I congratulate the Tánaiste on her appointment as Minister for Health and Children. Many within her own party have hailed the Tánaiste as some sort of Messiah come to resurrect the health service from complete disintegration. The Tánaiste is an experienced politician and I am sure the House wishes her well in her endeavours to restore a health service that the people deserve, but how can we be sure this is not just another false dawn?

If the Tánaiste wants any sobering reading in this regard, I recommend today's ESRI report which gives an independent snapshot of our health care system in the eighth year of this Government. In a comparison of 22 national health systems using three established performance indicators, Ireland came last and second last in two areas. Ireland had among the highest levels of alcohol consumption, is at the bottom of the league for childhood immunisations and is joint last with Japan in non-medical factors. Ireland ranked second last in health outcomes such as heart attack rates, cancer and suicide.

This country has the highest rates in the OECD of male and female mortality for heart attacks and is ranked "poor" for potential years of life lost due to female breast cancer. Ireland also ranked 14th out of 22 in the analysis of health status. We scored very poorly on infant mortality and our life expectancy figures from birth for both men and women was in the bottom one third of the countries surveyed. The Government is now in its eighth year and has spent €44 billion on the health service but the ESRI report suggests that the achievements have been almost negligible and are certainly nothing to boast about.

In the Tánaiste's analysis of her first week in office as Minister for Health and Children, can she give the House three targets she expects to achieve in the next 18 to 24 months? For instance, will the broken promise of the delivery of 200,000 medical cards be honoured? Will we see an end to waiting lists during her tenure of office and does she expect to end the chaos in accident and emergency units throughout the country? Will she give us three tangible targets by which we can set performance indicators?

I thank Deputy Kenny for his good wishes and assure him I am no Messiah. There is no magic wand and I have no silver bullet.

Where is the Messiah?

We cannot continue to put more and more money into the health services without serious reform, a fact everyone in the House acknowledges. The good news is that we have more nurses per capita than any other country in the OECD, although they and other health workers do not come cheap. In order to meet benchmarking and salary increases next year, we will need an additional €500 million.

One of the priority areas is accident and emergency units. It is unacceptable that people have to spend upwards of 12 hours on a trolley before they are admitted to a bed in an acute hospital. Allied to that are step-down facilities for the elderly, many of whom are in acute hospitals because there are no alternative services. A second ambition of mine is to reduce waiting lists. In that context, the national treatment purchase fund is making a major impact having treated 19,000 people to date. I want to continue to fund and support that, perhaps by extending its remit, because it is having a major impact through the use of facilities in the independent sector in Ireland and elsewhere to treat patients who have been waiting a long time.

A third priority area is the extension of the income thresholds for medical cards, which we all accept are too low. I cannot give commitments in regard to numbers but it is important that we concentrate on income thresholds, which I will make a priority. I also intend to prioritise oncology services.

I hope that in two and a half years we can make major achievements in those four areas as well as in health promotion. Ireland's health spending since 1997 has been double the OECD and EU averages. When spending is combined with outcomes such as dependency on alcohol, as Deputy Kenny acknowledged, suicide, cardiac disease and so on, the ESRI's combination of findings puts us in the position reported today. It is the Government's top priority in the next two and half years to accompany additional resources with radical reform.

In respect of the Tánaiste's answer on accident and emergency departments, will she publish a benchmarking system so we can know of increased performance according to length of stay in accident and emergency departments? Will she publish a benchmarking system in respect of those waiting six hours, eight hours, ten hours, 12 hours or more?

In 2001, the Government promised more than €1 billion over ten years for the primary care sector. Only €16 million has been spent in this area. The Government still refers to ten pilot projects when we were told that there would be 600 delivered by 2012.

The Deputy's minute has concluded.

I could not have not used my minute yet. I am not sure what stimulant the Ceann Comhairle is on today, but a minute does not go that quickly.

The budget for mental health dropped from 11% to 7% last year. The task force report on suicide is critical. Travelling the country, I heard the advertisements broadcast nationally for breastcheck, which are very good advertisements. The advertisement states that the procedure is perfectly confidential, safe, takes twenty minutes and provides a phone number. It goes on to state that it is only available in the east and in the midlands. Women in every other area suffer the trauma of hearing these advertisements about saving lives, yet they themselves are not in a position to avail of this very necessary service. Perhaps the Tánaiste might look into that as a matter of real urgency, not just for the facility, but for the business of systematic breast service facilities.

All of this was put into perspective for me yesterday by a man who stood in my own office in Castlebar, with a bag of blood and urine attached to his leg. He was on a nine year waiting list for urology services in the Mayo General Hospital and he will also have to wait 18 months before the consultant in Galway will be able to see him. When one talks to someone like that, one can understand the urgency, the fright and the trauma of what they have to go through. One can understand how badly people feel when they know that €44 billion has been spent in the past ten years. A hard-working man now has to go around like a cripple and feels he is going to die, yet the consultant cannot see him for 18 months. That is what the Tánaiste has to deal with. I will support her in many of the measures she has to implement, as the patient's interest has to be put first. We will not allow a system to be removed from people; we want a health system that is close to them and operates based on their need as distinct from what they have got in their pockets.

I thank the Deputy for his support in the case in Mayo. I do not know if it is a suitable case for the national treatment purchase fund. One of the issues surrounding accident and emergency is the lack of data. I have asked for patient data to be made available over the next two weeks as it is not collected at the moment. This is so that we can know the kind of cases with which we are dealing, the frequency of visits and so on. Tomorrow afternoon, I will meet the CEOs of all the Dublin hospitals regarding accident and emergency services. Suffice to say that this is a priority for me, for the Government and for the country. I appreciate the support the Deputy is offering. I know he cannot support me all the time, but I appreciate the spirit in which he offers that support.