We now have three major reports on reform of the health system – Prospectus, Brennan and Hanly. On 15 October the Minister for Health and Children announced that the Government had endorsed the Hanly report as Government policy and would implement in full its recommendations. Last week the Minister for Defence openly defied the Government's decision not once, not twice but three times, like Peter in the Garden of Gethsemane.

Last week the Taoiseach qualified the Government's support for Hanly with obscure references to geographics and demographics. Last week's Estimates contained an 8% reduction in capital expenditure in the health services. This clearly means that the hospitals in the designated regions cannot expect significant improvements in 2004. Last weekend, following a massive demonstration in Ennis, the Taoiseach committed himself and the Government to consultation with local communities before Hanly is fully implemented, which he suggested would take about ten years.

Communities throughout the country and of whatever persuasion are fearful of services in their local hospitals being removed, downgraded or dismantled. They receive confusing and conflicting messages from the Taoiseach, as leader of the Government, and from members of the Cabinet who support the report in Dublin and oppose it in the country.

It is time we had clarity from the Head of Government on the status of the Hanly report. Is it now Government policy and is it to be implemented in full? How is it to be implemented if there is no money in the Estimates for 2004? Is the Taoiseach not aware that this is causing outrage throughout the country because of the genuine fears and concerns of thousands of people who fear their local service will be removed, dismantled and gone forever? Is the Hanly report Government policy and, if so, how will it be implemented? What is the Taoiseach doing about the comments from members of the Cabinet on the issue?

I am glad to say a few words one the issue. I would be glad if, when I say a few words, people would not endeavour to misrepresent them to try to gain political capital in local communities. The Government is willing, as has been stated by the Minister—

I cannot hear the Taoiseach.

The Government is willing to undertake a radical reform programme for the health service. Having spent considerable time on them, we have now produced three expert reports – Brennan, Prospectus and Hanly. These are comprehensive reports which were researched in recent years. In all of these reports we are putting the patients first so they can receive the right treatment in the right place at the right time. Our commitment to health care is quite clear with increases of almost 200% since 1997. The Hanly report about which Deputy Kenny asked this afternoon will mean a better service for patients. It means a consultant-provided service that harnesses the contribution to all our hospitals enabling a wide range of appropriate services and procedures to be provided in local hospitals. It makes specific recommendations for two regions, for reorganising hospitals on the east coast and in the mid-west, and the reports set out the principles for the national organisation of hospital services. They propose measures to reduce doctors' hours and to improve medical education and training as part of the European working time directive. In pilot areas 300 meetings were held and 600 staff were consulted.

What about ordinary people?

Please allow the Taoiseach to speak without interruption.

Patients will die.

Consultation with Fianna Fáil.

I have stated time and again that project implementation groups will be set up in the two areas concluded in the model and that groups, individuals, community groups, professional groups will be able to make an input into those two project groups. That is in phase 1. In phase 2, Mr. Hanly and his group are to look at other areas of the country. That work has not commenced yet. It will take place in the future but I do not have the timescale on that. Local groups will also be able to make an input. All of this forms part of the overall health reform agenda for which everybody has been calling because everyone says that we have put in the staff, the resources and the capital programme but we also have to deal with the reform agenda. The hospital service executive group is being set up at present. A senior person and persons to form that group will be announced within days.

The Taoiseach's three minutes are up.

Thank God for that blessed relief.

I will be brief. That group will drive the operation of this whether it be the Hanly, Prospectus or Brennan report. As set out in the report there will also be a hospital services office that will link directly to the Hanly report and there will be the steering group for the overall plan. These are the main elements and groups which will drive the agenda. For people who say that the Hanly report said this or that about different parts of the country, I emphasise that Hanly made his report on two areas. A project implementation group will be set up in those areas. Individuals, groups and communities in those areas will be allowed to report. Hanly has not moved on to stage 2, which is the rest of the country, and I hope that is clear.

It is a pity the Taoiseach was not in Ennis last week.

It is the banner county.

The Tánaiste was there yesterday and she told me all about it.

The problem with the Taoiseach's reply is that one cannot believe anything from the mouth of this Government. There was the Prospectus report, the Brennan report, whose author complained twice about it not being implemented, and now the Hanly report and no money contained in the Estimates, if it is Government policy. I am glad to see that the Minister for Defence, Deputy Michael Smith, is here because he said the people of north Tipperary should not be sacrificed on the altar of Hanly yet he is quite prepared to sacrifice Deputy Hoctor on the altar of Hanly. There is a distinct difference between the view of Deputy Hoctor and those of the Taoiseach and Deputy Michael Smith on this.

When one looks at the unit in Blanchardstown which is not opened, the community care facility in Birr for 90 beds costing €20 million which is not opened, the scandal of Mullingar hospital which is unfinished for the last seven years, one cannot believe what this Government says. If the Taoiseach qualifies the Hanly report by saying consultation in respect of geographics and demographics will take place, does that mean there will be an accident and emergency unit in Nenagh and Ennis hospitals after his Government has implemented the Hanly report? Does it mean that the qualifications of geographics and demographics are going to save the other hospitals around the country? When the people start to march this time they will be unstoppable. The Taoiseach should not take away from people a service to which they have grown accustomed. Given the state of the roads in many areas he should not put that burden or pressure on them or unfortunately tragedy will result. If the Government wants to put its money where its mouth is, let us see in the Estimates where the money will be for the super-regional facilities. The Taoiseach will have left politics in ten years, as he has often said, and Hanly will not have been implemented. Is it a dead duck or not and will geographics and demographics save Nenagh, Ennis and Portiuncula and all the other hospitals? That is what the people want to know.

Hear, hear.

The Taoiseach should give a straight answer to a straight question.

As I have stated, and I thought it was what Deputy Kenny wanted too, because he always says that he wants to see a more efficient—

The Taoiseach should answer the question.

This is Leaders' Questions. Allow the Taoiseach to speak without interruption.

We want to see a more efficient and effective health service around the country.

We are not getting it.

We are endeavouring to implement a reform programme. That programme recommends that local hospitals would provide more services, more elective medical, and more surgical procedures, more out-patient services—

What about convalescent homes?

There will be pre and post-natal services and diagnostic facilities.

More queues.

There are no facilities in local hospitals.

It states that a full range of acute hospital services would be available within each region.

Except in Nenagh.

Demographics and geographics are important in that context as they were in the spatial strategy and in every other programme so that patients would not have to travel other than for specialised super-regional or national level services.

What about minor injuries?

Elastoplast.

What about ambulances?

Please allow the Taoiseach to conclude without interruption.

As the reform agenda states, local hospitals will continue to cater for minor injuries and illnesses and for the high percentage of patients who attend accident and emergency departments. Emergencies will be catered for by well-trained ambulance staff who can provide immediate treatment and bring the patient to the hospital best equipped to provide high-quality care.

Implementation of these proposals is under way. As I have already stated the membership of the expert group to prepare the plan for the national reorganisation of acute hospital services phase 2 will be announced shortly. It has not started. Submissions will be taken from interest groups. The project groups for the east coast and the mid-west are in preparation and will have a special responsibility to take full account of local geographic and demographic factors as the reports state in dealing with and progressing these proposals.