I note this morning that the Government has finally decided to move to implementation stage of the Hanly report, one month after its acceptance by Government. Will the Taoiseach explain to the House and to the country what is meant by the implementation phase? What is the strategy on a month by month basis whereby the effects of the implementation will be seen? What moneys are included in next year's Estimates for implementation of the report? Is the sum of €110 million for consultants, referred to in the last paragraph of the report, included in the Estimates for next year?

The Taoiseach must be aware that the European working time directive and the Hanly report are two separate entities. The Taoiseach now has ten months within which to implement the European working time directive with apparently no moneys included in the Estimates to allow for it. It was reported yesterday that ambulance response exceeds the 20 minutes response required to deal with urgent cases. It is clear that the national infrastructure, be it roads, helicopters or ambulance service, cannot deal with the implications of the Hanly report. Will the Taoiseach state the Government's strategy for the implementation of the report? Will he clarify his qualification of "demographics" and "geographics" in the context of Nenagh and Ennis hospitals? Last night's "Prime Time" programme stated that shutdown faces both of these and other hospitals. Is it true that implementation of the report on the basis of what the Government envisages means that the downgrading of a great number of hospitals will happen but the upgrading of others never will?

I am glad to deal with this matter again. As I have stated repeatedly, any reform procedures announced by the Government regarding the Brennan, Prospectus or Hanly reports do not involve the closure of any hospitals anywhere. The overall health strategy, in particular the Hanly report aspect of it, is a ten-year plan. It will mean a better outcome for patients, better quality hospital service and a significant increase in the number of consultants available to see patients promptly and treat them with the help of the non-consultant hospital doctors, the junior doctors, 24 hours a day, seven days a week. It will require substantial change in the contracts for hospital doctors and that is part of the reform.

Safer provision of services by non-consultant hospital doctors is required. They will no longer be required to work excessively long hours. They were working 80 and 90 hours a week. The Minister came to a financial arrangement with them to bring the hours down to 75 hours a week and those hours must come down to 48 hours a week in the future. There is a better training system and career structure for junior doctors and an integrated network of acute hospitals which work closely together to meet the needs of patients in the most effective manner possible. This includes local, general and major hospitals in each region.

Deputy Kenny asked about the implementation of reform. The three plans constitute an overall reform of the health services which has more than one aspect. The two pilot areas in the Hanly report are the Mid-Western Health Board, which covers Ennis and Nenagh, and the east coast area, which covers Loughlinstown hospital and St. Vincent's hospital. Implementation teams will be put in place. They will be chaired by independent chairpersons and will have full consultation with local interests, such as medical, paramedical or community groups.

Phase two of the Hanly report will examine the remaining parts of the country. The implementation phase is concerned with those two groups which are now convening. That will be part of the overall implementation team for all the reforms. A sum of €10.5 billion is being provided next year and the Minister has already made large provision for the work to be done. I have been repeatedly criticised in the House for the amount of money made available by the Government for pay and improvements in the pay structure. All of these measures constitute an attempt to deal with health reform.

Deputy Kenny commented on implementation of the reforms. The reduction in working hours of the non-consultant hospital doctors is to happen by 1 August 2004. The Minister for Health and Children has asked the Labour Relations Commission to convene a meeting of management and unions in order to quickly agree a process for dealing with that issue. It is under way. The implementation group comprising management and union representatives will then be established and will work intensively to find an agreement for the implementation of the reduction of working hours, including all the industrial relations elements.

The Taoiseach deserves a prize for the wooliness of his responses. He did not answer any of the questions I asked him about moneys being provided in next year's Estimates for infra structure or the implementation phase, as the Taoiseach calls it, of the Hanly report. I agree that the report never said there would be hospital closures but what is happening is the strangulation of hospitals by other means. In this morning's Irish Medical Times there is a report that the College of Anaesthetists will not recognise Clonmel hospital because of its inadequate facilities for training. The same happened in the case of Monaghan General hospital which was not recognised for obstetrical training because of the lack of sufficient resources and facilities.

The Taoiseach stated that the second phase of the Hanly report will be implemented after the local elections next year. Bearing in mind the "Prime Time" programme last night dealing with Nenagh and Ennis, does that not mean that for Mullingar, Tullamore, Tralee, Kilkenny, Castlebar, Bantry, Mallow, Monaghan and other hospitals, the implications of the Hanly report will mean closure and downgrading of the accident and emergency departments? The question was asked in the programme whether the Taoiseach would agree with somebody travelling for treatment from Drumcondra to Longford or some point 70 or 80 miles away when the infrastructure is not in place.

Is it not incredible that the Government is proceeding with this woolly, confused thinking about restructuring the health service when there is no money in the Estimates to implement the recommendations of the Brennan, Prospectus, Hanly or the primary healthcare reports?

Deputy Kenny, your time is concluded and you are over time.

The Taoiseach said yesterday that demography and geography are as important in this context as they are in the context of the national spatial strategy, which was never debated in the House. No programme should require patients to travel, other than for specialised, super-regional or national services. If the Taoiseach continues down this path of downgrading or removing facilities from the towns I have mentioned and others, he will rue the day politically. This is not the way to go about reform. Unless resources are made available for infrastructure before contemplating such outrageous measures, the Taoiseach will regret it.

I have stated already that €10.5 billion is being spent on health with €500 million in the capital programme.

Less than last year.

Normally I am criticised about county, regional and national hospitals. Now the Opposition has decided, because there is a reform process which we hope will improve the situation in the next ten years—

The Taoiseach should not worry about the Opposition, he should worry about his own backbenchers and Ministers.

The Opposition wants to protect what we already have.

What about Deputy Killeen?

The Taoiseach should tell his own Ministers.

The Government benches are not trying to protect what we already have but to improve it. We want a better service for patients, a consultant-based service that harnesses the contributions of all our hospitals enabling a wider range of appropriate services and procedures to be provided in local hospitals.

The Taoiseach should tell that to the people of County Monaghan.

The Government has been at it for seven years.

Although the contributions of the Opposition are usually not much good, I would have thought it would be interested in improving the health service, which is what we are trying to do. We have been through the reports of people who had thousands of meetings to see how to improve it.

Deputy Kenny is right in one respect, no one is going to change anything until the facilities are ready to create a better future. That is why the Government spends so much on health, has put 30,000 extra staff in the area, dedicated an enormous amount of money to the capital programme and will spend €10.5 billion overall. We expect support from the Opposition when we try to improve the health service, something we will continue to do.

The Opposition has given the Government too much support.

Deputy Crawford is not the leader of his party.