The Minister for Community, Rural and Gaeltacht Affairs, Deputy Éamon Ó Cuív, stated that the HSE is an impossible organisation with which to deal and that he can make neither head nor tail of it. He was a member of the Cabinet that invented, designed, framed and legislated for the HSE and brought it into being. If he can make neither head nor tail of it, what chance has a patient who is trying to get an operation, a parent who is trying to get an appointment with a speech therapist, or a carer who is trying to get home help and finds it impossible to penetrate the maze?

A month ago the HSE put an embargo on the recruitment of staff. That includes nurses, doctors, paramedics, the lot. It wants us to believe, and the Government supports it, that this will have no effect on patients. It does not have to recruit staff and we are to believe patients will not suffer. However, today we hear that operations are being cancelled at Cavan General Hospital because a consultant anaesthetist has gone on holidays and the HSE will not allow the hospital to hire a locum. We hear that the number of days on which breast cancer patients can be seen for biopsies at University College Hospital Galway has been cut from five to three. The head of MS Ireland said that people with debilitating neurological disorders have had physiotherapy, respite and home help services cancelled as a result of the cutbacks. We are told that an orthopaedic ward in Merlin Park hospital in Galway is due to close. All of this is in addition to the 41,000 people on hospital waiting lists and the bed closures in Tullamore, Clonmel, Limerick and Sligo about which I spoke yesterday.

By any standards, these cutbacks in the health service are affecting patients. The Taoiseach can come into this House as often as he likes and drown us in figures and results of surveys from places such as UCD. People who have used the health service will, when asked, say their experiences have been good. We have a good health service; the problem is accessing it.

Hear, hear.

We have professional people, namely, consultants, doctors and nurses, in our health service and most people's experience of it, once accessed, is good. The problem is that people are unable to access frontline services as a result of the cancellation or postponement of procedures and because appointments are not being made. One must go through a maze of bureaucracy in order to find out what is happening. The Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, has rightly described the HSE as an impossible organisation.

Is the Government taking responsibility for the Health Service Executive? The Government created it and it is, as the Taoiseach tells us, spending a great deal of money on it. Is the Government responsible for the Health Service Executive? Does the Taoiseach agree with the HSE embargo on the recruitment of staff or will he at the very least direct it to recruit and replace frontline staff? If the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, is correct — I believe he is — what will the Government do to ensure the Health Service Executive delivers the type of health service for which it receives all of the money about which the Taoiseach keeps telling us?

A number of points have been raised. I am glad Deputy Gilmore acknowledges our health service is good and that he agrees, as I do, that the more efficient that service is in treating patients, the better. Ministers and official members of the health committee have made considerable efforts to improve the service and to ensure an efficient structure. I must acknowledge — it is easy to criticise an organisation — that the facts speak for themselves. The HSE has halved the waiting list in respect of those awaiting procedures. While this is not perfect, the waiting lists have been halved. The resources provided have been used to good effect. I accept issues remain in respect of HSE structures. However, it is striving to bring together an enormous organisation which is different from that which existed a few years ago. The operation of such a large organisation and management of 120,000 people is not easy.

The Government provided the HSE with €14 billion in funding for this year. Every other organisation that received money from Government had to manage it. The HSE did not run into difficulties last year; in fact it had not spent all its money. This year, however, at the end of August it had overspent. It is not for Government to tell the HSE how it must implement its arrangements. The management, Accounting Officers and executive of the HSE must do this.

They are wasting it.

The Government has stated that frontline services should not be affected——-

They are.

——and that resources which must be clawed back must be taken from non-emergency areas. The Government has told the HSE that where difficulties arise, they should be addressed in conjunction with the staff under the partnership programme which deals with such issues. The HSE has taken our advice and is seeking to address its problems in an organised manner.

The reality is that Government, through the Department of Health and Children, the health committee and Cabinet health committee, is in daily contact with management of the HSE. The Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, pointed out a few areas wherein he believes his Department could help the organisation.

He cited an example of funding allocated to his Department for the provision of ambulances in rural areas and suggested this might be of assistance to the HSE. The Minister is directly engaged in the provision of funding, under the aegis of programmes operated by his Department, to assist the HSE and I believe this is the right thing to do.

A brief supplementary from Deputy Gilmore.

I am fascinated by the manner in which the Taoiseach describes the Government's relationship with the HSE. He seems to think it is the function of Government to advise the HSE or to have a word in its ear with, perhaps, a member of Cabinet then taking a kick at it when it is sufficiently popular to do so. Will the Taoiseach take any responsibility for the HSE? The function of the HSE is, as the Taoiseach stated, to deliver a health service. At the end of the day, patients in Cavan have had their operations postponed this morning and women in Galway are concerned about when they will be called for biopsies. This is the real, human end of the problem. The Taoiseach can talk about statistics and structures all he likes but, at the end of the day, this is about individuals in hospital waiting rooms trying to access a service which is difficult to access. It is quite clear that the HSE is not working or delivering. The Taoiseach repeatedly talks about the amount of funding it receives but at the end of the day the service that should be provided is not being provided. The main problem which arises does not relate to individuals or managers in the Health Service Executive but with the Government which refuses to take responsibility for it.

Hear, hear.

The Taoiseach believes his role is the provision of advice to the HSE by way of a word in its ear. I put it to the Taoiseach that the embargo in respect of recruitment did not arise out of thin air. I do not believe the HSE simply decided one morning to introduce an embargo on staff recruitment.

Deputy Gilmore must put a question to the Taoiseach.

Did the Taoiseach or Government tell the HSE not to recruit more staff? Is he insisting its budget is now more important to him than the patients it serves?

Hear, hear. That is the issue.

The current embargo has been in place for a month and is now to be extended for another month. Will the Taoiseach issue a direction to the HSE to recruit frontline staff so that the service can at least continue at whatever unsatisfactory level it operated up to now?

If, as the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, says, it is not working, will the Taoiseach do something about it? The current situation, whereby the State, as the Taoiseach rightly points out, is spending a great deal of money on the health service which is not delivering the goods to patients at the end of the line, cannot be allowed to continue.

It will probably receive another €80,000 for that; a bonus.

In reply to Deputy Gilmore, neither the HSE budget nor its approved staffing level has been cut. There has been no cut in its service agreement——

There has been.

There has been no cut in the resources provided for its service agreement or in its staffing level for 2007.

There has been.

There has been no cut. The budget allocation, service agreement and staffing levels for 2007 have not been cut. This is a fact.

A woman in Galway cannot get four hours home help. I will give the Taoiseach the facts later.

Another fact is that the HSE is seeing tens of thousands more patients in a faster time than has ever happened in the Irish health service. It is competently extending and advancing a more sophisticated service to patients in public hospitals and in community care than ever before. More community care packages and services than ever before are being provided throughout the country.

That is not correct.

Where are they? They certainly are not in Cavan-Monaghan.

Deputy Gilmore rightly stated there are a number of difficulties with the HSE. I have admitted that a consultant anaesthetist in Cavan is on two weeks annual leave and that at local management level it was considered that some of the non-essential caseload could be left aside for two weeks and a consultant locum would not be appointed.

Local management is blamed.

That was the decision taken locally. The Cabinet does not sit down and make calls about staff resources in each hospital and area of the country.

What is Deputy Ó Cuív saying?

What the Cabinet is doing——

Is discussing spin.

The Cabinet regularly sits down with the management of the Health Service Executive and the Department of Health and Children and we work through the HSE reform programme to make sure we get best value for our investment in services and resources and that the thousands of additional staff at the level of consultants, junior hospital doctors, nurses and others are used to the best advantage. That is what the Cabinet does.

It is not doing enough.

We are not involved in every separate decision but we are helping the HSE to structure its reform programme in an efficient way to ensure that it can see even more patients more quickly in the future.