On Monday, the Minister for Health wrote to the Oireachtas Joint Committee on Health and Children to advise that he would not now be attending tomorrow's scheduled meeting of the committee to discuss the HSE national service plan for 2014, because, as he said, it is still not ready. There is now the real possibility, uniquely, perhaps, that we will not have an opportunity to discuss the HSE service plan for 2014 in advance of the new year and its introduction, a bizarre situation.

The signing off and publication of the plan have already been delayed on several occasions. The Minister granted extensions to the HSE. I have to say that is not surprising because in budget 2014 the Government imposed cuts of at least €666 million on the health budget for the coming year. The Taoiseach knows this is unsustainable. I believe the Taoiseach has given his health Ministers, the Department and the HSE an impossible task. More important, he is imposing on front-line workers and patients within the health services an impossible burden. Can he tell us how it will be possible to maintain health services in 2014 on such a drastically reduced budget? All this, when, only yesterday, we had the publication of a Supplementary Estimate for a further €219 million in order for the Health Service Executive to be able to get to the end of this month. It is time to face the facts. I have it to say that there is grave concern.

It is reported that the director general of the HSE, Tony O'Brien, has written to the Government to state that the figure for medical card cuts in the draft service plan is in fact €133 million and not the €113 million as signalled in the Budget Statement. Moreover, the medical card cuts are against the advice of the HSE and the Department of Health. Can the Taoiseach confirm that letter and the figures it cites?

What I can confirm to Deputy Ó Caoláin is that the process followed here is well known to him. Deputy Ó Caoláin was at the meeting yesterday. He is aware of the Minister's intention to attend the committee once due process has been followed in respect of provision of the HSE service plan. The budget takes place in October. Then there is a Vote given for the health Estimate for 2014. Following that, the Health Service Executive has a requirement to produce its draft plan on how it intends to run the services for 2014 based on that figure. That draft plan is sent to the Minister for Health for his approval or amendment and acceptance of the report. The Minister has until Monday, 16 December to respond to the Health Service Executive following his having received the draft programme. That is the system that operates.

The Minister is currently going through the draft plan as submitted by the Health Service Executive. He has already made clear that for this year he requires a Supplementary Estimate of €199 million. This is not the first time this has happened in the Department of Health.

Clearly, he indicated last September or October that something less than €200 million would be required in respect of 2013. In response to Deputy Ó Caoláin, it is a matter for the committee as to when it wants the Minister to attend. I expect the Minister will comply-----

That also is the way it works in Ukraine.

Deputy Martin is someone to talk about health, is he not?

He has a very poor record.

Deputy Durkan should relax.

As a former Minister, the Deputy has a very poor record.

What were the overruns like in those years?

Thank you. Let us settle down now please.

I believe there were a few major overruns in Deputy Martin's time.

Over the runway.

Will the committee meet on Christmas Day?

Quiet please.

The answer to Deputy Ó Caoláin's question is that I expect the Minister will comply with his requirement to respond to the Health Service Executive with his views on the draft plan as submitted-----

Put him in charge.

-----and his recommendation for acceptance or otherwise.

Get him to send a "Dear Tony" letter.

Obviously, he will be quite happy to discuss this matter in public forum with the committee and as he indicated at yesterday's meeting, I am sure he is more than happy to attend. That process now is nearing a conclusion because there is a timeline on it. I expect that next week the Deputy will see the evidence and the conclusion of their deliberations of the Minister.

Next Thursday.

Perhaps on Friday.

What day is Christmas Day? It is two weeks from today.

There is no intention to try to delay the opportunity for the committee of which the Deputy is a member to discuss these matters and to give out, as the Deputy normally will, about matters that are of concern to him in the system.

The Taoiseach himself was good at it.

Thank you, we are over time.

The Minister's priority is to focus on the delivery of effective services on the front line and, clearly, there are challenges for all Ministers and all Departments in government in meeting these objectives and targets. The Minister, Deputy Reilly, is no different from that point of view.

One would almost draw from the Taoiseach's remarks that it was the committee's fault the Minister has not yet come forward with the service plan for 2014.

Deputy Ó Caoláin should read out the full letter.

Deputy Buttimer is not leader yet.

I assure the Taoiseach-----

Deputy Ó Caoláin should read out the full letter.

Would you stay quiet please?

-----and Deputy Buttimer that the committee-----

Read out the full letter.

-----is quite prepared to engage with the Minister in respect of the national service plan.

Deputy Buttimer, I will not ask you a third time.

Hear, hear.

One should be clear in this regard. The Minister gave an extension of ten days to the Health Service Executive, HSE, to publish the service plan. Then he gave a further ten days to the HSE to complete its deliberations. I have asked the Taoiseach important questions. I have asked him whether he is aware of a letter from the director general of the HSE in respect of the service plan, quite particularly addressing the issue of the cuts to medical card provision in the coming year and that the figure presented in the Budget Statement last October is an understatement of what actually is to be provided for by €20 million-----

Thank you.

-----and that it is €133 million.

A question, please.

Is the Taoiseach aware of this letter? Is he aware it is indicated strongly and clearly that the HSE and the Department of Health are opposed to the extent of cuts being sought in respect of medical card provision? Is he aware they also make the case that €666 million, which might not be the total sum involved, is impossible to extract from a health budget that has been decimated year-on-year over recent years? In conclusion, can the Taoiseach provide Members with an idea of the numbers of people who now are likely to lose their medical cards at the end of this year and in the coming year on foot of decisions-----

Thank you, Deputy.

-----to not only arrest but significantly reduce the sum being provided. Many who have known the certainty, comfort and assurance of a medical card, be they people in advanced years over 70 or, as in many cases in families across the country, children dealing with issues of grave sickness, now face the prospect of losing their cards.

I ask Members to try to stick to the allocated time. Otherwise, they should change the time allocated but please do not have me interrupting everyone day in and day out.

Hear, hear.

The Taoiseach has one minute in which to reply.

I do not wish to get into the details of any aspect of the many areas that are involved in the health budget. I am aware that the Health Service Executive wrote to the Minister with its submission of the draft plan for service provision for 2014. I am aware that a number of matters to which reference was made in the letter are being considered by the Government as how best to deal with them. I genuinely am not aware of the specific point the Deputy mentioned. However, I repeat that the Minister for Health has a responsibility to assess the draft plan, as submitted by the Health Service Executive, to provide services for 2014 and to respond to the Health Service Executive with his approval or amendments to the draft plan as he considers. This work now is concluding with the Minister for Health. I believe that next week, Members will see the result of his deliberations here.

Thank you.

The Taoiseach claimed not to be aware. Is it not past time that he made it his business to be aware?

The Minister's focus is on the provision of the excellent front-line services that are being provided. I do not agree with the Deputy's scaremongering tactics in this regard. An unprecedented number of medical cards have been issued and are being issued, with the highest ever numbers covered by the medical card service.

Tell that to the people who are waiting.

No one believes that.

I agree with Deputy Ó Caoláin that quite a number of sensitive cases came to light following the centralisation of the medical card system.

Scandalous cases.

The issue was called before the Cabinet sub-committee and a process was put in place to deal with cases, particularly where discretion was required. In recent weeks, numbers were raised that have brought a requirement for experience to deal with particular kinds of cases and I believe that has been put in place. In response to Deputy Ó Caoláin, next week will see the Minister respond to the Health Service Executive and its draft plan and all these issues will be dealt with in the best way possible-----

Will the committee have a chance to discuss it with the Minister before the Christmas recess?

-----and while maintaining front-line services, to give the most effective and higher standard of medical care to the people.

Forget about the Dáil. No business here.

Will the committee have that chance in the coming week?

Deputy Ó Caoláin agreed this at the committee meeting yesterday.

Is that what will happen?

I call Deputy Healy.

Yes, I do not see-----

I am not asking Deputy Buttimer; I am asking the Taoiseach and the Deputy is not in his seat yet.

The Deputy was at the meeting yesterday.

Deputy Buttimer has a few steps to go yet.

I call Deputy Healy.

The Deputy was at a meeting yesterday. It was a tentative meeting based on-----

Taoiseach, please. I already have called Deputy Healy.

Deputy Ó Caoláin is playing politics.

Deputy Buttimer, would you please stay quiet or else leave the Chamber?

Yes, he is eating into the Technical Group's time.

Throw him out.