Dara Calleary
Question:6. Deputy Dara Calleary asked the Minister for Health the way in which he proposes to improve the working conditions of non-consultant hospital doctors; and if he will make a statement on the matter. [39992/13]
View answerNon-Consultant Hospital Doctors Working Conditions
Questions (6, 7, 37, 58, 265)
Terence Flanagan
Question:7. Deputy Terence Flanagan asked the Minister for Health the steps he is taking to deal with the shortage of non-consultant hospital doctors; and if he will make a statement on the matter. [39925/13]
View answer
Brian Stanley
Question:37. Deputy Brian Stanley asked the Minister for Health the reforms being undertaken to address the underlying causes of the junior hospital doctors' dispute; and if he will make a statement on the matter. [40045/13]
View answer
Thomas Pringle
Question:58. Deputy Thomas Pringle asked the Minister for Health the direct involvement he has had with the IMO to resolve the dispute with the non-consultant hospital doctors over the implementation of the European working time directive; and if he will make a statement on the matter. [40061/13]
View answer
Bernard Durkan
Question:265. Deputy Bernard J. Durkan asked the Minister for Health the extent to which it is expected to be in a position to meet the concerns of junior hospital doctors in the context of the working time directive; and if he will make a statement on the matter. [40300/13]
View answerOral answers (14 contributions)
I propose to take Questions Nos. 6, 7, 37, 58 and 265 together.
These questions point in the same direction. As I said, Ireland must have sustainable arrangements to train and develop the medical workforce we need to provide safe and effective services to the population. I am committed to retaining our doctors. I find it disturbing that we train some of the brightest and best in this country who go abroad and prove they are the brightest and best working in some of the finest institutions and excelling all over the world. Meanwhile we go around the Third World taking doctors from its countries to buttress the service here. Having been a doctor, I believe it is very good that people go abroad and come back and that we should encourage exchanges of that nature. However, the manner in which it is operating at the moment is not acceptable to me. Like so much else in the Department of Health and the health service, it was allowed to evolve chaotically. What we are trying to do now is use this opportunity, which is a huge challenge, to fix something that should have been fixed years ago and that gives people a proper, clear career path in respect of their future.
One thing that is lacking and that I want to address is the area of final year medicine and having a mentor to advise one about what career path to take within medicine because it has so many different aspects and different careers suit different people. They do not get any mentoring. They finish, qualify and celebrate and then suddenly they are an intern and it is a case of "what am I going to do next? Do I go into surgery? Do I go into anaesthetics?" There is no formal advice available and there should be and I want that addressed as well. I am sure Professor MacCraith will provide that in his interim report. He will give me a final report later next year.
I have met with Commissioner Andor on a number of occasions in respect of the European working time directive and have given him a detailed plan and timelines as to how we are going to address this issue. There is no question that it will be a real challenge. As I said in my earlier answer, it is clear that a whole range of issues need to be addressed to resolve this issue. It is about the type of work they are doing, the numbers and the way they have been rostered in the past. I know that rosters have been drawn up by senior medics that the NCHDs could improve on massively when they look at them in terms of making their lives more bearable and livable. Sometimes, there has been real reluctance on the part of people to change purely because it is change. Change is challenging but we must all grasp and embrace it or we will end up with these recurring problems that we should not have.
The HSE established a national group to bring an urgent focus to implementation of the working time directive. I do not want to repeat all the issues I mentioned earlier. However, I note that progress has been made in the Labour Relations Commission to allow at least the deferral and suspension of the industrial action. I know that a number of further meetings will be necessary and I hope and encourage both sides to try to resolve this without impacting on patients.
With regard to the NCHD shortages, the overall position has stabilised since the last training rotation took place at the end of July and the majority of vacancies are now filled. However, challenges remain, mainly in smaller hospitals and in certain specialities, including emergency medicine, against an international shortage of doctors in these specialities. Where sites continue to experience challenges in terms of vacancies, hospital management implements contingency plans including revised rosters and where necessary, locum arrangements to ensure service delivery. System reform, in particular the implementation of the report on hospital groups and the framework for the development of smaller hospitals, will assist in achievement of a more focused and efficient deployment of NCHD staffing.
The other issue here is that we have a huge resource relating to teaching across our hospital systems and in primary care. We have not made as much use of that in the past as we could in the future so we will engage with the colleges to see how we can expedite that and make better use of the resources that are available to us.
I will call Deputies in the order in which they are on the Order Paper - Deputies Kelleher, Terence Flanagan, Ó Caoláin, Pringle and Durkan.
I thank the Minister for his detailed reply. We have had discussions about this issue in the Oireachtas Committee on Health and Children. We have heard from the Minister and representatives from the IMO and others. There is a clear wish for everybody to address this. I hope Professor MacCraith will come up with a strategy and plan and that resourcing will be put in place.
While we welcome the suspension of industrial action, the bottom line is that the HSE has been dragging its feet to a certain extent in addressing this issue. As the Minister quite rightly pointed out, this has been around for many years but it has been two and a half years since the Minister came to office and it seemed to take the threat of industrial action to concentrate minds, particularly in the Department and the HSE, on addressing this fundamental issue. While Professor MacCraith will hopefully bring forward a pathway for non-consultant hospital doctors to find a career in which to specialise in their particular fields, has the Minister assessed how many more non-consultant hospital doctor posts would be required to implement the working time directive in its entirety or is the Department still in that process?
We are still very much in that process because the answer to the question is contingent upon implementing the reforms. Going back to the key principle of our health policy, it relates to ensuring the patient is seen at the lowest level of complexity that is safe, timely, efficient and as near home as possible. That means we do not want consultants looking after patients who could be looked after by GPs, GPs or consultants looking after patients who could be looked after by nurses, nurses looking after patients who should be looked after by health care assistants and any of those groups looking after patients who should be looked after by allied health care professionals like physiotherapists and others. Unfortunately, because of the way the system has been allowed to evolve, if I as a GP want to get physiotherapy for a private patient without a medical card who cannot afford to go to a physiotherapist privately, I must refer him or her to an orthopaedic or rheumatology clinic. This is ridiculous because it is wasting the patient's time waiting for an outpatient's appointment at a clinic that I do not think they should go to, to move on to see the allied health care professional they need to see. We are putting in place ways of dealing with that. I will probably have to come back to somebody else on this.
I thank the Minister for his response. The working conditions, the process involved in becoming a specialist and the pay rates mean that many Irish-trained doctors go abroad. It is not enough for us to compare the pay rates in other EU countries, we must compare our pay rates with other English-speaking countries. The threatened industrial action by junior doctors further undermines the attractiveness of working in Irish hospitals. I am glad that has been suspended.
Does the Minister believe that Irish medical graduates deserve a fair deal and realistic working hours? I know he has responded on this point but does he think it is acceptable that two thirds of Irish-trained doctors are going abroad and will not work in Irish hospitals? That is an investment of about €50 million per year in doctors' education which is leaving the country. It undermines the health service. While our doctors are out there supporting other health systems around the world, we are bringing doctors in from other developing countries.
As the Deputy points out, I share his concern and it is something I am determined to address. I am looking to NCHDs themselves in respect of the work being done by Professor MacCraith. I want to provide a safe place for them to speak.
They are afraid to speak out because they will not get a good reference towards their next job. That goes on, and it is wrong.
I refer to pay rates. Let us be honest and straight about this and let me put this point on the record of the House today. I have been challenged for not tackling consultants' pay. We have tackled it. We have reduced the starting pay by 30% - it is now €116,000 to €121,000 per year. Some would say this will mean consultants will not stay in this country and will go elsewhere because we are paying less than the other English-speaking countries to which the Deputy alluded. The nearest English-speaking country to us is across the water, in Britain, and the other jurisdiction, in Northern Ireland. There the starting pay for a consultant is £80,000, or approximately €100,000. The pay is quite appropriate. If we constantly choose to compare people's pay in this country to that in the wealthiest countries in the world where the best people are, we will never get anywhere. Our country has a financial constraint; the money we are spending on our public service is borrowed and comes with terms and conditions. There is a new milieu and sadly we must all live in it for some time to come.
In the context of agreement being reached, will there be independent verification of the working time performed by junior doctors at our various hospital sites? How will that be confirmed? Will it be confirmed independently? What will be the knock-on effect of adherence to the requirements of the European working-time directive in respect of care of patients and the work-time commitments and responsibilities of other front-line health professionals?
A number of initiatives are on the way. One of my real complaints about the HSE when I was in opposition was its inability, in spite of being a national organisation, to bring any uniformity of approach to matters. One found excellence in one hospital but this was not transferred across to other hospitals. It is not always appropriate that the same measures should work in every hospital but one that has worked very well in Tallaght Hospital was fobbing in and fobbing out, a measure that cut the overtime bill considerably. The Deputy can draw his own conclusions from that. That must be done. We must transfer work undertaken by NCHDs to other grades and allied professionals. We need the organisation of hospital services to be done in such a way that we can support the European working time directive.
I want to see a situation where doctors can have a career, a life and a hobby. Currently, that is not the case for some - that is wrong and must be addressed. I do not wish to turn this into a political punch and judy show but I must tell Deputy Kelleher that the last Government simply threw money at the problem rather than face it down and reform the system. That is what we are going to do now.
The Minister used to criticise it every day for not giving enough.
We are short of time. I call Deputy Pringle.
Question No. 58, does not relate to working conditions or the conditions of non-consultant hospital doctors, their career paths or anything else in that line so I wonder why it was grouped with these questions. My question relates to the Minister's involvement in the dispute since the IMO balloted for industrial action. Much has been made in this House by the Minister about his taking back responsibility into the Department. He has said that the buck stops with him in terms of responsibility for the operation of the health services, the changes that have taken place within the HSE and the abolition process in that regard. Why did it go down to the wire, to the last minute, for interaction to take place with the doctors in this dispute? I welcome that industrial action has been delayed or postponed and I understand talks are talking place in the LRC today. However, the Minister should have acted long before without there being the need to take this to the wire, with consequent concerns being expressed in the wider community as well as among the doctors. That is a key point.
I am bemused. The reality is that, as Minister, I do not become directly involved in industrial disputes. The Department and the HSE handle these matters. If I have to become involved it is usually when matters have become extraordinarily serious and require direct ministerial involvement. I must put on the record of the House that I have done more in respect of this issue than any previous Minister by setting up the group in question at the beginning of the year in anticipation of this problem. The group was to address and work on the problem so that we would not have the situation we had some years ago when we had to undertake special recruitment overseas to bring in people. That is the first point.
Second, I refer to the group set up under Brian McCraith to create a clear career path. That is the first time this has been done, by involving the actual NCHDs so that they can get what they want from it. No disrespect to any particular group, but it is the interns, senior house officers and registrars who are not on the specialist training schemes. The specialist registrars are already on that scheme and their career path is clear for them. I want to retain as many of them as I can in this country. They also have an input but it is the lower grades, the younger doctors, that I want to see being sorted out so that they can stay here and continue to contribute to the land that reared and has educated them.
I thank the Minister for his replies. I have raised this issue before with his good self and also with his predecessor because it has been on the cards for a long time. In the context of the present negotiations or previous discussions on the issue, has it been possible to determine whether any structure or arrangement can be entered into which would encourage graduates to take up their internship in Irish hospitals as opposed to going overseas? What is the extent, if any, to which other jurisdictions face and address these problems? Other English-speaking jurisdictions must have a similar problem. Having regard to what the Minister has just said, can he indicate whether non-English-speaking jurisdictions have a similar difficulty in observing the working time directive and keeping their graduates at home, given the Minister's statement that there would appear to be an attraction for doctors in serving their time in that capacity in their own country in the first instance?
As to other English-speaking countries I do not wish to denigrate any country. There certainly were big problems with this across the water in the UK but I do not know how much progress has been made in recent times. I am sure there has been considerable progress.
I believe this comes back to sentiment. Maybe I will be shot for saying this but judging by many of the doctors I have met I do not believe money is the over-riding issue for them, nor, to a lesser extent, are the hours although that is a real problem. What really drives them away is the lack of a clear career path and the lack of respect. They do not feel valued. They feel undervalued and underwhelmed by it all, having studied so hard to reach that zenith and have MB BAO BCH or LRCPSI after their names, only to find they are hit on all sides as to where they will end up. Some see themselves working extraordinary hours for long years, never having enough time to study and to progress, and they become burnt out. That is not something they are going to do so they will leave this country and go somewhere else where they can enter a training scheme today and know that in six years, as long as they work hard and get their exams, they will be specialists at the end of it. That is what I want for this country. Nor do I necessarily mean it should take six years - it should be five.
Misuse of Drugs
Questions (8)
Denis Naughten
Question:8. Deputy Denis Naughten asked the Minister for Health the reason for the delay in updating the misuse of drugs regulations to deal with the misuse of benzodiazepines; the timeline for the enactment of same; and if he will make a statement on the matter. [39927/13]
View answerOral answers (5 contributions)
A draft Misuse of Drugs (Amendment) Regulations, which will amend the Misuse of Drugs Regulations 1988, was prepared in my Department following a consultation which took place with a wide range of stakeholders during late summer and autumn 2012. Amendments proposed include the introduction of measures to address the problem of the illicit trading and supply of benzodiazepines and z-drugs, which are prescription medicines, and other updates to the Misuse of Drugs Regulations. The proposed draft regulations constitute a major amendment to the Misuse of Drugs Regulations.
In order to obtain input from stakeholders and interested parties on the text of these draft regulations prepared following the 2012 consultation, a further consultation process was carried out during the summer. The proposed amending text and an explanatory document were published on my Department's website, inviting written submissions. The deadline for submissions was Friday, 6 September 2013. More than 90 such submissions have been received and are currently being reviewed by my Department.
Arising from the consultation process, the Draft Misuse of Drugs (Amendment) Regulations will be submitted to Government seeking the Government's approval to notify the draft regulations to the EU Commission and member states under the technical standards directive. At the end of the three month EU notification period, the Government's approval will be sought to make the relevant orders.
It is anticipated that the new regulations will be introduced early next year.
I thank the Minister of State for his response. Mr. Basil Miller, director of communications at the Wellbeing Foundation, stated in 2011 that 95% of patients are being given antidepressants contrary to guidelines. That equates to roughly €55 million per year which is paid out by the HSE for antidepressant drugs for patients who would be better off on treatments other than medication. There are savings to be made here as we come towards the budget.
The Department of Health has promised to address the issue of over-prescribing, but it does not seem to be happening. When exactly next year will we see regulations in this area? Not only is it costing the health service money, but it is costing lives. Prescription antidepressants are freely available on the streets in Ireland and this is delaying important treatment for vulnerable people, which can only lead to self-harm and death.
The issue the Deputy raises is related to this question, although it has a slightly different focus. The focus of Deputy Naughten's question was on the misuse of drugs regulations and the increasing problem of the availability, literally on the street, of prescription drugs, many of which are antidepressants and drugs prescribed for anxiety. Deputy Flanagan is correct to link that with what he claims is the practice of over-prescription, especially in the treatment of anxiety and depression. While the issues are linked, they are not precisely the same and there is an onus of conscience in the HSE and on the part of policy makers generally in respect of prescribing strategies. We have taken this on board in the area of prescribing in general, and not just in the area of prescribing and depression, so we can ensure that appropriate prescribing strategies are applied by the medical community. We rely on the professionalism of our doctors in huge measure, and that has always served us well, but I will take into consideration the points made by the Deputy.
Is the Minister of State aware of the study by the National Documentation Centre on Drug Use which was published last year under the auspices of the Health Research Board? It found that 49% of opiate-dependent clients surveyed had reported using non-prescribed benzodiazepines in the previous month. The greatest number of these are former heroin users who are on methadone, but this clearly demonstrates either over-prescription of these drugs, which are being sold on by those for whom they were prescribed, or that these drugs are being wrongly prescribed so that people have them to pass on, which they are clearly doing.
The authors of the report recommend a more formal and active assessment of the needs of clients on methadone treatment and rapid access to evidence-based treatment for benzodiazepine misuse. Will the Minister of State adopt these recommendations, or has he already investigated the implementation of the recommendations of that report?
The Deputy raises a very good point, which was precisely the motivation for the consultation process and the intended introduction of these amended regulations. The Deputy is absolutely right; this is an increasing problem. There is poly-drug use, such as combinations of benzodiazepines with methadone or alcohol. It is a major new challenge in this sector and something with which we are only beginning to get a grip. We understood the drugs problem in Dublin to be the heroin problem, but it has a different dimension now and the Deputy has touched on that in large part. Many of the recommendations to which the Deputy has referred are actually in the draft regulations that I proposed and hope to introduce next year. I do not have time to go through them right now, but they include issues such as unauthorised possession of benzodiazepines, controls on the licences for importing and exporting them, and stricter prescribing and dispensing rules. There is a list of recommendations, all of which I hope to include in these regulations.
Medical Card Data
Questions (9)
Micheál Martin
Question:9. Deputy Micheál Martin asked the Minister for Health the number of medical cards that have been withdrawn in 2013; and if he will make a statement on the matter. [40013/13]
View answerOral answers (7 contributions)
The number of cards that have been issued following review and the number that have been withdrawn are not readily available in the format requested by the Deputy. Details of the number of medical cards and GP visit cards are provided to my Department each month by the HSE. These figures are currently provided on a net basis, showing the balance after new cards have been issued and other cards, as appropriate, have been deleted from the executive's database - for example, following a review of a person's circumstances. The most recent figures provided to my Department by the HSE reflect the position as at 1 September 2013 and show 1,863,062 medical card holders and 124,361 GP visit card holders.
There is no point in beating around the bush here. There has been a change in the policy for awarding discretionary medical cards. Every Deputy in this House is inundated with people who historically had been awarded a medical card based on health needs on a discretionary basis. I accept that there is no change to the guidelines, because there are no guidelines on discretion. However, the evidence shows that the number of medical cards awarded on discretionary grounds has been reduced dramatically and is now under 59,000. There has been a continuous pretence that nothing has changed, but something must have changed because we have reduced the number of medical cards by such a large amount.
I would like to quote from an article in The Irish Times today about the Ombudsman, Ms Emily O'Reilly:
[The Government] also had an absolute right to govern, she said, and if it wanted to get rid of schemes that was its right. “But what is not right is if they are not clear and open and honest in relation to what they are doing.”
There is a problem, because people who are very ill and who are the sickest in our society cannot access medical cards on a discretionary basis.
The departing Ombudsman also said that her officials' examination of complaints about the removal of discretionary cards showed "nothing substantial had changed in relation to the regulations that applied." The report went on to state the following:
In the past, in situations where a person’s income was above the threshold, appeals officers looked at other factors, such as their level of illness or need for equipment or medication, she said. Now people are being denied cards where their income exceeds the limit.
In fact, that is not the case. Precisely the reason for having a discretionary medical card regime is that we are not confined to allocating medical cards to people who come within income limits. That is what a discretionary card is. If somebody comes within the income limits, they get the card. There is no issue about that. The discretionary card only goes to people who are above the limits. That is what it is for, and it is being implemented.
We can debate this forevermore, but there are now fewer discretionary medical cards out there than was previously the case. At one stage, 80,000 medical cards were given out on a discretionary basis, but that is now down to 59,000. Clearly, there has been a tightening of the discretionary award. I believe this is purely a budgetary exercise, because the fact is that these were given to the sickest people in our society. The HSE has decided to withdraw them as a cost saving measure because they are the medical cards that are most expensive to the State. It is a cynical exercise and we see it time and again. Deputies from all sides are inundated in their offices every week by people who are very ill. One example is a person with motor neuron disease and a child with Down's syndrome and other complications who had a medical card that has been withdrawn. That is happening wholesale and the Minister of State cannot deny it. The pretence that there has been no change in the awarding of discretionary medical cards is quite bizarre. It is unacceptable that the Members opposite pretend there has been no change. There has been no change. Discretion is being used and they are deciding not to grant the cards.
On the question of medical cards being reviewed and potentially withdrawn, I wish to draw to the Minister of State's attention to an issue that some farmers are experiencing. They have an income level whereby they are not eligible for tax, yet the HSE demands that they produce audited accounts. It is demanding a higher burden of proof than Revenue does. Will the Minister of State investigate this matter with a view to the HSE and Revenue sharing information? Some low-income farmers must incur accountants' fees just to qualify for medical cards to which they are already entitled.
No matter what effort the Minister of State may employ, he cannot discount the fact that there has been a reduction in the number of discretionary medical cards. The Minister acknowledged it during his last engagement with the health committee when he stated that discretionary cards were no longer being granted to cancer patients in the same way as previously. Ms Laverne McGuinness, a senior representative of the HSE, also admitted that the number of people on discretionary medical cards had decreased. How does the Minister of State square the circle? The reality is that we are dealing with people who are victims of the new assessment, policy or whatever. People are suffering the loss of medical cards on which they depended. We want to see those cards restored.
At the risk of irritating the Deputies with repetition, it has never been the case since 1970 that the law provided for the allocation of medical cards to persons on the basis of illness. Discretion does not suggest that someone must have the card. It means that someone must apply a particular assessment to a situation. This is what we are doing. It was centralised two years ago. We have not denied the change in the numbers. There is no pretence - the numbers are the numbers. We have given all of the numbers. Indeed, I have provided numbers for 1 September to the Deputies. All of the facts are before the House, as is proper. The Deputies will also be aware that there has been a significant increase in the number of medical cards in the system generally. It must be acknowledged.
I will consider Deputy Harris's point. I do not disagree with it, but the extent to which we have information and clarity from Revenue, the HSE or otherwise to ensure that the system works is an advance, not the opposite.
Health Insurance Prices
Questions (10)
Bernard Durkan
Question:10. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department have monitored private health insurance costs; if any particular reason has been identified for increases in such premiums; if he is satisfied that the principle of community rating continues to exist; if private health insurance costs increases have been associated with any particular section in the health service; if particular changes are envisaged which might go some way towards stabilising private health insurance costs in general; and if he will make a statement on the matter. [40056/13]
View answerOral answers (8 contributions)
I have consistently emphasised the vital need to address the rising cost of private health insurance and the necessity for all private health insurers to address their cost bases aggressively. Last year, I established the consultative forum on health insurance to generate ideas to address health insurance costs. During the summer, I appointed an independent chairperson, Mr. Pat McLoughlin, who will work with my Department and the insurers on a review process to give effect to real cost reductions in the private health insurance market. I want all insurers to address the base cost of their claims and to see all procedures provided in an appropriate and safe health care setting.
The Health Insurance Authority, the independent statutory regulator of the private health insurance market, recently provided my Department with information on claims costs in the private health insurance market. Almost €2 billion was paid in claims by private health insurers in 2012. Some 46% was paid to private hospitals, 27% to public hospitals, 20% to consultants and 7% mainly for outpatient benefits. The average claim per insured person increased by 12.6% per annum between 2008 and 2012, largely as a result of increased usage of hospital services, with insurers attributing premium increases to increased claims costs and ageing memberships. Clearly, increases of this magnitude are not sustainable.
Community rating is a fundamental cornerstone of the private health insurance system, but it is under pressure from the market segmentation strategies being used by insurers as they seek to minimise their risks by trying to enrol younger, healthier lives. The Government is committed to the principle of community rating and, in 2012, clearly demonstrated this by introducing a permanent scheme of risk equalisation. The new scheme, which took effect from January 2013, is an essential support to community rating, providing a cost subsidy from the young to the old and from the healthy to the less healthy. The continued participation of younger customers in the market is clearly important and is one of the issues that the consultative forum is actively considering.
Work on these issues is progressing and I welcome the positive engagement by the private health insurers in the process but we need more robust audits. We have started that process with the VHI. Indeed, a large private hospital in this country - I will not say where - needed to repay €5 million. Another case saw €7 million being returned by doctors.
I thank the Minister for his comprehensive reply. Concerns have been expressed by many of those who have faced gradually increasing health insurance premiums in recent years. In their heyday, they contributed equally and reliably to the system when it was less competitive and provided better value for money. They did so in an economic environment in which they often paid as much as 17% interest on their mortgages, etc. I reject the suggestion in some quarters of the market that they are now a burden on the system.
Will the Minister indicate whether comparisons have been made with the system operating in the adjoining jurisdiction? Have people been subjected to the same increases? If not, how can the situation of Irish consumers be improved?
I am glad that the Deputy has raised this important issue. It is the third leg of the health stool - the Department, the HSE and the VHI - and is responsible for 80% of pay-outs. I am determined that we address the cost base. Why do we pay the same sort of money for a procedure that used to take two hours that now only takes 20 minutes? I discussed this matter with the VHI. After much pushing and shoving, it agreed to reduce the fee by as much as 20%. If there has been an 85% reduction in the time it takes, surely the reduction in the fee should be more than 20%. I intend to encourage the VHI to pursue these issues and to use clinical audits to challenge doctors about the necessity of the tests they are doing.
There have been double digit increases in health premiums in recent years, but we have kept the increase to 6% this year. Deputy Kelleher-----
Some 3% is the straw that broke the camel's back.
-----is shaking his head. His Minister made a mess of the health service. I could tell the Deputy that I have been two and half years in the Department and that it takes longer to get things off the ground in health than in other Departments, but I will not, as that is what his leader, Deputy Martin, stated in 2002.
Hear, hear.
It is taking the Minister a long time, too.
I hope that everyone enjoys the weekend. The Ballinasloe horse fair is taking place and everyone is welcome to attend.
Written Answers follow Adjournment.
The Dáil adjourned at 5.50 p.m. until 2 p.m. on Tuesday, 1 October 2013.