Enda Kenny (Mayo, Fine Gael)
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I congratulate the Tánaiste on her appointment as Minister for Health and Children. Many within her own party have hailed the Tánaiste as some sort of Messiah come to resurrect the health service from complete disintegration. The Tánaiste is an experienced politician and I am sure the House wishes her well in her endeavours to restore a health service that the people deserve, but how can we be sure this is not just another false dawn?

If the Tánaiste wants any sobering reading in this regard, I recommend today's ESRI report which gives an independent snapshot of our health care system in the eighth year of this Government. In a comparison of 22 national health systems using three established performance indicators, Ireland came last and second last in two areas. Ireland had among the highest levels of alcohol consumption, is at the bottom of the league for childhood immunisations and is joint last with Japan in non-medical factors. Ireland ranked second last in health outcomes such as heart attack rates, cancer and suicide.

This country has the highest rates in the OECD of male and female mortality for heart attacks and is ranked "poor" for potential years of life lost due to female breast cancer. Ireland also ranked 14th out of 22 in the analysis of health status. We scored very poorly on infant mortality and our life expectancy figures from birth for both men and women was in the bottom one third of the countries surveyed. The Government is now in its eighth year and has spent €44 billion on the health service but the ESRI report suggests that the achievements have been almost negligible and are certainly nothing to boast about.

In the Tánaiste's analysis of her first week in office as Minister for Health and Children, can she give the House three targets she expects to achieve in the next 18 to 24 months? For instance, will the broken promise of the delivery of 200,000 medical cards be honoured? Will we see an end to waiting lists during her tenure of office and does she expect to end the chaos in accident and emergency units throughout the country? Will she give us three tangible targets by which we can set performance indicators?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I thank Deputy Kenny for his good wishes and assure him I am no Messiah. There is no magic wand and I have no silver bullet.

Pat Rabbitte (Dublin South West, Labour)
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Where is the Messiah?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We cannot continue to put more and more money into the health services without serious reform, a fact everyone in the House acknowledges. The good news is that we have more nurses per capita than any other country in the OECD, although they and other health workers do not come cheap. In order to meet benchmarking and salary increases next year, we will need an additional €500 million.

One of the priority areas is accident and emergency units. It is unacceptable that people have to spend upwards of 12 hours on a trolley before they are admitted to a bed in an acute hospital. Allied to that are step-down facilities for the elderly, many of whom are in acute hospitals because there are no alternative services. A second ambition of mine is to reduce waiting lists. In that context, the national treatment purchase fund is making a major impact having treated 19,000 people to date. I want to continue to fund and support that, perhaps by extending its remit, because it is having a major impact through the use of facilities in the independent sector in Ireland and elsewhere to treat patients who have been waiting a long time.

A third priority area is the extension of the income thresholds for medical cards, which we all accept are too low. I cannot give commitments in regard to numbers but it is important that we concentrate on income thresholds, which I will make a priority. I also intend to prioritise oncology services.

I hope that in two and a half years we can make major achievements in those four areas as well as in health promotion. Ireland's health spending since 1997 has been double the OECD and EU averages. When spending is combined with outcomes such as dependency on alcohol, as Deputy Kenny acknowledged, suicide, cardiac disease and so on, the ESRI's combination of findings puts us in the position reported today. It is the Government's top priority in the next two and half years to accompany additional resources with radical reform.

Enda Kenny (Mayo, Fine Gael)
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In respect of the Tánaiste's answer on accident and emergency departments, will she publish a benchmarking system so we can know of increased performance according to length of stay in accident and emergency departments? Will she publish a benchmarking system in respect of those waiting six hours, eight hours, ten hours, 12 hours or more?

In 2001, the Government promised more than €1 billion over ten years for the primary care sector. Only €16 million has been spent in this area. The Government still refers to ten pilot projects when we were told that there would be 600 delivered by 2012.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's minute has concluded.

Enda Kenny (Mayo, Fine Gael)
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I could not have not used my minute yet. I am not sure what stimulant the Ceann Comhairle is on today, but a minute does not go that quickly.

The budget for mental health dropped from 11% to 7% last year. The task force report on suicide is critical. Travelling the country, I heard the advertisements broadcast nationally for breastcheck, which are very good advertisements. The advertisement states that the procedure is perfectly confidential, safe, takes twenty minutes and provides a phone number. It goes on to state that it is only available in the east and in the midlands. Women in every other area suffer the trauma of hearing these advertisements about saving lives, yet they themselves are not in a position to avail of this very necessary service. Perhaps the Tánaiste might look into that as a matter of real urgency, not just for the facility, but for the business of systematic breast service facilities.

All of this was put into perspective for me yesterday by a man who stood in my own office in Castlebar, with a bag of blood and urine attached to his leg. He was on a nine year waiting list for urology services in the Mayo General Hospital and he will also have to wait 18 months before the consultant in Galway will be able to see him. When one talks to someone like that, one can understand the urgency, the fright and the trauma of what they have to go through. One can understand how badly people feel when they know that €44 billion has been spent in the past ten years. A hard-working man now has to go around like a cripple and feels he is going to die, yet the consultant cannot see him for 18 months. That is what the Tánaiste has to deal with. I will support her in many of the measures she has to implement, as the patient's interest has to be put first. We will not allow a system to be removed from people; we want a health system that is close to them and operates based on their need as distinct from what they have got in their pockets.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I thank the Deputy for his support in the case in Mayo. I do not know if it is a suitable case for the national treatment purchase fund. One of the issues surrounding accident and emergency is the lack of data. I have asked for patient data to be made available over the next two weeks as it is not collected at the moment. This is so that we can know the kind of cases with which we are dealing, the frequency of visits and so on. Tomorrow afternoon, I will meet the CEOs of all the Dublin hospitals regarding accident and emergency services. Suffice to say that this is a priority for me, for the Government and for the country. I appreciate the support the Deputy is offering. I know he cannot support me all the time, but I appreciate the spirit in which he offers that support.

Pat Rabbitte (Dublin South West, Labour)
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Like Deputy Kenny, I wish the Tánaiste success in the health portfolio. She has set out three priorities and I do not dispute them. It is urgent that they be dealt with after the many years of drift. Deputy Kenny referred to the publication of the ESRI report today, and to the fact that we are second from the bottom of 22 OECD countries in comparative performance on health status indicators. This means the general health of the country, as compared to those countries, is second from the bottom.

Specifically on the mental health services does the Tánaiste appreciate that as a total percentage of the health budget, we now spend just over 6% of the total health budget compared with 11% in the 1990s? Does she agree that the mental health services are the Cinderella of the health service? What is the status of Government policy following the announcement of her colleague, Deputy O'Malley, in respect of the sale of public lands surrounding 14 psychiatric hospitals in the country and the commitment that that money will be ploughed back into the psychiatric services? Is that Government policy? Has the Department of Finance or the new Government stopped it? What is the status of it? I ask this because of a particular case in the Tánaiste's constituency, where €31 million has been realised from the sale of lands around St. Loman's. A commitment was given that it would be used in an area that has the poorest provision of psychiatric services per capita in the country, although it has the highest clinical demand. I speak of community areas four and five. The sale of the lands realised €31 million, but only €15 million has been dedicated to the psychiatric services. How can that be reconciled with the announcement with much fanfare during the summer, of the transformation of land assets into what the Minister called health assets, specifically for the mental health services?

Mary Harney (Dublin Mid West, Progressive Democrats)
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More resources into mental health is a priority. We have to ensure that people who require institutional care live in the best possible circumstances. Among the issues I would like to see dealt with is the situation regarding the Central Mental Hospital. All of these issues require resources, including the removal of people with intellectual disabilities from mental health institutions. The intention is that any resources that can be found from the disposal of assets would go into that area. We need to carry out an audit of what we can generally sell in the country. There are quite a number of properties currently in the possession of health boards, soon to be in the possession of the HSE, that will not be required for health related facilities. I would like to see those disposed of in an orderly manner and the resources raised put into health care, including mental health.

There is one proviso. We also have commitments on social and affordable housing. Each Department was asked some time ago to provide sites for social and affordable housing. We have to marry a number of different priorities. As far as I and the Minister of State at the Department of Health and Children, Deputy O'Malley are concerned, we have to put more resources into the development of modern state-of-the-art facilities in the mental health area.

Pat Rabbitte (Dublin South West, Labour)
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The progress on social and affordable housing has been weak. The Tánaiste should consult the Minister for Justice, Equality and Law Reform; I notice he is making considerable progress in one-off housing down the country.

Can the Tánaiste please deal with the question? Is it Government policy to sell off the land surrounding the psychiatric institutions and to dedicate the money to the development of the psychiatric services? That is the specific question. The Tánaiste said she would like to see them being sold off and the resources dedicated to the mental and general services. The Minister of State made a clear announcement and what I am trying to establish is whether it means anything. Is that the purpose for which the lands will be sold off? I gave the example of St. Loman's, where €31 million was realised in the sale and €15 million was dedicated to the services. Why was that the case? Will the Tánaiste do something about it? I cannot believe that seven and a half years later, we are talking about doing an audit. There was no audit done when religious lands were sold off. On the other hand, the Minister of State at the Department of Finance, Deputy Parlon, has had no difficulty in purchasing lands all around the country for a decentralisation programme more realised in the imagination than in reality. We are to do an audit seven and a half years later. That really is not good enough when people are suffering deprivation in the psychiatric services area. A report, The Stark Facts, produced by the Irish Psychiatric Association shows that resources, including clinical resources, are concentrated in areas that are least deprived. In terms of a service regarded generally as the poor relation of the health services, the areas most deprived of psychiatric services are the poorest areas in the country.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I call the Tánaiste to reply.

Pat Rabbitte (Dublin South West, Labour)
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Do we know what is Government policy on this matter? I know what the Tánaiste would like to do. I do not question her good motivation. What is Government policy on this matter and when will it be implemented?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Specifically in regard to St.Loman's, I am not in a position to advise the Deputy what happened to the missing €15 million from the mental health area, although perhaps I can check that.

The overall policy is that any sale in the health area that can be made should go generally into health, with one proviso in respect of social and affordable housing. My Department, like every other Department, has been asked to come forward with land that may be suitable for social and affordable housing. To the best of my knowledge, there is no formal Government decision in regard to this matter, but that would be the intention. As far as audits are concerned, it will not be a long drawn out audit, but in the Department of Heath and Children we do not have a piece of paper that indicates what lands may be available to be disposed of over the next year or 18 months. It would be very useful if we knew what we could dispose of with a view to putting the money into health care.

Pat Rabbitte (Dublin South West, Labour)
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What did the Minister of State, Deputy Tim O'Malley, say?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I think he was talking about specific pieces of land.

Pat Rabbitte (Dublin South West, Labour)
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No, he announced in respect of 16 psychiatric institutions——

Joe Higgins (Dublin West, Socialist Party)
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I want to raise a number of issues concerning people originating from outside the European Union now seeking refuge and shelter in this State on humanitarian grounds. The Tánaiste told the "Gerry Ryan Show" on Tuesday last correctly that a hard line should be taken against the atrocity known as female genital mutilation, also called FGM. Will she consider making FGM and the threat of this barbarism grounds for getting refuge in this State? Will she intervene with the Minister for Justice, Equality and Law Reform to give humanitarian leave to remain in this State to Juliet Imiruaye, a victim of FGM, a campaigner when a midwife in Nigeria against FGM, and in the five years she has been in Ireland a woman who has contributed extensively to that campaign, against whom now unfortunately a deportation order has been made? It is reported in The Irish Times today that there is a slight window of opportunity. I ask the Tánaiste to intervene in this regard.

A further cohort of parents of Irish born children, born before the Supreme Court judgment and the constitutional referendum on citizenship, are in an awful limbo, daily facing the anguish of uncertainty which extends to their many supporters and friends, Irish born, in the community.

I know the Minister for Justice, Equality and Law Reform has much to occupy his mind over the next week. If he goes to Roscommon for the weekend he may be obliged to sit in his tent wrapped in his sleeping bag as he has no permanent roof there. Will the Tánaiste ask him if he will concede to those who do not even have one home humanitarian leave to find that home with their children in this country?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I very much share the Deputy's view in regard to female genital mutilation. I have spoken to the Attorney General about this matter and he assured me that it is covered under the Offences Against the Person Act. I have spoken to the Minister for Justice, Equality and Law Reform in regard to Juliet Imiruaye and he has agreed to give her a stay of six months while he reviews the case. I very much hope as a result of that stay of six months and the review he will be in a position to allow her to stay on humanitarian grounds because she has made a major impact in Ireland in regard to this issue.

Joe Higgins (Dublin West, Socialist Party)
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That is a very positive development. We would be a disgrace in front the nations and peoples of the world if we were to deport a woman in Juliet Imiruaye's position.

Will the Tánaiste elaborate on her last comment on whether she also appreciates the particular case of some thousands of people with children who are Irish citizens who were advised quite solidly by the legal profession and others to withdraw their application for asylum on foot of a hope of residency before the Supreme Court judgment? They constitute a category that needs urgent intervention. The ESRI or other reports that have been published in the past week indicate that these people's labour will certainly be needed here. Their situation requires particular intervention. Will the Tánaiste positively consider their position?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The more general question is more appropriate to the Minister for Justice, Equality and Law Reform. The legislation that is required on foot of the referendum will come to the House shortly.

In regard to the specific case, because of the contribution Juliet made in regard to this issue and the contribution she has made in regard to health services generally and given that she asked me to intervene, I was very happy to do that on her behalf.