Minister for Health James Reilly is facing fresh questions within the Government over his command of the portfolio after declaring he will not realise €108 million in pay savings required in this year's budget.

Although the spokesman for Taoiseach Enda Kenny said Dr Reilly remains bound by the Haddington Road pay agreement, he said the difficulties set out by the Minister illustrated the extent of the challenge he faces to assert control over expenditure in the middle of an overhaul of the health service.

However, Dr Reilly's assertion on Monday and reiteration yesterday that the budget requirement for €108 million in pay savings this year was not achievable is seen at high levels within Fine Gael and Labour to have further undermined his authority.

"We are stretching to find the last €78 million, but the other €108 million is clearly beyond our kin and has to go back to the whole of Government to consider," Dr Reilly said at an event at the Mater hospital, Dublin, yesterday.

No decision
Although work is separately under way to recast the ongoing review of the discretionary medical card scheme, the Taoiseach's spokesman said no decision has been taken in respect of the savings originally foreseen from the initiative.

With medical card entitlement a major issue in the local and European elections, Minister for Finance Michael Noonan said it was clear that changes were required.

“Obviously the approach to the review of medical cards will have to changed. We’re not going to do it before the election because we’d be accused probably of some kind of stunt,” Mr Noonan told reporters.

“But shortly after the election that issue will be addressed and some preparatory work has been done already.”

Dr Reilly said he understood the pain and distress the removal of medical cards was causing and “a number of options [were] being considered”.

In question, meanwhile, is whether Mr Kenny moves Dr Reilly from health when he reshuffles the Cabinet in the wake of the elections on Friday.

In particular, many on the Labour side of the administration are deeply unhappy with his stewardship of the health portfolio. Savings not made in health would have to be found in other departments if a supplementary health budget is to be avoided.

The Minister's remarks on pay savings prompted Fianna Fáil to say he had set out an "untenable" position.

Unachievable
"The fact is that Minister Reilly is continually presenting health budgets that have no basis in reality. He is now asking his Cabinet colleagues to find that unachievable €108 million from their departmental budgets," said Fianna Fáil health spokesman Billy Kelleher.

Mr Kenny's spokesman said the health budget was not discussed when the Cabinet met yesterday. "My understanding is everyone is bound by Haddington Road. I haven't spoken specifically to the Taoiseach on the matter," he said.

Signed off
At a Fine Gael campaign event yesterday in Dublin, Mr Noonan said the Government was told at the time of the Haddington Road talks that health officials had signed off on the agreement.

"It's principally an issue for Brendan Howlin in the first instance. Brendan is the Minister for Public Expenditure and Haddington Road was negotiated by Brendan Howlin," Mr Noonan said.