The House is debating a Private Members' motion in the names of Deputy James Reilly and all Fine Gael Deputies on cutbacks at Crumlin hospital. This is a matter of serious concern, particularly to the parents of the children involved. The Taoiseach is aware that Crumlin hospital provides 80% of the country's specialist treatment for children.

During the course of the debate last night, the Minister for Health and Children stated: "I find it strange that when we ask hospitals to make efficiency savings, some hospitals decide that the most sensitive area is the one that must be cut first." This statement amounts to an outrageous attack on the doctors and nurses who keep this element of our health service ticking over.

Hear, hear.

As the Taoiseach is well aware from his visits to Crumlin hospital, parents who go through its doors are not looking for a manager or Professor Drumm, but a doctor or nurse to treat their sick children. This is probably the most emotive and sensitive aspect of health. I have visited the hospital many times. The children there have cancer, holes in their hearts, curved spines and so on. Their problems are the most sensitive.

Does the Taoiseach believe and accept the Minister's statement last night that doctors and nurses are effectively victimising children with serious illnesses in the interests of saving money? If he does not, will he ask her to withdraw her outrageous attack or remove her from her position?

Hear, hear.

Of course the Minister for Health and Children was not saying that at all. The Minister for Health and Children was making the point that, before last Monday——

We are not deaf.

——evening, it was being suggested that it would be necessary to close theatres and wards. That would be the job of the board of management and the management of the hospital. The board met on Monday evening and thankfully was in a position, with no changes to the budgetary arrangements, to make a decision that ensures that this in fact will not be the case.

I think that what the Minister for Health and Children is simply trying to outline is that an excellent service is being provided by that hospital. A reputation has been hard won and built up over many years. In the context of finite budgets, even in the context of this year's budget of a 3% reduction compared to last year, there is an increased level of activity in Crumlin hospital, which itself is confirmation that, through more efficiencies and more effective management of the resources, it is possible to increase throughput and output without generating the need for extra resources per se.

There will always be, in the context of any hospital or any health facility in the event of more resources being available, the possibility of more throughput and output in activity being able to be generated, but we have all agreed in the House for many years that it is only through service planning on a year-to-year basis that we can provide a sustainable health service. Working within those budgets, Crumlin management and its board of management were able to make a decision where, in fact, the closures that were regarded as necessary or unavoidable before last Monday's meeting thankfully did not come to pass because of the fact that they were able to make other decisions.

The Taoiseach did not answer the question. I asked him whether he believed the Minister for Health and Children's statement to the effect that she found it strange that the first cut to be made would be in the most sensitive area, thereby directly attacking doctors and nurses——

Hear, hear.

——who are not responsible for this position. The layers of bureaucracy above them, created in the bureaucratic monster funded by the Taoiseach and the Minister, are responsible.

The Taoiseach did not tell me that St. Joseph's ward is closed or that 4,000 bed days will consequently be lost. He did not tell me that 800 operations for young and sick children will be delayed this year. These facts were determined and witnessed by the Members of the Oireachtas, including some from Fianna Fáil, who visited Crumlin hospital yesterday.

Savings of just over €9 million are being sought in a system built up and funded by the Taoiseach and the Minister, Deputy Harney, and through which she is making an outrageous attack on doctors, nurses and other front line staff. Between 2007 and 2008, €60 million was spent on taxis and transport. A 10% efficiency would have created 66% of what Crumlin hospital needs this year. Bonuses for HSE bosses amounted to almost €1.5 million in 2007.

Scandalous.

Outside consultants and PR cost €17 million last year. In her contribution last night, the Minister admitted that we are spending too much on advisers and outside consultants. On the growth of bureaucracy in the Health Service Executive, HSE, there were six grade eight senior management positions in 2000. Now there are more than 700. Despite all of that administration, there is at least €160 million in unpaid bills to hospitals. Advisers to Government last year cost €6.2 million. Some of that expenditure was transferred into the Taoiseach's Department from the Minister for Health and Children's budget. There is no evidence of any efficiency being created by Government in the HSE.

Let me return to the point I made at the outset, children from all over the country have to visit Crumlin hospital when they have a major problem. I spoke to a mother in the hospital recently who was sleeping in a room for three months with her head under the sink while her child with cancer was receiving treatment. The Taoiseach is aware that doctors and nurses work under the most pressurised conditions in that hospital to deliver what they know they can do best, namely, the sensitive treatment of major operations for young children. What happened in the House last night amounts to an outrageous attack on the nurses and doctors in Crumlin by the Minister for Health and Children.

Hear, hear.

The Taoiseach should have her withdraw that statement or remove her from her position.

Hear, hear.

Remove her.

This is not the kind of health system we want. This party will assist the Government to bring about efficiencies so that children can get treatment when they need it. When parents burst through the doors of a hospital, it is not Professor Drumm they are looking for, it is not a manager nor a senior executive at grade eight level, it is a doctor and a nurse who will be able to treat their child. As Deputy Reilly has pointed out, the longer one leaves curvature of the spine problems, the more costly it will be and the more interventions that will be required to bring children to a point where they can live a normal life.

Where does the Taoiseach expect to make efficiencies this year so that Crumlin hospital will not have to cut back on operations? Does he agree with the Minister for Health and Children's statement that doctors and nurses are deliberately victimising children with serious illness in the interests of saving money? If he does not agree with that statement, will he ask her to withdraw it or remove her from her position?

If she did not say it, she cannot withdraw it.

The Minister, Deputy Harney, did not say that.

What she said was——

That is the problem with Deputy Kenny. I heard the quote.

She said, "I find it strange that when we ask hospitals to make efficiency savings, some hospitals decide——

Deputy Kenny has had his say.

The Taoiseach should be allowed to speak without interruption.

Here are her words. Deputy Kenny had approximately ten minutes when he should have had only three.

It is the Taoiseach's turn now.

——that the most sensitive area is the one that must be cut first." That is what she said. What does that mean?

The Taoiseach should be allowed to speak now without interruption.

It is not happening now, Deputy.

What it means is that there is a need to manage the resource and direct it to the priority areas where it is required. It was directed not just in this specific case but generally to all boards of management in voluntary hospitals and to the HSE in respect of those hospitals that are run by the HSE. The reforms are ongoing and they are providing savings and putting clinicians at the front line. The whole purpose of the reforms the Minister has been leading is to bring hospital teams together to work for a better output for the resource that is available. That is being achieved by bringing forward clinical directors and involving clinicians in decision making and the management of hospitals, rather than have people acting individually as consultants within the hospitals. That is the case with many important services, including cancer services. It was suggested last week, for example, that cancer services would come to an end in Galway but that proved not to be the case either. If one looks at it simply on the basis of a status quo, against a background of a finite and challenging budgetary situation, then one has to make changes to ensure we get the outputs we need. The fact of the matter is that on page 19 of the Fine Gael Party’s pre-budget statement it is suggested that efficiencies of 3% should be imposed on all health budgets.

Absolutely.

The efficiencies must be targeted.

The reduction in the budget——

Outside consultants cost €17 million.

If I might complete the point——

I agree there should be efficiencies, but not at the expense of children.

Deputy Kenny should allow the Taoiseach to speak without interruption.

——because I listened in silence to what Deputy Kenny had to say.

Deputy Kenny should allow the Taoiseach to conclude.

Based on that assessment by Fine Gael, in order to get some consistency into the argumentation——

A total of €17 million was spent on outside consultants.

If I might be allowed to make my point.

Deputy Kenny, the Taoiseach listened to you in silence and he must be extended the same courtesy.

I am sorry for being unruly, Taoiseach, but this is a sensitive matter. It is about children.

He must be extended the same courtesy.

Even if he is talking rubbish.

As I pointed out previously, this is a democratic forum. The Taoiseach has been asked a question and he must be allowed to answer it.

He is not answering it.

That is a novel idea for the Deputy. The point is that the 3% reduction aligns exactly with the comparison between the 2008 budget and the 2009 budget for this hospital. It involves a 3% reduction in its budget. If, as stated on page 19, before the budget the Fine Gael Party says——

A total of 800 operations have been postponed.

——there should be an efficiency, how can it suggest a 3% reduction in the budget cannot generate any efficiencies?

The Government has postponed 800 operations.

Worse still, there is an inconsistency in Deputy Kenny's approach.

A total of €17 million has been paid to outside consultants.

As the Minister, Deputy Harney——

The Taoiseach should be allowed to finish, please.

Some children will not be able to have operations.

As the Minister, Deputy Harney, outlined in her speech yesterday evening, there has been an increase in staffing, including nurses and clinicians. We welcome that.

Now the Government wants to leave them idle.

Based on reportage I saw in newspapers, including this morning, there is approximately €30 million in a fundraising account that is available also in that hospital. It is a matter for the management to decide how it wishes to utilise those funds.

It is a matter for the Minister.

It is important that we can ensure children with scoliosis have the required procedures carried out as quickly as is clinically appropriate and based on the advice and expertise available. The HSE has asked the hospital to come forward with a position on that to see how many more procedures can be carried out this year.

Why did the HSE not do that two months ago?

We have seen through the National Treatment Purchase Fund and other mechanisms, means by which this can be done.

Only two cases will be treated in the next month.

It is only fair, therefore, that if we are to have a debate on health reform and the need to improve the provision of our health service, it must be based on the fact that we have finite budgets that are challenging. We cannot come to the House and suggest we continue with the status quo and expect the same outputs.

Yes, but the Government spent €17 million on outside consultants.

That is a political football.

We should have a continuing debate on it. All of us must be prepared to challenge everyone in the health service to make the necessary reforms that will get the outputs that need not result in the closures that were predicted in this case or in Galway——

That has happened.

——that can allow for a mature debate in this House that will serve the people better by the provision of the taxpayers' money to best effect.

Nothing the Taoiseach has said will relieve the pain and suffering of children and the distress of their parents.

It is a political football.

No, it is being real. The Minister should go back and look up a tree somewhere in north Dublin.

You have them all cut down.