The Minister for Health, Deputy James Reilly, has bypassed any meaningful democratic scrutiny of the HSE service plan by the Oireachtas by delaying its publication until the last sitting week of the year. As the Taoiseach knows, details of the plan were leaked before the Dáil had sight of it and before it could be discussed by the health committee. All the spin about health cuts, including the spin that cuts affecting medical cards would be smaller than previously signalled, does not impress anyone. I draw the Taoiseach's attention to the case of Merryn Lacey, a four-year-old girl from Donabate who is fighting stage 4 neuroblastoma, a very rare form of children's cancer. She is currently undergoing chemotherapy. Yesterday she had her application for a medical card rejected. There is also the case of Kate McShane, about whom I have talked to the Taoiseach before. She has Down's syndrome and needs long-term medical care. She is still being denied a medical card. What of those profoundly deaf children awaiting bilateral cochlear implants? I welcome cautiously the fact that €3.2 million has been allocated for them, but that sum is actually less than what is required. Does the Taoiseach accept that the only valid test of the HSE service plan - whenever we get around to discussing it - will be whether it results in these citizens getting the treatment and service to which they are entitled? Receiving the service is their right. Could the Taoiseach assure parents of seriously ill children and every other sick citizen that the HSE service plan will be such that they will get the treatment they deserve?

I explained this process to the Deputy before. The budget takes place and Votes go through in respect of the ceilings for each Department. The HSE prepares its draft report based on those figures and submits it to the Minister for Health. The Minister examines the draft proposition and recommends changes or amendments thereto, and he either signs off on it or does not. The Minister engaged in very careful consideration of the draft report by the HSE and made recommendations for changes to it. Following the amendment of the report, he approved the service plan for 2014.

The question of the €113 million that was allocated in respect of the probity issue concerning medical cards is one of serious importance for people around the country. The position was that when this was included in the budgetary figures in the first instance, it was subject to a process of examination. The Minister for Health examined this, in accordance with his duty, both from within the Department and from the point of view of the HSE. He found that the figure of €113 million in savings in respect of medical cards was not achievable. Owing to that, a change was brought about.

The position is that €47 million was available from the Department of Social Protection because of the drop in the number on the live register and savings made in that Department by its Minister, Deputy Joan Burton. Only 22 cards in the entire country were returned voluntarily because of changes of circumstances, such as somebody getting a better job or benefiting from a rise in income. There are more medical cards issued now than ever before. Therefore, the normal process of the validation of eligibility will continue. I do not suppose the Deputy is expecting me to say that the Minister should have changed the eligibility criteria for medical cards, because he did not do so. There will be an ongoing review of medical cards, as has always been the case. However, the figure that was included in the original budget was not acceptable to the Minister, so he changed it. That is a good thing.

The Government made the cut. The Taoiseach should not be absolving himself.

I thank the Taoiseach for explaining to me once again how the HSE service plan is arrived at. I find that very instructive. Let me assure the Taoiseach that he does not have to explain it to me ever again.

What he could do is answer the question I asked him, which was whether he will give assurances to the parents of seriously ill children that this new service plan will ensure that they get the services they require. I have explained to the Taoiseach before that it appears to me that the Minister for Health dreams up figures, cuts services and then at the end of the year comes back to the House with Supplementary Estimates of hundreds of millions of euro. All of this begs the question - from where did the Minister pull the original figures in the first place?

It goes without saying that any society, but particularly one which describes itself as a republic, should be judged on how it treats its most vulnerable citizens. I make the case that these children and other sick citizens are among the most vulnerable. I ask the Taoiseach again if he can give an assurance that this service plan, which I believe is a blueprint for greatly reduced services, will give our citizens the services they require. Whatever about the differences between the various figures that were given, the fact is that the health budget will be cut by over €600 million. Does the Taoiseach agree that over €600 million in cuts will have utterly devastating consequences for our citizens and our health services?

I agree that this will be a challenging year for the Department of Health, no more than for any other Department. I made it perfectly clear that the fact that the country has exited the bailout programme does not mean that everything is rosy in the garden. Deputy Adams, as the leader of the party of the impossible, is never going to be satisfied no matter how much is allocated to any particular sector. That is his job and that is fair enough.

The health service plan for 2014 has now been approved by the Minister for Health.

We know that.

While this will be a challenging year, we expect that the Minister's philosophy of cutting costs but not front-line services will continue to be effective in the interests of patient outcomes, which is the most important element of any health service. Outcomes and the opportunities for patients to have the best level of service as close to home as possible are our focus. In the service plan for 2014 there are a number of new and important initiatives. A sum of €1.48 million has been provided to deliver patient-centred improvements in maternity care, which was raised in this House previously. There is an extra €8.3 million for the cancer area and an additional €2.92 million for organ donation and transplantation services. I had discussions with some well known people recently about the importance of the latter. A sum of €35 million has been provided for an additional 60,000 medical cards in 2014, while €37 million has been provided for free GP services for children under six. An additional €14 million has been provided to address priority needs in the disability area and €20 million has been ring-fenced for the recruitment of mental health staff.

That is far below what is required.

The plan also provides €3.2 million to commence the sequential and simultaneous bilateral cochlear implant programme, with particular focus on those aged between five and six. That is an issue which Deputy Adams himself raised in this House. While we do not have all of the money to do all of the things we would like to do, these are key service initiatives which will take place in addition to effective delivery of front-line services for patients in 2014.

Other patients will be paying for those services.

Front-line services are not being delivered.

I agree that it is challenging for the Department of Health but it is the commitment of this Government to continue to cut costs but not services.