the uncertainty in respect of the fair deal scheme and not to allow a repeat of last year's debacle. He should not hide behind the HSE when asked questions in the House.

On a final positive note, I thank the Minister publicly for his comments last week at a time when parents of children with autism were being subjected to very unkind remarks. I acknowledge that the parents concerned appreciated his intervention to set the record straight and give the facts. As I do not want to be negative all the time, I thank him for doing this.

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"commends the Government for:

— its health reform programme and acknowledges the measures taken by the Government to mitigate as far as possible the impact on patients and services of the funding and staffing reductions required over the next few years;

— the range of recent initiatives taken by the Health Service Executive to improve the processing of medical cards, including the rule that any medical card holder undergoing a review, and who genuinely engages with that review, will not have his or her entitlement withdrawn before that review is complete, regardless of the expiry date shown on the medical card, as well as other process enhancements and staff redeployment;

— recognising the challenges facing public nursing homes in 2012 and the future, in terms of staffing and infrastructure, and directing the HSE to adopt a more proactive approach and produce a plan which will seek to protect the viability of as many units as possible within the current fiscal and budgetary constraints;

— the additional indicative funding of €55 million provided in the abridged Estimates published last year for the nursing homes support scheme - the HSE national service plan 2012 targets an additional 1,270 people to be in receipt of funding under the scheme by the end of 2012;

— accelerating the type of service delivery reforms that will move to models of care across all service-care groups which treat patients at the lowest level of complexity and provide services at the best possible unit cost; and

— its acknowledgement of the vital role of smaller hospitals which will be detailed in a framework document to be published shortly;

and welcomes the Government's determination to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent "money follows the patient" system of funding that will be supported ultimately by universal health insurance."

I am sharing time with Deputies Doherty, Feighan and Keaveney.

To begin with Deputy Healy-Rae, not alone were the comments hurtful to parents of children with autism, they were also untrue, unfounded and had been discredited. Raising children with autism presents enough challenges without having people cast slurs on the parents who work so hard and love their children so much.

It is hard to take a lot of the guff from Deputy Healy-Rae when his father propped up a thoroughly discredited Government-----

The Minister should not go down that road and disgrace himself in making comments about retired Members.

No, we will not go down that road, as it would be too uncomfortable; therefore, we will leave it at that.

Deputy McConalogue saw fit to make all kinds of allegations, but the reality is that I will reform the health service. I say to the Deputy who sees no changes taking place that there is none so blind as those who will not see. Who caused all those who have lost health insurance to lose it? I would like to ask Fianna Fáil Deputies that question. I am glad to see the previous Minister for Health and the leader of Fianna Fáil present, with his Cork colleague. Who caused all those who have lost their jobs to lose them, as a result of which they are now without health insurance? Who caused the uncertainty in the economy?

Deputy Fleming expressed concerns about what was happening on the fourth floor of the GMS Payments Board building. I was there only two and a half weeks ago and things have changed. The board previously removed medical cards if people's details were not filled in fully, but that has ceased. Persons in communication with the board will now keep their card until the process is finalised. Everybody on social welfare will keep his or her card.

That is not happening.

This has happened in the last couple of weeks. There are individuals who have not responded to three inquiries from the board.

Politics aside, that is not happening.

Actually, there are 21,000. Of this number, 4,500 have had no transactions on their card for the last two years.

One million people have medical cards.

When the Deputies opposite ask Mr. Paddy Burke at the Committee of Public Accounts why he is paying doctors for looking after patients in respect of whom there has been no activity on their medical card for two years, it will be interesting to hear the take on this. There is a balance to be struck with probity, but the fault should always lie with the State in these situations. That is why Mr. Burke has now changed things to reflect this.

Deputy Kirk raised the issue of providing a telephone number for Deputiess. There is such a telephone number for them, about which I will say no more.

Deputy Kelleher made a few contentious remarks about waiting times and the SDU which has proved to be a success. It has not been successful enough for my liking, as there are still too many patients on trolleys. However, for the first time in 14 or 15 years, we have seen a drop in the numbers lying on trolleys. Since the middle of December, they have been lower than in the previous year. The 30 day average which for every month for 12 months before August 2011 was 30% above the figure in the year before-----

That is a statistical construction, another PR con job.

This is reality, not perception, in which the Deputy dealt.

It is a statistical construction.

There are 117 reports lying on the shelf which cost who knows how many million euro to compile.

It is absolutely true. I remember it happening long before I became involved in politics.

We will wait and see what the Minister achieves.

We still face big challenges which we are going to deal with with the help of front-line staff, the SDU and the clinical programmese to reform the health service. When the last Government had millions of euro available and doubled the spend on health over a period of ten years, it did nothing to reform the health service.

The Minister wanted to spend more.

Look at cardiac or cancer care services. There has been a dramatic transformation, as the Minister knows. He is a propagandist.

Let us look at the motion. The Members opposite want me to talk about what I may or may not have done. Since becoming Minister, we have assumed responsibility. Notwithstanding the Deputy's contention that we defer everything to the HSE, we do not. All operational matters are to be referred to the Department. We have formed a new relationship with the HSE which we will soon abolish. We have created an interim board, with direct interaction with the Department and me as Minister. We have instructed that parliamentary questions on operational matters be sent to us. The management system has been instructed to tell managers that they must take responsibility. We have told the managers of hospitals that they must keep to their budget and that if they do not, there will be consequences, and there have been. We have changed the board of Tallaght hospital, something the previous Government failed to do during its tenure when it was clear there was a problem with the board and in the workings of the hospital. We have also introduced new management systems to the hospitals in Limerick and Galway, both of which were in serious trouble and failing to meet their budgets. University College Hospital, Galway was the only hospital in the country that failed to adhere to the 12 month limit for inpatient procedure waiting times.

I will not go through the rest of the list of things we have achieved. We managed to maintain services throughout 2011, despite a cut of €1 billion. We cannot expect that there will be no impact as a result of the €750 million cut we must make this year, but we will minimise it and there will no linear effect as happened in the past, when every percentage reduction in spending led to a similar percentage reduction in activity.

Why has it become necessary to do this? The irresponsible behaviour of the previous Government caused the country to lose its economic sovereignty and brought the economy to its knees, while its Ministers, like Tweedledum and Tweedledee, said that they had heard nothing or knew nothing.

The Government has faced up to the task. It has been honest in telling the people the scale of the problem and it will continue to do so. It is equitable that we are focusing on those who have had to wait the longest. When we do this, some of those in the middle will clearly have to wait a little longer.

More bluff. There were only 700 when the Minister took office.

In June 2011 there were over 2,260 patients who had been waiting for 12 months.

That figure has gone up by 47%.

By December, it was a little over 300. These are the facts - like them or lump them. The Deputy should check and he will find out that what I am saying is true.

I have spoken to people who know the facts-----

This represents a 79.9% drop.

-----and they are appalled by what the Minister has been up to in cooking the books.

I have said that there is none so blind as those who will not see. Equally, there is none so deaf as those who will not listen.

Timeo Fine Gael et dona ferentes.

In the period between June and December the total number waiting for six months or more increased from 54,000 to 59,000, an increase of 10%, not 47%. That is not something we want to see but something we expect to see when we focus on ensuring patients will not be left waiting years for procedures, which the previous Government allowed to happen.

The Minister knows that is not true. I am asking the Minister whether the National Treatment Purchase Fund delivered.

Everything is different when Deputy Martin is in opposition, but when he was in government, he had a different approach entirely. When they had money, they would not use it to reform the system and now they make other allegations, stating that general practitioners are withdrawing services in the north east. GPs are not.

They have withdrawn co-operation on primary care teams, which is an entirely different matter.

They have withdrawn co-operation.

Deputy Kelleher said "service".

They have withdrawn co-operation, which is a service.

Deputy Kelleher has also made a claim, on which I would like to get clarity, that a person was refused a renewal of their medical card when they were terminally ill. I would have thought it was an application. If there was a slowness in application, I regret that, but that is something that started under the Government of which Deputy Martin was a member-----

Deputy Reilly is Minister 12 months.

-----and long before I came into power. I have now since set up, as another proactive piece of work, a group to look at discretionary medical cards. It is a group made up of doctors - community doctors, epidemiologists, a GP and others - to ensure the situation is operational once again. That was the discretion of the CEO of the health board and since the CEOs of the health boards no longer exist, no one seems to have the discretion to address that.

Deputy Kelleher states the fair deal scheme is not working and that it is all clogged up. Some 200 beds were released under the scheme yesterday.

On the contingency plans, which Deputy Kelleher bemoans and wants to see published, individual managers in individual hospitals have their individual plans. They are overseen by the regional directors of operations who report to the national director who reports to the assistant secretary in the Department. We have a clear line of vision right down through the system. I have been to several hospitals already and will be to more before the end of this month.

My main concern at present is that we maintain a safe service for all our patients, including all the expectant mothers. The other day I was in Holles Street hospital, where I opened a new theatre, and they have their plans well in place to deal with the number of midwives leaving. They have more midwives to come in place. Similarly, in Limerick, they have their plans. I was there on Saturday morning last.

Deputy Kelleher can scream all he wants. It seems his motion is quite peculiar in so far as it speaks of the failure of the plan before the day has even come. I do not understand it.

The motion speaks of 170,000 patients treated by the NTPF, but at what cost?

There were 170,000 done.

Was €300 million value for money?

It certainly was.

It certainly was not.

It is much better than what the Minister is doing now.

It certainly is not.

It is much better than what the Minister is doing.

The motion denounces the closure of acute hospital beds and operating theatres, as outlined in the regional service plans. Whose fault is this? Who left us with a basket case of an economy to deal with?

The motion condemns the Government for failing to halt increasing medical card waiting times. We have already addressed that.

The Minister has not. He mentioned it but he did not deal with it.

Fianna Fáil condemns us for introducing the insurance levy. That party introduced it when it was in government. I increased it this year.

The Minister increased it by 40%----

Yes, but Deputy Kelleher states in his motion that we introduced it.

-----and this time last year Deputy Reilly was apoplectic with rage.

All right, Deputy Kelleher.

More inaccuracies from Deputy Kelleher's side of the House. Let me put this to Deputy Kelleher. If we had not increased the levy, as a previous speaker stated-----

A kick in the teeth to people.

-----the VHI has confirmed that premia would have had to have increased by 17.5% instead of between 6% and 12%.

This is the last year of the levy. Unlike the Government of which Deputy Martin was a member which kept talking about bringing in risk equalisation, we have the legislation ready to go and it will be in place by 2013.

I will tell Deputy Kelleher what really bothers me most about his motion.

Is it the fact that it exposes the Minister?

What is really objectionable about the motion is that it rejects the plans of the Minister for Health, Deputy Reilly, for universal health insurance. The people of this country spoke, if Deputy Kelleher did not hear them.

They rejected Fianna Fáil utterly. They voted for Fine Gael and Labour, both of which had universal health insurance at the heart of their health policies.

Fianna Fáil should not dare tell the people or the electorate that they have no mandate-----

-----and its members should not dare tell us-----

But where is it?

-----that we should not follow that mandate.

(Interruptions).

Deputy Kelleher alluded to the fact that I gave plenty of notice-----

There is not even a paper on it. No detail. Nothing.

The Minister has two minutes remaining. Order for the Minister.

They do not want to hear.

Deputy Martin only sings when he is winning.

An old lady once said to me: "The truth isn't fragile; it won't break." I stated before the election it could take up to two terms to fully bed it in-----

-----but Deputy Martin wants it in the morning.

That is some stroke. The first time I have ever heard a Government state it will wait for two terms.

I have outlined the progress we have made.

The Minister has no work done on it at all. That is the truth.

Where is the Dutch model now?

We have much more to do. We are facing real challenges in the short term. Over recent weeks, the cases of flu-like illness have increased and last week they doubled, and we expect them to double again this week. This will put pressure on GPs, primary care, hospitals and emergency departments, but we have plans in place to deal with this, in the same way as we have plans in place to ensure we have a safe service for all expectant mothers and for emergency departments and paediatric departments. We will keep a close eye on this. I stated that I would not be like the previous Minister, putting distance between myself and my responsibilities. I will take responsibility.

The Minister is not taking it.

I will be visiting hospitals. I have visited hospitals. I will be hands on.

The Minister is dumping on people. He is blaming administrators. He is blaming officials.

Who did it to the Joint Committee on Health and Children?

Deputies Martin and Kelleher's prescription-----

What about prescription charges?

Prescription charges.

-----is no change. Their prescription is no reform. Deputy Martin's prescription is to pretend like he did when he was Minister for Health and Children-----

We reformed dramatically.

-----with 117 reports and no action taken.

That is the reality.

We will take action, we have taken action and we will continue to take action.

The previous Government wrecked the health services.

I am not interested in Deputy Martin's preoccupation with the past or the perception of change. I want real change. I will instigate that change-----

We did real change.

-----and I will support that change.

We are waiting for something from the Minister and we are getting nothing.

Deputy Martin gave us the HSE.

We have the tools to make the difference. We have the people to make the difference. What they did not have in the past was real leadership. What we have allowed happen is the creation of an environment that allows new leadership to flourish. That is happening. It is happening through the clinical programmes, through the special delivery unit and on the front line.

As a result of that and because of those good staff, we will fix the health service. Ultimately, we will get this country out of the economic morass in which Deputy Martin left it through his own ineptitude when he was in power.

Rhetoric and no detail.

I will tell Deputy Martin this much, and I will say this to the good people of Ireland as well: we are not a nation of quitters, and nor is Fine Gael. We will prevail.

I call Deputy Regina Doherty.

Great speech, Minister, but what about these facts here?

Deputy Healy-Rae should resume his seat.

When I asked the Minister a question on 7 February, the answer I got was-----

Stop this nonsense.

Where is Mattie?

(Interruptions).

Order. I call Deputy Regina Doherty.

I welcome the opportunity to speak on this motion. The HSE service plan introduced this year represents is a five-year plan. Unlike previous Ministers, the current Minister, Deputy Reilly, along with the Ministers of State, Deputies Kathleen Lynch and Shortall, have the vision and, more importantly, the commitment required to deliver a modern and effective health system.

The Minister has stated that his overriding commitment is to introduce a single-tier service that will deliver equal access to care based on need, not income. Within months, legislation will be introduced for a new risk equalisation scheme.

We must work within challenging budget constraints. However, there is a Government and health Ministers who see that cost-saving measures will be effective in areas like procurement, drug price reductions and cutting fees in GPs and pharmacists. This reconfiguration and reform will bring with it greater productivity and focus on staffing levels and skill mix.

The 2012 plan will deliver the key elements of the programme for Government in the areas of mental health where approximately 400 extra staff for mental health services will be recruited to enhance the child, adolescent and adult community teams as well as suicide prevention and counselling services. Within the primary care section, the moratorium has had a significant effect on staffing levels, and additional funding of €20 million is being allocated to fill these vacancies to strengthen the primary aid services. GP visit cards will be issued to long-term illness claimants.

The 2012 plan ensures that acute hospitals will continue to deliver to patients the best possible service on each hospital site. The special delivery unit, under the leadership of Dr. Martin Connor, will ensure that 95% of attendees at emergency departments are discharged or admitted within six hours of registration. This delivery of reform in acute services will modernise and achieve the best service to the patient, who is, by the way, the primary stakeholder in all of this. These reforms will result in the patient, who is the most important stakeholder, getting the best effective care as soon as possible. In the area of disability, people with physical, mental and sensory disabilities have the same rights as everyone else. This action plan demonstrates that, even at times of cutbacks, the Government wants to remove obstacles so that disabled people can participate in society. The accelerated move towards a new model of individualised person-centred services in communities can help to achieve efficiencies, particularly in regard to services for those with mild or moderate intellectual disabilities. A €1 million fund is available for autism services to address waiting times for specialised therapies and early intervention teams.

The planning for the health requirements of our people is always a priority. I want to broaden the discussion. Obesity in our society is now a political issue, along with factors such as the environment, smoking, alcohol and drug consumption and physical inactivity. Bad health translates into higher health care costs. Healthy children develop into healthy adults. We have to inform and reform our way of life.

The health costs of alcohol-related injuries, deaths from alcohol-related road incidences, liver cirrhosis and suicides, as well as negative effects on the workplace are all hugely significant. The Minister of State, Deputy Shortall, has taken action with the launch of the report on national substance misuse from the steering strategy group. Harmful consumption of alcohol is the third main cause of early death and illness after tobacco and high blood pressure.

Smoking is the single largest cause of avoidable deaths between the ages of 35 and 69. Some 18% of all deaths in the EU can be attributed to smoking, with lung cancer now overtaking breast cancer as the major killer of women in this country. Following on from this, we must stop young people from taking up the habit and we must fight the illicit tobacco trade.

The Opposition must understand we all have a responsibility to act. The Government, unlike the Opposition, recognises that we have to control and reduce water-related diseases. By creating healthy lifestyles, we can reduce the costs of the health care bill and promote a healthy society. These are a selection of observations taken from the total plan. I look forward to further debate on the health care system and to seeing the results which will benefit the most important stakeholder - the patient.

I support the Minister and the work he has done in the past year. He has the great task of trying to reform the health service. Despite billions of euro having been thrown at it in the past 14 years, despite the vested interests not being tackled and despite the erratic nature of services, the Minister is now taking on those vested interests and ensuring equal access to the health service. I have no doubt this will deliver a health service of which we can all be proud.

I come from the constituency of Roscommon-South Leitrim. At the mere mention of the health service in Roscommon, everyone's ears prick up. I was in Roscommon hospital yesterday. The urgent care centre there is going well and, under Mr. Bill Maher and his management team, the hospital has a very bright future. Endoscopy services will be provided there and, hopefully, there will be palliative care and rehabilitation services. I believe twice as many procedures will be carried out in that hospital as were carried out two years ago. I am certain it will be the best small hospital in the country.

People wonder why this happened. A little more than eight months ago, the surgeons and the management team in the hospital clearly stated their accident and emergency unit was unsafe. This unit had a sign outside the door which read "A&E" but it was not the accident and emergency service I would expect in Sligo, Galway or Castlebar. It had no cardiac surgeon, no paediatric surgeon and no anaesthetic cover overnight. Yet, people called it accident and emergency. It was an accident and emergency unit for a local area but it was not what we expect of an accident and emergency unit in the modern age.

We have heard a great deal of nonsense. I can understand that people are fearful. However, many politicians from all sides and many leaders played on the fears of the patients. I have no doubt that under the Minister, Deputy Reilly, patient care in Roscommon and in such areas throughout the country will be much safer. I have watched seven paramedics going out, saving lives on the roads and in houses, resuscitating people and bringing them to a real accident and emergency unit. We do not, however, hear about that. We do not hear of the number of lives that have been saved. We hear only from the people that go to their local radio stations or newspapers and put the fear of God into others. A week later, by the time the information is corrected, the story is over. I have seen press releases stating that the Roscommon home will close, that the Roscommon urgent care centre will close, that people will die and lives will be lost. At the end of the day, the truth will always come out. The truth is that the Minister, Deputy Reilly, and Fine Gael and Labour will deliver a fair health system.

One newspaper in my area has for the past 30 weeks run articles on "our hospital crisis". How could anyone expect that to be balanced reporting? How can we expect the people to get a fair sense of what is going on? I am a politician from that area. I cannot go out at night to have a drink in any of the towns or villages in County Roscommon because of the nonsense that has gone on. If I had to stand up again and make the decision I had to make nine months ago, I would do exactly the same thing, because it was the right decision for Roscommon hospital, for patient care and for the country.

The Minister, Deputy Reilly, Fine Gael and Labour should keep doing what they are doing because I have no doubt they can take on the vested interests and provide the best health care system with equal status for everybody. I have no doubt we will achieve that. Furthermore, if someone wants to say something negative about the health service, they should first look at what is positive about it. In Roscommon, we need to work together to ensure we have the best small hospital for the future.

I am happy to acknowledge some of the achievements in health that are listed at the beginning of the Fianna Fáil motion. However, I cannot help but raise an eyebrow at some of the other content of the motion, one part of which calls for the Government to immediately put in place proper governance structures for the HSE. Has Fianna Fáil forgotten it was only recently in government and it was during this time in government that the HSE, in its present dysfunctional form, was established? While the former Minister for Health and Children, Ms Mary Harney, normally got the blame for the HSE, it was the current leader of Fianna Fáil, Deputy Martin, who was responsible for its creation and for the failure to put in place the proper governance structures the HSE does not have today.

As Deputies opposite are aware, the Government intends to bring a bill to the House this session that will provide for governance of the HSE. That Bill will deal with the maladministration and, to be frank, the incompetence of the last Government.

The line in the motion that condemns the Government for the €750 million in cuts is enough to raise both eyebrows. Have the current Fianna Fáil Deputies forgotten it was the late Minister for Finance, Mr. Brian Lenihan, who signed the memorandum of understanding with the European Commission, Article 21 of which commits the State to correct its budget by €15 billion and to balance its budget by 2014? Members of the current Fianna Fáil front bench bear culpability for the collective Cabinet responsibility in regard to the decisions that were made at that juncture.

These cuts in health and in other areas of society are Fianna Fáil cuts necessitated by agreements that were made as a consequence of the reckless management of the public finances during its time in office. While the Ahern Government took the easy option of simply throwing money at the issue without proper regard for the duty of prudence with State finances, this Government is determined to seek the best possible value for money in the interest of the taxpayer.

Taking the area of mental health as an example, under the comprehensive policy of the framework laid down in A Vision for Change, care in the community is one of the leading values of the principles of mental health policy. As with many other areas in the State, the main providers of care in community are charitable and voluntary organisations which receive funding from the State. For example, I understand there are 69 separate such organisations in the State providing residential care for persons with intellectual disability. These organisations provided a valuable and necessary service. Each one of them, I understand, has a human resource function, a finance function, a payroll function, a vehicle fleet function and a public relations function. The challenge for the Government at this time is to get more with less and to ensure effective resourcing of the organisations which provide important services to citizens. There is no need for these organisations to get involved in a turf war. The objective must be to provide shared and amalgamated services which provide a better outcome for clients and service users.

We can simply no longer afford to spend, as Bertie Ahern and the Fianna Fáil Party did, without any regard for the prudence of public finances. Of the €110 million adjustment being sought under the Health Service Executive western area service plan, €85 million is accounted for in pay adjustments and improvements in efficiencies. This is the pattern being repeated across the State in a reflection of a return to the virtue of proper management of the finances of our State. This comes after 14 years in which there was an absence of any prudential approach to public expenditure under the Government of which Deputy Kelleher was a member.

(Interruptions).

That party destroyed this country and sold our economic sovereignty. Yet Deputy Kelleher and his colleagues have the cheek to put forward a motion suggesting that they would reform the Health Service Executive. Their fingerprints are all over the mismanagement and dysfunction of the HSE. The colleague sitting beside Deputy Kelleher earlier was the architect of the executive. Members opposite no longer have Mary Harney to blame; that cushion is gone. History speaks for itself in this matter. The motion contradicts the party's very existence and its performance in government.

I propose to share time with Deputy Michael Colreavy.

I am not sure whether I can move my amendment to the motion at this point.

The Deputy cannot move it at this point, but he may refer to it in his contribution.

My party has tabled an amendment because the motion in the name of the Fianna Fáil Deputies does not go far enough either in its analysis of the causes of the crisis in our public health services or in the measures it proposes. Last week, the Minister for Health, Deputy James Reilly, told us that 4,200 staff members will have left the public health services by the end of this month. That is higher than previous estimates and, despite all the assurances of the Minister, the Taoiseach and their colleagues, including the Minister of State who is in the Chamber this evening, Deputy Kathleen Lynch, there is no public confidence that contingencies are in place to fill the gaps that will appear in the health services, perhaps not immediately on 1 March but very soon thereafter. The Government has repeatedly tried to portray this exodus from the health services as simply a matter of people taking early retirement. It omits to mention that the recruitment moratorium remains in place and, as such, most positions will not be refilled and existing staff will have to fill the gaps in services. Front line services will be thrown into deeper crisis. That is the inescapable reality that will present.

This is all part and parcel of the contraction of health services under the austerity regime begun by the Fianna Fáil-Green Party Government and continued by the Fine Gael-Labour Party coalition. The Fianna Fáil Party motion rightly condemns the €750 million in cuts from the health service budget for 2012 but conveniently ignores the €1.5 billion taken out in 2010 and 2011 under the previous Administration. That is one of the contradictions in the motion. The assaults on our public health services arise directly from the toxic policy which all three parties share, Fianna Fáil, Fine Gael and the Labour Party. They are truly the austerity parties of Ireland.

Since we had Dáil statements on the Health Service Executive's national service plan, we have seen the publication of the plan for the Dublin-north east region and the western area. The former is shocking in the extent of the cuts it imposes on public health services in the region. Expenditure reductions of €120.55 million are to be achieved in 2012 on top of the funding reduction of €493.5 million imposed between 2009 and the end of 2011. This region covers north Dublin city and county as well as counties Cavan, Monaghan, Louth and Meath. The plan reveals that the region will see 400 staff retiring at the end of February. What is hugely worrying is that in addition to this, up to 561 more staff will "need to leave the service" this year.

The Minister failed to respond to the point I made at Question Time last week that this additional reduction amounts to a very serious further diminution of staff. If the situation was not already bad enough in terms of what was flagged up by the early retirement exodus, we now have a clear statement of intent on the part of the HSE in the Dublin-north east region that an additional 560 staff members will "need to leave" in the course of 2012. I asked the Minister to acknowledge that the departure of 961 health service staff within one region will have devastating consequences for service delivery and for patient safety. His response was to accuse me and my party of scare-mongering. That is crass in the extreme.

This exodus of staff will indeed be a devastating blow to health services across the board. It is not what I want to see and I take no relish whatsoever in having to address these facts. The plan further states that these massive staff reductions will be needed "before any priority replacement staff are recruited". That tells us very definitely that key front line service staff in the Dublin-north east region will not be replaced. Staff will not be recruited to cover these essential areas until such time as the significant staff exodus, including the 561, is completed. That is what is stated in the report.

We are threatened with 100 bed closures in acute hospitals across the region and 105 long-term care bed closures. Some €71.3 million is being slashed from the hospitals budget. There will be cuts of €10 million in primary care, including cuts to out-of-hours GP services; €7.5 million from older people services, including reduced home help hours; €12.6 million from disability services, including 534 fewer respite nights; €7.92 million from children and family services; €2 million from social inclusion services; and €500,000 from palliative care. These cuts come directly in the wake of reductions already imposed in January, including outpatient clinic reductions on the back of the deficits carried forward from 2011.

The HSE west regional service plan was also published last week. It proposes to slash public health services across the board in the largest of the HSE regions geographically, which stretches from south Limerick to north Donegal and from north Leitrim to Connemara. Patient care will be hit hard in a region that has experienced some of the worst of the health cuts of recent years, with reductions of €104.8 million set out for 2012 . The plan reveals that the west will see 683 staff retiring by the end of February, with further job cuts to be imposed before the end of the year. There are major cuts across all key services. The loss of 132 long-term beds will be a blow to the care of older people, as will the threatened closure of care homes.

One direct result of this is the ending of residential care at Lifford hospital. As my colleague, Deputy Pearse Doherty, stated, this Government, like its Fianna Fáil Party predecessor, has ignored the people of County Donegal who took to the streets in their thousands demanding that community hospitals remain open and that health services be cut no further. When speaking at a Fine Gael rally in Stranorlar in June 2010, the then Fine Gael spokesperson on health, Deputy James Reilly, pledged support for Lifford and other community hospitals. He said: "Certainly Lifford will not be closing, that's for sure. It's far too important and serves far too big an area." These are the words of the now Minister for Health, Deputy Reilly, who a few moments ago occupied the seat now occupied by Minister of State, Deputy Lynch.

The cuts in service plans as presented are set to close hundreds of nursing home beds and an as yet unknown number of nursing homes. We are facing a year of terrible cuts and a crisis such as we have never experienced before. It challenges me to understand the effort employed during the early to middle months of last year in terms of the recruitment of essential non-consultant hospital doctors in order to stave off the crisis that would present as of 1 July when, with the exodus of 4,200 by the end of this month, there is no sign whatsoever of any foreboding in terms of the difficulties that will present for front line service providers. All of this was well signalled for some considerable time. The Minister for Health, Deputy Reilly, must accept that we are careening headlong towards the mother of all crises in our health services. He is in the driving seat. It is time he applied the breaks and took corrective action. I urge him, and all voices that can bring influence on him, to do so. It is in all our interests and those we represent. I urge Deputies of all opinion to support the Sinn Féin amendment.

Last Friday, the Minister for Health, Deputy Reilly, visited Sligo Regional Hospital, the HSE recruitment offices in Manorhamilton and Our Lady's Hospital, Manorhamilton. I regret I was not aware of that visit. It appears that the only people who knew of his visit were local Fine Gael representatives and, presumably, a photographer.

Possibly, although I cannot verify that. Had I known the Minister was visiting Sligo, I would have arranged for a number of groups to meet with him, including members of the Save our Cancer Services campaign, the Friends of St. John's Hospital who are fearful of further bed closures and the Friends of St. Patrick's Hospital in Carrick-on-Shannon who are fearful of further public bed closures to the long-stay hospital there.

I understand that the Minister had to travel on to Galway following his meetings in Sligo and Manorhamilton and that he was two hours late arriving in Galway because he had to walk the final mile of his journey owing to traffic delays. The Minister at least now understands what it is like for people required to travel from Donegal, Sligo or south Leitrim to Galway several times a week on a bus for cancer services.

The Minister, Deputy Reilly, when in opposition said all the right things and was elected on that basis. Members of the Save our Cancer Services campaign acknowledge that they canvassed for members of the Government parties on the basis of the solemn promises they made and that they now feel they misled people because those solemn promises have been thrown back in their faces. I wonder if the Minister, when visiting Our Lady's Hospital last Friday, informed staff that it would be announced tomorrow that its day hospital service, which is probably the cheapest, most economical and most valuable service, one which transforms the lives of the people who attend it, is to be reduced from five to three days per week? This is wrong. Many people are not in long-stay homes because of day hospital services. The result of this paring, pinching and pulling back on this economical service will be the return of people to long-stay nursing care or, worse, home but not fit to care for themselves. The home help service has already been reduced and as such there will be no capacity there. This is what we are getting from a Government and Minister who promised so much.

Did the Minister tell the staff of Our Lady's Hospital that a consultant rheumatologist who is going on maternity leave will not be replaced and that this will result in the waiting list for rheumatology services for people in pain suffering from arthritis growing from one to two years? This is not acceptable and the Minister knows it. I urge the Government to accept Sinn Féin's amendment.

I welcome the opportunity to speak on this important motion on health services. It gives me an opportunity to hammer home once again what is going on in our health service, in particular the €750 million cuts to the National Service Plan 2012 which will have a detrimental affect on patient safety and front line services. Closing acute hospital beds and operating theatres should never be an option. The sick, the elderly and the disabled did not cause this financial crisis and should not now have to pay for it. That is the key issue in this debate tonight. It is the reality to which the Government must face up.

The Croke Park Agreement is an important part of this debate. I am sick and tired of all the attacks on public servants, teachers, nurses, doctors and, in particular, those providing front line health services. The Croke Park Agreement is now a dirty phrase. Let us look at the facts and at what is happening on the ground. The Croke Park Agreement has thus far succeeded in delivery of €3.5 billion in payroll and pension costs. The staff are delivering on the ground. In the first year of four, Croke Park Agreement measures have led to savings of more than €680 million, made up of payroll and efficiency savings plus cost avoidance initiatives. Last November, the Croke Park Implementation Body outlined additional reforms achieved and under way and reported concrete progress on leave standardisation, rationalisation of services, redeployment, shared service initiatives and many other local and national reforms. The body will quantify the savings achieved in its second annual report in mid-2012.

The following savings have been achieved thus far by public servants on the ground - €50 million per annum through the redeployment of surplus teachers; €7 million through new rosters in medical laboratories; €3.5 through changes in radiography services; €20 million through changed prison work practices; almost €1 million by St. Michael's House disability services; €220,000 by Our Lady's Hospice in Dublin; €685,000 annual savings by Teagasc and a further 20% cut in local authority staffing, resulting in a further €16.5 million in payroll savings. These figures and statistics have not thus far been put into the public domain. These are the facts.

While I disagree with sections of the motion, in particular the part which deals with the universal health issue, it is important that the other issues are dealt with in a comprehensive manner. It is a bit rich of the Minister, Deputy Reilly, to have a go at the Independents. For as long as I have been a Member of this House, the Independents have always put health and disability issues top of the political agenda. We have always used our vote to deliver services to people on the ground. That is the reality.

I welcome the opportunity to contribute to the debate. Although the service plan for HSE west was published last Friday, strangely enough it could not be accessed on the Internet until today. The reason is obvious when one examines it and learns of the cuts involved therein. The community in County Donegal and around Lifford in particular have learned of the announcement to close Lifford hospital and the charade of a consultation period over the next three months on which the HSE intends to embark. About what will the HSE consult? The hospital will close and that is it. Consequently, this consultation is merely to be seen to be talking to people and supposedly to be consulting the community, when everyone knows the hospital will close and the decision already has been made.

I note also that 320 fewer subvented beds will be available for elderly people in the HSE west area. In addition, 150,000 hours of home help will be lost, albeit with the same number of people being served by the home help service. There will be nowhere for those elderly people to go. As there is nowhere else available for them, Lifford hospital should be kept open and maintained in order that these people at least can have some comfort and security in their own communities. Instead, the Government will force families into paying increasing amounts to put elderly people into private nursing homes with no subvented beds. Moreover, there are great difficulties in respect of the fair deal scheme and home help is not available for such people. This is the outcome of this health plan and this is the very hospital that, as has been pointed out earlier, the Minister, Deputy Reilly, when in opposition stated would not close. He stated that this was an area that was deprived and which needed that hospital. Nevertheless, it now is evident that it will close and will be taken from that community.

Debate adjourned.
The Dáil adjourned at 9 p.m. until 10.30 a.m. on Wednesday, 22 February 2012.