It is now virtually impossible to pick up a newspaper or listen to a news bulletin without learning of a further crisis in the health service. Last week, we had the story of failures in X-ray services in the north east. Last Monday night, a "Prime Time Investigates" programme showed the dilapidation of our health service, including the case of an elderly woman trying to cope with caring for her husband, a stroke victim, without a home help. Medical experts are warning of a diabetes epidemic and we have the continuing trend towards the privatisation of the health service.

Today we learn that 100 jobs are to be cut in Our Lady's Hospital for Sick Children in Crumlin. I understand those affected are mainly agency and temporary workers who have been taken on by the hospital because the recruitment embargo prevented it from recruiting in the normal manner. We are told, by way of a circular issued by the hospital yesterday, that 100 staff will be removed from the hospital because the Health Service Executive has given it €14 million less than its projected expenditure this year. One cannot take 100 staff out of a hospital without affecting patient services. This measure will inevitably result in sick children not getting the treatment they need in the hospital and parents of sick children being told their child will have to wait because the hospital is unable to provide the services it should provide.

All the crises in the health service come back to the failure of the HSE, the instrument established by the Government to run the health services, to manage the health service properly. I have two questions for the Taoiseach. First, what will be done to ensure Crumlin hospital has the staff it requires to treat the sick children who present for treatment and to assure the House that in different economic circumstances, cuts in expenditure will not be made in areas which affect the most vulnerable, among whom are children who are ill and need treatment? Second, will the Taoiseach take up the proposals developed by the Labour Party's spokesperson on health, Deputy Jan O'Sullivan, and published by my party last week for the reform of the health service and, in particular, the HSE? It is manifestly clear the HSE is not managing and running the health service to deliver the quality of care required.

I remind the Deputy he was a member of a Government which unanimously agreed that, based on bitter experience in the past, the best way of trying to develop the health services was to introduce service planning. On the basis of allocations provided to hospitals, service plans would be drawn up and adhered to in the interests of maintaining a level of service that had been provided on an ongoing basis and building incrementally, year on year thereafter, in the event of further investment being made in the health service. This was unanimously agreed at the time and I was the first Minister for Health to introduce and live by those disciplines.

On the particular issue which has arisen in Crumlin hospital, the problem in relation to service planning is that there was an overspend of €10 million last year and the projected overspend, on an increase in the allocation from €128 million in 2007 to €137 million this year and an increase in the hospital's budget of almost 40% over the past four years, is of a further €14 million beyond the €137 million figure. What is being said and must be accepted by all of us is that if we are to have planned and sustainable improvements in the health service, quite apart from the reforms being put forward by the HSE to build greater community care services in order that services are not all taken up at the acute hospital end, we also have to maintain the reforms introduced by previous Governments, including the one of which the Deputy was a member. Service plans have to be adhered to in the interests of developing services in the short and longer term.

The Opposition now appears to suggest that we can develop a health service based on the demand led system of budgets regardless of what budgets are allocated to which hospitals. The idea that this approach rather than trying to adhere to the budgetary disciplines required would not create even greater dislocation or more problems escapes me. That is the position in relation to Crumlin hospital.

What is being required is that we try to live within existing allocations. Owing to the good work Crumlin hospital has been doing and its important work nationally, an agreement was made to deal on a once off basis with last year's overrun of €10 million and provide a further €7 million in respect of a projected overrun of €14 million this year, while requiring the hospital to work within its budget which will be amended from €137 million to €144 million this year based on an allocation of €128 million last year. That is what is being required of the hospital and consultation is ongoing between management and representatives to determine how to meet this requirement.

That is what they spend their time doing.

Some 70% of the hospital's costs are staff related. The employment of temporary and agency workers cannot continue on an ongoing basis. No permanent positions are being cut or anything like that. The hospital must be managed within its allocation. Otherwise, as the Deputy knows, under the law introduced under the Administration of which he was a member and with which I agree and supported at the time, the overrun will become a first charge on the allocation for the following year, which places even greater pressure on the hospital's ability to maintain the agreed level of service. We all agreed on this approach in the interests of trying to provide a means by which we have some sense of budgetary and management discipline in delivery of the health service.

If one takes 100 people who are working in a hospital out of it, one will affect the service the hospital provides.

That is the point.

When parents show up in Crumlin hospital with a sick child, they will not want to hear about service planning, budgetary discipline, the millions of euro allocated in this or that year or which Administration introduced what legislation. They will want to have their child attended to and cared for. If there are 100 fewer staff in the hospital, this will be less likely and it will be more likely they will be told to go away and wait. The job of the Taoiseach, Government and HSE, the body the Government set up to run the health service properly, is to have this problem fixed and the issues of service planning, budgetary planning and so on sorted out because patients, the people suffering at the receiving end of a health service that is not working, do not want to hear these excuses. They want to get better, be cured and secure the services they need in our hospitals. The problem is that the body the Government set up to run the health service is not doing its job efficiently.

Last week, the Labour Party published a set of proposals on the reforms required in the HSE to put right this problem, including a proposal to introduce a voluntary scheme to remove from the Health Service Executive the overlapping layers of management, administration and bureaucracy which appear to be getting in the way and eating budgets which should be used to provide the staff required at the front line to deliver the service in hospitals and health centres. We are long past the stage of arguing about budgetary discipline, service planning and all this gobbledegook——

It is not gobbledegook.

It is gobbledegook to patients. It is gobbledegook to a parent who comes into a hospital with a sick child but is told that the child cannot receive any service. The Taoiseach must sort this out and reform the HSE so that we do not end up in a situation where different hospitals or services are not functioning from one week to the next. It is long past time to sort out the mess in the health service, reform the HSE and provide the care to patients for which taxpayers are paying.

That is the beauty of being in Opposition. You can have it every way.

Let me answer the question.

We all remember the Taoiseach when he was in the Opposition.

It is a comfortable position.

He hounded the Government day and night. He cannot take his medicine.

I would like to answer the question.

This is Leaders' Questions. The only people allowed to speak are the party leaders and the Taoiseach. I ask the Taoiseach to address his remarks through the Chair. It would help.

If the contention is that we can improve the health service without any reference to the budgets that are allocated, then I fundamentally disagree.

If that is not the position of the Opposition——

After 11 years in Government, is the Taoiseach responsible for anything?

Will he admit that he was over here at all?

I listened in silence to what Deputy Gilmore had to say and I would like to respond to him. If his position is not that the health service can be developed without reference to budgets, then we must live within those budgets; otherwise, we cannot develop the health service. People who come into hospitals with serious cases will of course be dealt with.

They are not dealt with.

The issue is that they will be dealt with through the increased allocations being provided. If the position of the Opposition is that once the allocation is made, it does not matter as long as it is sorted out, then things cannot be done that way. Members of the Opposition know it cannot be done that way because it was not done that way when they were in Government.

The second part of the question related to the idea that these reforms will sort out the problem——

Call a meeting. Bring them in.

There has been much involvement in the past by local representatives at health board level, but that did not solve the problem. The problem can be solved by supporting the reforms that we are trying to bring about, which will ensure that we have greater investment in community care. We cannot have a situation where the acute hospital sector takes up all the allocation to the extent that it is currently doing. We must reform the health service, as Professor Drumm said yesterday in the interview he gave in response to this programme.

That will be a long time.

It will not be a long time, because what is involved is——

After 12 years the health service is a shambles.

People can come in here and continue to argue for the status quo. However, the status quo will not solve the problem. If the suggestion from Deputy Gilmore is that nobody wants to hear about the budgetary situation, then I am sure that is true. However, if one is in the job, then one must work within those budgets. If the Deputy was in my position, he would have to do the same. The only way we can solve that problem is by working with those who are trying to implement the reforms on the basis of increased allocations.

Resources are being increased significantly. An extra €5 billion has gone into the health service in the past four years, yet perennial problems arise and we are trying to deal with them. The only way we can do that is for everybody to change the structures by which the system is being delivered. That is the truth of it. The Health Service Executive is involved in making those changes.

It is doing this by cutting home help service.

No, it is not. There are 63,000 more families receiving home help than when Deputy Higgins was in Government.

There are 10,000 home help packages that were not available a few years ago. Reforms are being implemented and primary care is a critical part of those reforms. The amendment of the consultants' contracts, by bringing them into clinical directorates in hospitals, and the management of services in our hospitals are an important part of that.

The fundamental point is that allocations have been increased and there has been no cutback in the amount of money being provided. When we make the allocation, we must ensure that the service plans work to those allocations. Otherwise, as the Deputy knows — this is not gobbledegook — the legal position is that this will be a first charge on whatever goes in next year. That will greatly undermine the ability of the staff and the management who are working hard to provide the level of service that is currently being provided.

It is just a bigger bureaucracy.

Deputy Gilmore and I both know that is the case. We must start from the reality that there are finite budgets, however much they are increased, and we hope to increase them again in the future. The amount of resources going into the health service in the past five to six years is unprecedented. As Professor Drumm said, we must ally resource allocation with reform in the delivery of the service. Otherwise, we will continue to have the sort of debates we have been having until now, with no prospect of a solution.

A total of 34,000 extra administrative staff have been employed in the HSE.