The list of calamities around the Minister for Health, Deputy James Reilly, continues to grow. At the weekend hundreds of people took to the streets of Castlebar, in the Taoiseach's constituency, to protest against the Minister's decision to cut home help hours. The Minister of State, Deputy Jan O'Sullivan, is on record as saying these cuts are not right. She made those remarks in response to the situation of Catherine Brosnan, who has had home help hours cut for her son, Christopher, who suffers from cerebral palsy. Catherine Brosnan is not alone. Very many parents throughout the State who have children with severe disabilities have seen their service cut or taken away entirely.

At the weekend there were the further revelations that the Minister unilaterally had added new locations in his constituency to the primary care centre list-----

Which subject is the Deputy discussing?

-----the evening before the announcement was made. For the past 18 months, the Minister has had a track record of unmitigated disaster. He closed public nursing homes while being up to his neck in the private nursing sector. He promised he would make savings in the areas of consultant contracts and generic drugs, and would recoup costs for private beds in public hospitals. Worse, he has imposed savage cuts on the most vulnerable in society.

What is your question, Deputy?

He mishandled the demands of the family of Savita Halappanavar in regard to an inquiry.

I do not believe the Deputy heard me. I asked the subject matter she was discussing.

I am addressing the track record of the Minister.

No. This is Leaders' Questions.

Allow me to put my question.

The Deputy put a question to the Taoiseach and had two minutes to do it. She is over time.

The Minister's explanations in regard to the primary care centres are ludicrous and do not stand up to any scrutiny. Everybody knows that the position of the Minister, Deputy Reilly, is untenable. The dogs on the street know this. When will the Taoiseach come to this realisation and relieve Deputy Reilly from his position as Minister for Health?

The Deputy is perfectly entitled to join her colleagues on that side of the House in tabling a motion four months in advance of being able to move it - if she wants to follow the shallow road of popularity.

In any Department there are difficulties and they will continue. The Minister for Health has taken on the task of cleaning up the most unholy departmental mess left behind by an outfit that put together all the health boards and imposed the superstructure of the HSE, which was palpably and patently unworkable. To make these changes in a time of enormous economic challenge is never easy. The cost base of the health system in this country is exceptionally high and this issue will continue to be dealt with. I commend those people working in the health system who have already made serious changes to the way they do their business, in rosters and implementing and maintaining front-line services under difficult circumstances. Nobody denies this.

The people who marched in Castlebar at the weekend-----

Did you meet them?

-----were very welcome and have every right to make a legitimate protest. I met the bogcutters in Loughrea the other night and they are also entitled to protest-----

Was Luke there?

-----as are other people who want to walk on the streets in regard to any concern they may have. However, as I told the people in Loughrea, they are not entitled to block the public road when people are going about their legitimate business.

The Minister, Deputy Reilly, has set out his strategy for dealing with the health system, namely, by changing the structures to bring about a situation where there will be universal health insurance and where the effort of everybody working in the health service will be to do more with less, as is happening. The idea is to bring about a situation where there will be health services across the board for young and old alike of which we can be proud. We have a long way to go on this. The Deputy has not made any constructive suggestion other than to mention dismissal of a Minister.

Very constructive.

In this country people usually decry lay people for their failures in finance or any other departmental area but when there finally is somebody who understands medical politics and has a clear strategy for where we should aim and be, he too is decried. I do not claim we are all perfect. We all make mistakes. However, the responsibilities of the Minister, Deputy Reilly, and the Ministers of State, Deputy Alex White and Deputy Kathleen Lynch, are such that they are the trio leading the enormously difficult changes in the Department of Health at a very challenging time. I commend them for their efforts.

This is not easy; it is difficult for many people. I asked the person who has responsibility for home helps in the western area how he is implementing these reductions. His perspective was that he eliminated any reduction in service to those who had to use hoists, were on palliative care or those who had only one hour's home help. Where there is a medical requirement for such a service it will continue to be given. It is not easy and is not as flúirseach as we would wish but changes must be made in the interest of getting this right for everybody and for the future.

It is not easy, certainly not for those people who are on the receiving end of what the Taoiseach called the strategy of the Minister. The families who are being hurt directly in the here and now by his cuts to home help hours are living a terrible reality and the Taoiseach appears to be either immune or indifferent to that reality. The Minister has a responsibility. He has a duty of care to citizens and a responsibility to act in a transparent, fair and accountable way but has done nothing of the sort. His actions in respect of the primary health care centres are the kind of stroke politics-----

Can I have the Deputy's supplementary question, please?

-----that Fianna Fáil perfected over many years. He now follows in that dishonourable tradition. I do not choose to personalise this against an individual. I am saying very clearly that in Deputy James Reilly we have a Minister-----

What is the Deputy's supplementary question?

-----whose strategy is failing and who fails to meet even the most basic criteria-----

This is not speech time. The Deputy is not listening to me.

-----of openness and good governance.

Will she please give me her supplementary question?

I can only presume that just as the Minister told us yesterday if he had it all to do again he would do it again in the same way, the Taoiseach is standing by him and is refusing to take any action.

Please put your supplementary question.

I reiterate my question. What will the Taoiseach do about his Minister for Health in a scenario where he is so abjectly failing and where public confidence in him is so clearly lacking?

Before the Taoiseach takes his place, I want to read the following for the information of the House:

Under Standing Order 27 - which deals with Leaders' Questions - at the commencement of public business on Tuesdays and Wednesdays, the Ceann Comhairle may permit, at his or her discretion, a brief question not exceeding two minutes from each leader in opposition to the Taoiseach about a matter of topical public importance in respect of which the following arrangements will apply.

The order then deals with the time limits, namely, two minutes for asking the question, three minutes to reply and a minute's supplementary which shall be brief.

Will those responsible for asking Leaders' Questions please adhere to the standing order?

Allow the Taoiseach to reply.

I do not want to have to interrupt people on a continuous basis. A habit is growing in the House of asking multiple questions in one, which is not allowed and will not be permitted. I will not repeat this warning. Please respect the Chair or get the Whips to discuss the matter. If people want to change the Standing Orders let them do so but I have to apply the orders as they read.

I thank the Ceann Comhairle for that clarification. I thought Deputy McDonald would welcome that Government is in a position to make announcements about the provision of primary care centres. I gave Deputy Martin the three headings that apply: direct funding, leasing arrangements and public private partnerships.

The decision in respect of public private partnerships is very clear. If there were only 20 centres on the list, we would run the clear risk of general practitioners not buying in to facilitating the servicing of their primary care centres were they to be built. This was the position at a number of locations throughout the country.

I would have thought that what we are doing here, which is part of the economic stimulus of €2.5 billion announced by the Minister for Public Expenditure and Reform and relating to health, roads, education, justice and the major development that will be the Grangegorman centre, would be welcome. Deputy McDonald will understand that while there are 35 centres on the list, only 20 will proceed to be developed by means of public private partnerships. It is those 20 in respect of which there is competition, buy in and planning permission. In addition, all of the conditions are being measured up to in the context of these centres in order that the final 20 can be got across the line. It is not a case of stating that the 35 centres will be built, one after another. Some 20 centres that can be commenced and completed will be bundled together and will proceed by means of public private partnerships.

I do not welcome the reduction in home help hours. Neither do I welcome the Taoiseach's support for a Minister who proposes such cuts.

I would have thought that even the Deputy would have welcomed that, particularly as she is a member of a party which was involved in closing 800 long-stay beds in Northern Ireland.