We have arrived at a stage in this country where whatever this Government states is quite unbelievable, whether on the subject of recent events or in the form of general statements. It is a few years ago since the then Minister for Health and Children, Deputy Cowen, told us that 32,000 people were on the waiting list. In 2002, the then Minister, Deputy Martin, made a specific Government commitment that he would end waiting lists in two years. The current Minister for Health and Children, Deputy Harney, said in May this year that the HSE would find efficiencies that would not impact on patients. This is in the context of the Government giving clawbacks of over €100,000 to people who are able to buy their first house for a price in excess of €1 million. There are now 41,000 persons on the waiting lists of hospitals around the country.

The Minister for Health and Children said on 21 September that no patient would suffer because of cutbacks introduced across the country. I have met consultant after consultant who has told me that patients die at the end of waiting lists because services cannot be provided for them. Patients die, which is a direct contradiction of what the Government has been saying. Every day we hear of more and more of these cutbacks in various locations around the country such as 30 nurses and four consultants sacked from Sligo General Hospital; dental services for children in Inchicore and Bluebell cancelled; the 24-hour accident and emergency service at the Mid-Western Regional Hospital in Ennis ended; breast cancer services at 13 hospitals closed and no other service put in their place; the 24-hour bed unit for the rehabilitation of elderly patients at Merlin Park closed, with another to follow; and the cancellation of essential suicide prevention training in the form of applied suicide prevention skills. One can go into any community in this country and see what is happening.

In recent days we have learned that Monaghan General Hospital will be stripped of further services and will have to suffer the removal of another ward despite recent expenditure. The Midland Regional Hospital in Mullingar is to cut medical day cases by 55 per month. In South Tipperary General Hospital in Clonmel, an operating theatre and six surgical inpatient beds will be lost.

The Government stated clearly this month that no patient would suffer because of cutbacks. Meanwhile, Ministers sit in this House and act as if they had no responsibility in the matter, as if the HSE made its decisions at a remove from Government. I remind the Taoiseach that hospital consultants have told me, face to face, that people are dying at the end of waiting lists because they are not able to get a service which we should provide for them. Is the Taoiseach telling me that he is spending €15 billion on a world class health service? The Government is unbelievable in everything it states, from the Taoiseach to his Ministers. Can the Taoiseach say how the 41,000 patients on waiting lists can have any confidence in what they hear coming out of the mouths of Ministers of this Government?

Hear, hear.

I will tell Deputy Kenny some of the facts about the health service and answer some of his questions.

Tell him about Beaumont Hospital.

Has the Taoiseach been in Beaumont Hospital recently? It is not a centre of excellence.

Some 120,000 people work in the health service as of this morning.

The Taoiseach should check his statistics.

If Fine Gael Members do not want to listen, there is no point in me saying anything.

The Taoiseach must be allowed to reply to Deputy Kenny's question.

If the Deputy wants to come to the House and criticise everything in the health service then so be it, but I will give him some of the facts of the situation. As I said, 120,000 work in the health service and they deal with 100,000 patients per month. Both the adult and children's waiting lists, as produced by the HSE, are at record lows right across the system. Some 100,000 inpatient and day care procedures are carried out in public hospitals every month — in excess of 1 million annually. Even if 41,000 is the figure — as I said yesterday, I do not know if it is — it is comparatively low against the figures from last year, three years ago, five years ago or ten years ago. It is a much smaller proportion of the total figure.

There will always be people on waiting lists. The National Treatment Purchase Fund, which issued a report recently, states there has been a consistent pattern of reducing surgical waiting lists throughout the public hospital system over recent years. The report points out that, for most common procedures, adults and children now wait between two and five months, compared to between two and five years some five years ago.

Who was the Minister five years ago?

The Taoiseach is great with figures.

That is a simple fact according to the people who deal with the issue. If Deputy Kenny wants to say that the people dealing with the issue know nothing, while he knows everything, that is fine.

The National Treatment Purchase Fund has stated there is no need for anyone to wait more than three months for an operation and that it is unacceptable that they should do so. If people in such a situation contact the National Treatment Purchase Fund, its members will be only too glad to deal with them. As I said yesterday, some hospitals are not co-operating fully with the fund but the HSE is dealing with that issue.

On Deputy Kenny's second point, it is a fact that the HSE exceeded its allocated Vote of €14 billion by €222 million. The health service is Vote is €15 billion and the HSE gets €14 billion of that amount. At the end of August, its Accounting Officer stated that it was €220 million over budget and that it had to take corrective measures to put itself back into line, like any other agency or department. It has designated a number of areas where this has to take effect. I am not here to manage every one of those. The HSE knows its allocation. In fairness to Deputy Kenny, I do not believe he is saying the HSE should ignore the budget it agreed to last January, that it should not manage within that. That is what it must do. It has a very large capital programme this year and it got a further increase in staff numbers. It must now pull back on staff numbers at the end of the year.

They are management staff.

They are not management staff. The case in Cavan that Deputy Kenny mentioned arose because a consultant was on holidays and no locum has been put in. The HSE must manage within its budget and these are some of the effects of that.

There will soon be no full-time staff to manage patient care.

Not very many years ago legislation was introduced by Fine Gael, which I supported, so there is no criticism of that, under which health boards could not exceed their allocation and must manage within that.

What did the Government do before the election?

Deputy McCormack is not the leader of Fine Gael.

I was only asking.

The HSE must get itself into line by the end of the year. There is no alternative to that. It accepts it has an obligation to do it. This time last year the HSE had underspent and there was a race to spend the money it had in the last few months of the year. I was criticised because its capital programme was not spent. This year it has its management together——

Some management.

It is like the Irish rugby team.

It has got its systems and structures together. It has spent its capital programme and it is on target with regard to its capital programme. It is not in the same position as it was last year. Deputy Kenny's allegation that the HSE is not providing a top quality service in most areas of health is untrue. UCD did a very large and comprehensive survey of the health service, taking in more than 3,500 people. Rather than myths about it, it showed what the people who use the health service think of it. The Deputies opposite should factor that in rather than jumping up to complain because somebody has found out he or she cannot order a chair or a table out of a budget of €15 billion.

The message from the Government is that one should not get sick in this country.

Hear, hear.

It is unfair of the Taoiseach to say that Opposition Members run down the frontline staff in the health service. We recognise the pressure they are under. We recognise the job they do. The Taoiseach should remember that the people did not elect the HSE. They elected the Government. What we have now is a single person Government where every member of the Cabinet believes whatever the Taoiseach says, whether it is right or wrong.

The figures in regard to the National Treatment Purchase Fund that the Taoiseach mentioned are sanitised. They refer only to surgical cases. They do not refer to medical cases. Nor do they refer to the fact that there are huge waiting lists to see doctors in the first instance. One member of the Cabinet, the Minister for Community, Rural and Gaeltacht Affairs, Deputy Éamon Ó Cuív, who is absent this morning, said that the HSE is a complete shambles, that it is impossible to deal with it.

The ratio of persons working in the HSE is interesting. There are nine national directors and 61 assistant national directors. That is nearly seven to one. When Professor Drumm addressed this parliamentary party a number of years ago in Portlaoise he said there are 2,500 persons working in our system who do not know what their job is, who do not know where they fit into the system and who will be paid for life. The Taoiseach tells me we have a world class health system. Consultants and nurses tell me that people on the end of waiting lists are dying because they cannot access the service. Do the Taoiseach and the members of his Cabinet who believe everything he says accept any responsibility for ensuring there is real efficiency in delivering to patients the care they deserve and for which they pay, and that there are more services and less administration? The Taoiseach agreed with me earlier this year that there is an obscene bulge in the administrative recruitment sections of the HSE compared with the number of nurses and doctors in the front line who are needed to give patients the first class frontline service they deserve. Does the Taoiseach accept responsibility to ensure that taxpayers, who are now spending €15,000 million, will be happy in the knowledge that they are getting an efficient, professional service that is patient-centred and does not deal in the kind of sanitised version of a health service the Taoiseach talks about from the lofty heights of the Office of the Taoiseach?

I can only give the factual position. A total of 100,000 inpatient and day care procedures are done in the public hospital system every month, more than 1 million annually. This is not a big country. The figures are, therefore, impressive. At the end of September, which is right up to date, there were 19,083 adults and 2,320 children waiting for more than three months for hospital treatment.

They have to wait two years to see a consultant.

Those figures include both medical and surgical areas. Across the entire public hospital system that is a total of 21,403. The breakdown in regard to adults is 8,026 waiting three to six months, 6,046 waiting six to 12 months, and 5,011 waiting longer than 12 months. In the case of children the breakdown is 1,020 waiting three to six months, 784 waiting six to 12 months and 516 waiting longer than 12 months. I do not accept that 12 months is acceptable. Traditionally patients waiting for less than three months have not been included in waiting list statistics, but since the National Treatment Purchase Fund took over, it collects that information. It has confirmed that at the end of September the number of adults waiting for less than three months was 16,000.

The National Treatment Purchase Fund consistently highlights its concern that some patients are still waiting too long for treatment. They are offering the service in many cases but the hospitals will not use it.

One cannot get on the National Treatment Purchase Fund list unless one is on a consultant's list.

We have doubled the number of consultants. I presume they are doing their best to administer the services.

I must ask the Taoiseach to conclude.

In regard to some of the short-term difficulties the HSE is having, it must get itself within its annual budget which is employing 120,000 people and spending €14 billion. It must manage its budget the same as every other agency. It has agreed to do that.