It now is patently clear that this is the most incompetent Government in the history of the State. On Sunday, the Minister for Health and Children announced she had approved and authorised a statutory service plan from the HSE involving cuts of €500 million. That plan was placed in the Oireachtas Library yesterday and is obsolete today. My understanding is the Health Service Executive prepared its service plan and submitted it to the Minister for Health and Children for authorisation.

However, in light of changing circumstances, the chief executive of the HSE will be obliged to seek a further €400 million in cuts. This will strike at the heart of the most vulnerable in our society as it pertains to a critical major public service plan. The Minister for Health and Children, who sat at the Cabinet table and heard of the changing economic circumstances from the Minister for Finance, should have been in a position to tell the HSE it was basing its service plan on the wrong figures, in the same way the budget was drafted using incorrect figures. Arising from the service plan submitted by the HSE that now must be amended, can the Taoiseach explain to the House the numbers of beds that will be cut and the number of people who will be made redundant? Can he spell out the impact on waiting lists and trolleys, 400 of which were occupied yesterday, as well as on capital projects for hospitals nationwide next year?

Deputy Kenny often has spoken of the need for efficiencies in the delivery of public services, which is precisely the context in which——

Front line services should not be cut.

——the HSE has devised its service plan.

What about beds?

It has obtained efficiencies totalling €280 million during this year, which will be repeated next year. The figures being spoken about in the public debate this morning are not those of the HSE.

As Deputy Kenny observed, the HSE has set out a public service plan to support its goals, which are to maintain services to patients and clients in both hospitals and community settings in a manner that is fully consistent with patient safety and best practice. It is to expand certain services, particularly in respect of cancer and therapies for children with disabilities, to which additional funds of €15 million and €10 million, respectively, have been allocated, as well as an additional €120 million in other areas. Moreover, it is to support the reorganisation of services and the management of costs in such a way that services will be maintained and expanded. Furthermore, it is to work with the social partners in the health sector to achieve the objective of maintaining services to the public with a much tighter budget and to manage closely the significant risks of cost increases arising from the need to provide medical cards and other services as a result of the economic downturn.

The HSE service plan has been prepared and approved by the Minister on that basis. It refers to the budget of €14.7 billion that will be paid for health services next year, which constitutes an increase of 3.2% over this year's budget. Her approval and the finalised plan take account of all recent developments, including the budgetary position, the deterioration in the economy and the need to manage risks. In her letter approving the plan, the Minister also has set some specific and challenging requirements for the HSE.

This is a challenging and much-improved service plan, which sets out clearly the links between the services planned, the budget for those services and the staff needed. It is a plan that will require more than ever the active involvement of staff at all levels to make the changes necessary to deliver it. The goals desired by the Government across all areas only can be achieved with real co-operative engagement of management and staff from the outset of the year, drawing on the commitment of all to patients first and foremost. The HSE's management is engaged with staff representatives on these issues. I believe this is the best way to proceed and is the basis on which the plan was set up.

An injection of reality is needed.

Can the Taoiseach explain the reason this Health Service Executive service plan, which was placed in the Oireachtas Library only yesterday, is out of line by a further €400 million this morning? Everyone is in favour of efficiencies——

In theory.

——and of giving patients the best level of service. While there were ten HSE employees at grade 8 in 2000, there were 713 in 2007. I asked the Taoiseach what are the implications, in respect of the cutting of front-line services, on foot of an amended plan involving cuts of €900 million from this service? What are the implications for front-line services, the employment of nurses and doctors and patient care? The Minister for Health and Children, Deputy Harney, appears to be the only person in Ireland who states that too many people are working in accident and emergency units nationwide. Last night, 400 people were obliged to lie on trolleys.

She never visited any of them.

Again I ask the Taoiseach, how many beds will be taken from the system by this cutback?

That is the question.

How many people will be let go from the Health Service Executive? What are the implications for waiting lists and patient care? What are the implications for any future development to take place in the health business in 2009? The Taoiseach should answer these questions clearly and unequivocally, based on the up-to-date information in his possession. As this is the Taoiseach's last morning in the House, this matter should be sorted out in order that Members know where they stand.

Hopefully it will be his last morning.

Certainly——

Until next spring.

The Taoiseach, without interruption.

The health service would never be sorted out were Deputy Kenny in charge, because he is in favour of the status quo plus——

Please.

The Taoiseach was in that Department for long enough. He was glad to get out of it. He called it "Angola".

What did Fine Gael do?

Please let the Taoiseach finish.

He ran out of it.

I do not know what the Deputy is on about.

Are the Deputies opposite finished?

Let the Taoiseach finish.

The Taoiseach has blown his chance.

Are they finished?

He was afraid to face up to the problems and he ran out of it.

Allow the Taoiseach to finish.

He ran out of it.

I remind Deputy Kehoe this is Leaders' Questions.

Whenever the Whip is ready.

The Taoiseach, without interruption.

If the Taoiseach had his way, he would have——

Whenever they are ready.

The Taoiseach is seeking a diversion. He is trying to back out of it.

The Taoiseach, without interruption.

The position with Deputy Kenny is that he calls for reforms but when they are being implemented he opposes them.

I asked the Taoiseach a question.

A continuing reconfiguration is taking place in the health service. There will be a continuing emphasis on more——

Beds.

——day places and day surgery.

Sorry, Deputy Brian Hayes is talking about beds.

Beds, yes, that was the question.

Beds do not determine the health service. There is more than a hospital service in developing our health service and the HSE is involved in a reform of the service.

Tell that to my constituent who cannot get one this morning.

To stick to the point.

Bed numbers. Answer the question.

Sorry, Deputy Hayes. I will answer it in my own way. If he ever becomes leader, he can ask the questions.

The Taoiseach is answering Deputy Kenny's question. Please allow him to do so.

The whole purpose——

They have no idea.

——for driving these efficiencies is to maintain, not to cut, service.

They are being cut every day.

They are not being cut every day. In fact, there have been improvements in the health services in a range of areas. Where waiting times were two to five years, they are now two to five months. In 60% of all of those specialties for which there are waiting lists, they were reduced during the course of this year, if the Deputies look at the statistics that have been produced by the relevant authorities.

Does the Taoiseach believe that?

If Deputy McCormack wants to portray the health service being totally dysfunctional in every respect, that is his point of view but it is not fair on those who are working in the health service and it is certainly not the experience of the vast majority who receive health services in this country.

Nobody said that.

That is not to contend for a moment that we do not have problems, but those problems are being dealt with on the basis of reforms of health services and we all know, if we were honest enough to admit it, that the status quo plus will not give us a sustainable level of services. We need work practice changes.

Why do they not do it then?

We must see——

——and we are already seeing in the engagement that is taking place——

Ten years.

——between the management and staff representatives that we have had efficiencies of €280 million alone this year, which will be repeated next year.

What we have seen over the past ten years, to respond to Deputy Stagg, has been a continuing improvement——

They poured money into a black hole.

——and an increase in funding to the health service.

It is also clear that resources alone will not provide the solutions to the health service, but continuing and concomitant reforms with it, and that is what the HSE management is engaged in. If people were fair and looked at the changes taking place, they would recognise that in many cases those changes have been for the better.

We only asked about beds. The Gettysburg Address all over again.

I call Deputy Gilmore, without interruption.