Today's newspaper reports carry a statement from the Minister for Health and Children admitting that there will be cutbacks in jobs in health this year. He is refusing to speculate about whether this will amount to 5,000 jobs. This might be funny if it were not so serious, because the battle of Ballymascanlon still continues and apparently rages without cessation inside the Cabinet. It appears as though the Government, particularly the Minister for Finance, has taken the view that we live in an economy, not a society. Has the Taoiseach intervened in this row? Are we to have a Department of Health and Children and a health budget or a health service? Having dealt with these warring factions, will the Taoiseach indicate whether the proposed heart-lung transplant unit in the Mater Hospital is to be scrapped on foot of the Minister for Finance's comment about the dictating of medical treatments? Over €8 million has been spent on this unit, which was promised by Fianna Fáil in the 1997 election. Has the Minister for Finance proved that he is capable of hard decisions, if not wise ones?

The Minister has also questioned the use of artificially manufactured blood products in the treatment of haemophiliacs. This has been denied by the Minister for Health and Children. What is the truth? Will the Taoiseach clarify the number of job losses foreseen for the health area? Was the Minister speaking only of unapproved jobs, or are these to go as well as a segment of the 5,000 pertaining to the Department of Health and Children? Will those jobs include speech therapists, physiotherapists and occupational therapists? Will there be more unfortunate incidents like that in Kilkenny last week where local facilities were not made available by a Department?

The Minister for Health and Children will continue to implement the health strategy. The 5,000 jobs mentioned in the budget were part of the overall figure for all public services. There is no question of one area taking up any substantial number – they will come from across the entire service. There has been an enormous increase in staffing levels in the last few years. The increase in health service employment reflects a variety of factors – demographic pressures, record levels of funding activity, provision for additional replacement staff due to changing work practices, changes in the composition and structure of employment growth and reductions in vacancy levels resulting in reduced dependency on agency staff.

Following the announcement on budget day of the planned reduction in public service numbers, discussions will commence between the relevant Departments regarding the practical steps required to implement the measure over the coming years. As the Minister for Health and Children stated, the Department's priority will be the maintenance of front line staff to provide a service to the public and protect essential services. The reductions in numbers can be achieved through natural wastage across most Departments over the next three years. With costs increasing by 88% because of the rise in the number of staff in the last few years, it should be possible to achieve that.

Bed capacity services, the treatment purchase fund and acute hospital activity will continue. The Minister will continue to develop primary care and the lung transplant programme, for which €4.5 million is being provided for 2003. Provision for the treatments of disabilities, cancer and cardiovascular disease are all contained in the Minister's Estimate for next year. In his last report, he stated that more than 70 of the 121 strategy actions are being worked on.

The Minister for Health and Children and the Minister for Finance have always been the best of friends, that is how the Minister for Health and Children manages to get the billions of euro needed to run the health service.

The Minister for Finance stated that the health strategy will not be implemented next year or the year after. Is that a fact? How many of the unapproved staff in the health service will be let go and how many will be approved? How many jobs will be lost to the health service as a result of the cut of 5,000 in public service numbers and the embargo on recruitment? Will those jobs include physiotherapists, speech therapists and occupational therapists? Why is one Dublin hospital paying more to lawyers than doctors while in another major Dublin hospital a psychiatric patient has occupied an orthopaedic bed for the past three months? Are we to have a health service or a Department of Health and Children with a health budget? Will the Taoiseach intervene to prevent the warring factions from making a shambles of a health service where hundreds of thousands of people are ill at ease because of inadequate service? The Taoiseach's own consultants reported that the Department of Health and Children is unable to absorb money because of the way it is being flung at it and that it is an obscene waste of taxpayers' money. In a perversion of logic, people are being flown out of the country while hospital wards here are being closed.

Work is continuing in 70 of the 121 strategy actions. The Estimates for next year show the Government has provided for 74% of the net total increase in public expenditure to be set aside for health expenditure. Staffing levels in the health service have reached 96,000. The tightening up of numbers should be achieved by natural wastage and the Departments will work that out between themselves. Front line services will be maintained. By the end of the year, 520 beds will be funded, 70 more than in the strategy target. More than 1,800 patients are in the treatment purchase fund and 960 treatments are expected this year. I reject the allegation that the health service is not well funded and staffed at both day to day and infrastructural levels. As the Minister continues to implement the health strategy, it will improve.