Táimid ar ais arís agus ba mhaith liom an Taoiseach a fháiltiú ar ais go dtí an Dáil. Tá súil agam go raibh sos maith aige thar an samhradh.

I am sure the Taoiseach will agree that the high point of the samhradh was the achievement of our Olympians and Paralympians. For me, the low point was the Government's plan to take entitlements from citizens with disabilities. Among other entitlements, the Government proposes to reduce personal assistant hours. Citizens with disabilities have rights. Those disabled citizens and carers who camped outside Tithe an Rialtais and picketed the Cabinet are to be commended. Is laochra iad agus daoine an-chróga atá ag déanamh obair an-tábhachtach agus iontach ar son a gclann agus a bpáistí agus ar son fear agus ban eile atá faoi chois ag an Rialtas.

These brave citizens forced the Government to do a U-turn. However, it still intends to proceed with cuts in home help hours and home care packages. The proposed reductions in agency staff and overtime will throw our hospitals into even greater crisis. Cuts to hospitals across this State, including in my own constituency, will result in more bed and ward closures, more citizens on trolleys and the undermining of essential services. This is nothing short of a scandal.

This Government has been in office for 18 months. I acknowledge it picked up a mess left by the people on my left. However, will the Taoiseach accept that following 18 months in office he and the Minister, Deputy Reilly, are presiding over a deep crisis in our health services? Does he not see that the cuts promised in the forthcoming budget will make this crisis even worse?

Tá fáilte roimh an Teachta Adams thar n-ais. Tá sé ag leanúint ar aghaidh leis an rud a bhí sé ag rá roimh an samhradh.

Sin é.

Tá súil agam go bhfeicfidh mé é Dé Domhnaigh seo chugainn freisin. B'fhéidir gur pointe an-ard a bheas ann. Deputy Adams will shortly have an opportunity to put on the record his party's constructive suggestions as to how we should deal with the fiscal challenge faced by our people and country not just for the next year, but beyond. I look forward to hearing constructive suggestions from him.

It is not with any pleasure that anybody stands up to say difficult choices must be made in the time ahead. The proposal to reduce personal assistant hours for those who work with members of their families or persons who are disabled was dealt with swiftly by the Minister, Deputy Reilly. I listened to the powerful words of Martin Naughton when he spoke outside Government Buildings. That matter was dealt with swiftly by the Minister, Deputy Reilly. The savings will come from cash management, travel and so on from within the administrative disability budget.

On the progress made over the past weekend at the Labour Relations Commission in respect of consultants and the number of other matters to be referred to the Labour Court, progress within the Croke Park agreement will lead to further savings, increased efficiency, greater throughput of patients and greater focus on patients' needs. That is an issue on which the Deputy will have an opportunity to have his say. Deputy Adams should not kid himself; while we have made steady progress through choppy economic waters, this country faces a series of challenges up ahead, which will not be easy for anybody. I do not underestimate the scale of that. In so far as health is concerned, the focus of the Minister for Health and the Government must be on the patient who deserves the best care and attention he or she can get.

Within the resources available, it is clear that many people are now doing so much more with less and that the impact that was assumed back in February when many people left the public service by choice was dealt with efficiently by front line staff in a whole range of areas.

We have work to do to change the structure of the health system to get to the point where the programme for Government can be implemented in terms of a single tier health system in which there is far greater focus and affect on the needs, requirements and facilities available to patients. Does Deputy Adams not understand that everybody in this House has the same philosophy in that regard? We may have differences of view about how one goes about this. The Minister, Deputy Reilly, dealt swiftly with the issue the Deputy raised.

I call Deputy Adams who has one minute for a supplementary question.

I am sure the Taoiseach will agree that the judgment of any society of any state is the protections it affords to its citizens, in particular the elderly, children, vulnerable people and people with disabilities.

Such as Jean McConville.

In particular, a State which calls itself a republic-----

Jean McConville.

-----where citizens have rights. The heckler is totally out of order. I will raise that matter later with the Leas-Cheann Comhairle.

This is Leaders' Questions.

The Deputy is totally out of order.

What did he say?

We are dealing with serious issues here. The Taoiseach in his response to me said that the Government is making difficult choices. The Government is making the wrong choices.

Hear, hear.

It is also making the wrong choices in regard to its election commitments. Most of what it is doing is totally in contradiction with what it promised. Does the Taoiseach recall the Leaders' debate in February 2011? The Tánaiste said that the first issue the Labour Party would address in government, in terms of equality and decent supports for people, would be that of disability. The Taoiseach agreed with that and said it would be an absolute priority. However, once the Fine Gael and Labour parties got into government they commenced cutting services to the elderly and those with disabilities while at the same time kowtowing to vested interests in the EU and the financial sector. Next month, on the Taoiseach's watch, unguaranteed bondholders will received another €1 billion. The Government is taking money from vulnerable front line sectors to put into unguaranteed bondholders.

The Taoiseach and Tánaiste have expressed confidence in the Minister, Deputy Reilly, which is hardly surprising.

A question please, Deputy.

Apart from the "Yes" men and women in the Labour and Fine Gael parties, he is on his own.

Hear, hear.

The Taoiseach is totally and absolutely on his own. Those who are working in and using the services do not share that confidence. With more cuts planned for December, will the Taoiseach not accept that it is long past time for the Minister, Deputy Reilly, to go? I know he is only implementing Government policy. Minister Reillys come and Minister Reillys go.

Deputy Adams will always be here.

It is important the Government gets back to implementing the mandate it was given and keeps the promises it made as opposed to doing the exact opposite. It should uphold the rights of citizens, in particular, those who are vulnerable.

I am interested in the Deputy's comment about protection of our citizens. I would like if he would elaborate on that sometime.

Absolutely. Does the Taoiseach want me to do it now? The Taoiseach asked me a question. Does he want me to do that now?

Deputy, the Taoiseach has the floor. One speaker at a time, please.

I hope that comment is not out of order. I would be interested to hear the Deputy elaborate on his comment.

Má shuíonn an Taoiseach síos, déanfaidh mé anois é. Is it better to do it now? Let us have a real debate now.

Deputy Adams.

Certain citizens with disabilities had to camp outside-----

The Deputy will be aware that up to 2011 there were budget reductions of approximately €1.75 billion in the health services. The year 2012 saw further reductions of €0.75 billion. The fact is that €130 million in additional savings have to be achieved by the end of this year. Some €63 million or almost 50% will come from more focused cash and stock management initiatives, savings in medical equipment which are non-capital, items such as furniture, education, training, office expenses, travel, subsistence and advertising. Some €6 million in savings will come from the non-imbursement of certain non-essential products. Removing gluten free products will result in savings of about €3.6 million on an annual basis.

Shame on the Taoiseach. Coeliacs are----

All of those have no impact on patient care. That means that €60.5 million in savings will come from specific service related measures. Deputy Adams will have an opportunity shortly to spell out what he would do, not that he will ever have the chance. Agency and overtime reductions will account for savings of €35 million. The reduction in average length of stay is key to the delivery of agreed activity levels with fewer beds and therefore less staffing. There will be re-alignment of services in line with international best practice, redeployment of staff and revision of rostering practices. All of these have been referred to by the Minister, Deputy Reilly, and will be dealt with again in the debate on the motion of no confidence.

What about home help hours and home care packages?

The Minister has directed that every efficiency will be extracted prior to cutting any service. Patient safety is paramount. Care and sensitivity is to be applied in the case of Letterkenny, Naas and Our Lady of Lourdes Hospital, Drogheda where there are significant service challenges and a heavy dependency on overtime and agencies. The Deputy will be aware of the situation in so far as sick leave is concerned and so on. Inpatient discharges are 2.7% higher than the period last year and 8.1% above target. All of these can be dealt with during the course of the Private Members' motion.

The point is that the Minister, Deputy Reilly, and his Ministers of State follow Government policy and the mandate given to the Government was to sort out the public finances of the country, restore our economic sovereignty and give an opportunity for this country to provide jobs, employment and careers for our people and young people in particular and not to have them travel to other lands by necessity. That is a situation that is not easy to achieve. It is not with any great pleasure that any Minister has to refer to this as the challenging road ahead but as a women said to me last week, sometimes it is necessary to do hard things in the interests of the country. The impact of what has to be done in terms of patient care and patient facility is very close to the heart of Government and the heart of the Minister, Deputy Reilly, and will continue to be so.

I call Deputy Ross on behalf of the Technical Group.