As the Taoiseach is aware, obesity is a major issue affecting children and adults across the western world. It requires a societal response and full range of interventions. I propose to focus on those who are morbidly obese, particular morbidly obese public patients who need urgent intervention in the form of bariatric surgery. Clinicians have stated that morbidly obese people need this type of surgery to save their lives. The Minister for Health, Deputy James Reilly, has rejected calls by Professor Donal O'Shea of St. Vincent's University Hospital to restore bariatric surgery to the hospital. Only 20 operations have been carried out at the hospital this year and it does not have funding to perform any more life-saving operations. The 200 people on the waiting list for bariatric services at the hospital have been clinically assessed and the course of action designed for them by clinicians is to have this form of life-saving surgery carried out.

The Minister has been dismissive of the calls for the restoration of this surgery. The Minister stated that prevention is better than cure. He also stated that in its wisdom, St. Vincent's decided to perform the 20 operations in the first five months of the year. I do not know whether it occurred to the Minister that this decision by the hospital was made not merely "in its wisdom". Clinically, it decided it wanted to save lives and perform those 20 operations. It needs to perform more of them.

This is a callous and dismissive response to a serious issue for those patients involved. It is not good enough to say, as the Minister is saying, that it is tough on a patient that he or she is now morbidly obese, he cannot and will not do anything for the patient, and the next operation will be in 2015. The simple question I have to put to the Taoiseach is how many lives have to be lost before the Government will get the message, intervene and do what is right in terms of the prioritisation of life over death.

I regret if the language used by the Minister, Deputy Reilly, in referring to the process by which 20 important surgical interventions were carried out, was deemed to be callous or uncaring by Deputy Martin. I would be certainly sorry about that.

I noted this report. Deputy Reilly also stated that one does not have sufficient resources available to do every operation that one might like to do and for that reason, I understand that the clinician involved, who is a skilled person, carried out the 20 operations in the first half of this year. I am not competent to say on what basis they were prioritised or whether those who were on the waiting list are in a more serious condition than those who were operated on or whatever, but I believe, as Deputy Martin does, that prevention is better than cure.

This is an issue that has arisen over the past years. Despite the fact that there is a huge voluntary movement in terms of health initiatives on such important issues as diet, activity and exercise, the Minister made the point that there is not an endless resource for this operation or any other. He also made the point about the extraordinary level of commitment that is required for essential drugs, where, for instance in regard to hepatitis C, there is a 95% curable rate with what will be developed in AbbVie in Sligo. In these cases, while the moneys are not there now to perform all the operations that might be deemed to be necessary by the clinicians, I am sure it is possible for the clinician expertise to be able to ask what can be done for the patient in the meantime pending an operation.

Deputy Martin will be aware that given the circumstances that apply, patients have unfortunately had to wait for a very long time for many different kinds of operations and still do - much too long in many cases. The Deputy refers to this case. Unfortunately, this is an issue that has to be dealt with by these clinicians. Pending a clinician's assessment of the necessity for an operation, I am sure that advice to otherwise deal with the problem is available. Clinicians know best about the urgency of carrying out an operation, if it is to be a life-saving operation, and I am sure it is on that basis that they prioritise them.

I hope the 20 operations carried out this year have been successful. The Minister made the point that if one takes funding from other priority areas where operations are required, one does not do any favours to those others with different ailments. It is simply a case of not having funding available to be able to do all that one needs or might like to do just now. In the meantime, I would hope that the expertise of the clinicians will be available to those who are deemed to require an operation carried out at some stage.

I put it to the Taoiseach that he insults those who are morbidly obese when he states that prevention is better than cure. We are referring here to patients who could be 20 or 24 stone, facing imminent organ failure. One would not say that to a heart patient, nor to a cancer patient. We have developed those services, such as cancer services, where we want immediate intervention based on clinical assessment.

Professor O'Shea made a good point when he stated that because the Minister does not take it seriously enough, obese patients were subject to the last remaining acceptable discrimination. The Minister does not get it that this is a life-saving operation. This is not a lifestyle choice for those concerned right now. It is an urgent surgical intervention that is required to prevent loss of life.

We prioritise in the health service. One always would prioritise in terms of life-saving surgical interventions vis-à-vis non-life-saving surgical interventions.

A question, please.

The Minister has chosen not to do this on this occasion. There are other areas where he is spending millions of euro-----

We are over time.

-----in terms of providing medical cards to those who will be healthy and young, but he has taken that choice. There is a small number of patients here. There are 200 on a waiting list right now. The Minister has it within his capacity to address this problem if he stopped insulting patients.

Would Deputy Martin put his question?

The Minister should stop saying to them that it is tough that they are morbidly obese and that prevention is better than cure. That is not good enough.

The Minister did not say that.

That is what is being said.

Deputy Martin should put his question.

In reality, that is what is being said.

That is what Deputy Martin is saying.

I ask the Taoiseach to engage with the clinicians involved here. Will he meet them? Will he work out with them and the hospital a solution to this which will ensure that the life-saving surgery that is required happens? It can happen, and the Taoiseach knows it. It happened with the discretionary medical cards, even though we had to press for change in that area for two years. The Taoiseach can implement change here too if he intervenes effectively and appropriately.

I am not sure whether the heat is getting to Deputy Martin but it is wrong for him to stand up here and state that I insulted patients who have a problem because they happen to be morbidly obese.

What are called "bariatric services" are provided in two public hospitals, St. Vincent's here in Dublin and Galway University Hospital, and that forms part of the HSE's overall response to this problem. In the case of St. Vincent's Hospital, where Professor O'Shea operates, this service was originally provided by St. Columcille's Hospital.

I know all that. That is in the note that was just handed to the Taoiseach.

In the context of the reconfiguration within the hospital group, the service was transferred to St. Vincent's last year.

Deputy Martin stated the Minister prioritises patients. This is a matter for clinicians and medical expertise. Specific funding was made available to provide continuity of service. Typically, St. Columcille's carried out 20 cases per year. We are advised by St. Vincent's that it provided in excess of that this year to date. With regard to University College Hospital in Galway, I understand it treats on average 50 cases per year-----

I told the Taoiseach that last week.

-----and it is not anticipating any reduction in service levels this year.

Here is an important point for Deputy Martin. While a definite clinical need exists for those with chronic obesity, bariatric surgery is required for a minority of obese patients, 2% of the population. The vast majority require clinical treatment that is both hospital based and community based, and the HSE will continue the further development of this service, in 2015 and beyond, within the overall context of this service in the planning process.

Deputy Martin made the point that these are life-saving operations. On that basis, I would assume that the clinicians, who know best here, would prioritise which of the patients need to be dealt with most urgently. The Deputy asked me to meet the clinicians and he referred to the discretionary medical cards issue. In many cases, the persons who are now receiving back their discretionary medical cards have conditions and challenges that will last all their lives, and they may live for a long time - we hope that such be the case.

The Minister took those cards off them.

We are over time.

In these cases, it is a matter for the clinician-----

At the same time, the clinicians are saying it.

-----to prioritise, on his or her expertise, who should be treated next.

They have. They cannot see anybody until 2015.

I am sure Deputy Martin does not expect the Minister to start taking funding away from other priority cases, such as cancer or leukaemia-----

I am not saying that.

-----that are deemed by clinicians to be urgent as well.

I am sure the Deputy is not asking for that.

No.

Seventy cases are being dealt with: 50 in Galway and 20 in St. Vincent's on a priority basis.

Some 200 are on the waiting list. Patients will die.

If the service is community-based and hospital-based, I am sure that the specialist information and expertise from the clinicians is available to those patients who are going to need these operations in due course.