I wish to ask the Taoiseach about legislation relating to health. Page 4 of the programme for Government states: "A system of universal health insurance will be introduced by 2016, with the legislative and organisational groundwork for the system complete within this Government's term of office." It is now April 2015. Can the Taoiseach confirm that legislative promise will not now be achieved and that the commitments will not be realised within the Government's term of office? Can he further confirm that universal health insurance, with a public or private insurer, will be compulsory with insurance payments related to ability to pay? Will that happen between now and the general election?

When can we expect the universal primary care Bill? Does the Taoiseach envisage it coming into being within the next 12 months? When can we expect the integrated care agency to be established? I have been pursuing this for quite some time and getting very little in the form of confirmation. It is more than four years since the programme for Government was published. It stated that investment in the supply of more and better care for older people in the community and residential sectors will be a priority of the Government. What has actually happened in the past three to four years are reductions. There have been reductions in fair deal allocations and in the number of home helps, many of whom only get half an hour or 40 minutes with the people they are looking after. We were told we would get more home care packages but we are getting fewer. We were told there would be a review of the fair deal scheme and we have asked time and again on the Order of Business for the publication of that review, or a timeline for its publication, only to be stalled every time. I would appreciate it if the Taoiseach would indicate definitively when we can expect the review.

On primary care, there remains a fundamental issue in terms of the extension of the medical card and access to primary care without fees for those who are chronically ill or have long-term illnesses. The programme for Government stated that access to primary care without fees would be extended in the first year to claimants of free drugs under the long-term illness scheme. It also stated that access to primary care without fees would be extended in the second year to claimants of free drugs under the high-tech drugs scheme and that access to subsidised care would be extended to all in the next phase, while access to care without fees would be extended to all in the final phase.

About four or five pages in the programme for Government are devoted to health. I have asked the Taoiseach on numerous occasions when we can expect all the proposals contained in this document to be realised. I have received long letters in response and the over-riding conclusion is that very little of it will be implemented before this Government's term ends. Would the Taoiseach accept that this is a sham, that the section pertaining to health in the programme for Government is completely illusory and that if someone came down from Mars, read it and compared it to the reality over the past five years, they would be left scratching their head? I have not even gone into bioethics. It is said that assisted human reproduction, stem cell research, post-mortem procedures, organ retention and organ donation and an opt-out system will be legislated for but none of this will happen. The patient safety authority is not happening. There is an obligation to at least commit to ditching these five or six pages because they are completely illusory and are misleading the public in terms of the rhetoric and the reality. Could the Taoiseach answer in terms of the specifics of the legislation about which I asked?

Universal health insurance will not be introduced in the lifetime of this Government. On taking office, the Minister for Health reflected very carefully on the timeframes set out for health reform. He pointed out last July that he determined that while good progress had been made in implementing health reform, the original timeframe for full implementation of universal health insurance was too ambitious. He pointed out that notwithstanding this, the Government remains committed to its major programme of health reform and plans to continue to press ahead with those main foundations for universal health care. This includes the phased extension of GP care without fees; implementing a number of key financial reforms, including activity-based funding; the establishment of hospital groups; and improved chronic care management. Hospital groups, primary care centres and the GP card system for children aged under six and people aged over 70 are part of the foundation necessary for universal health insurance in addition to the requirement for people to take out private health insurance based on age limits. This is all under way. The Government recently allocated €75 million for home care packages and the fair deal scheme in order to reduce the waiting list from 18 weeks to approximately five weeks. This seems to be working well. Obviously, we hope this is managed in the best interests of the patients.

The integrated care agency is part of the Government's commitment to reform of the health service. Future Health referred to the agency as the health care commissioning agency and this agency will be charged with driving performance improvement in health services through value-based purchasing. The Minister is reviewing how best to develop the structure that is required to replace the HSE - I know Deputy Martin's party now has a different view - including the question of a health care commissioning agency. Future Health set the broad direction of travel for reforming the health system and made it clear that an incremental, phased approach to implementation was taking place. This is just one of number of structural changes envisaged under Future Health. Others include hospital groups, community health care organisations, a health care pricing office and the commencement of activity-based funding. The Minister intends to build on these as part of the wider structural reform agenda. However, the complexity and scale of the issues to be addressed require detailed preparatory policy work to provide the basis for legislative proposals. The next incremental step in that process will be to develop policy on a health care commissioning model in an Irish context.

In respect of the review of home care, the HSE is progressing a range of measures to improve the position overall. Providers are monitored through service-level agreements with the HSE. They are supervised through local and regular operational meetings and the review of care plans for individual patients. The HSE is undertaking a full review of home care services with a view to improving services generally. This includes national quality guidelines, which will apply to all home support services, including those procured by the HSE from external providers.

If I have left anything out, I will respond to Deputy Martin.