Government members complained when David Cullinane (SF) said he was taking the opportunity to tell Minister for Health James Reilly to his face that he should resign.

“I don’t believe you are fit to run our health services,” Mr Cullinane told the Minister during a debate on the Health Insurance (Amendment) Bill.

Colm Burke (FG) interjected that Mr Cullinane’s comments were not appropriate to the matter under discussion. John Gilroy (Lab) said he hoped Sinn Féin was not attempting to import into the Seanad the disgraceful behaviour it had exhibited in the Dáil.

Acting chairman Terry Brennan (FG) ruled that Mr Cullinane had strayed beyond the Bill’s contents. Later, when the Minister sought to respond to the resignation call, Mr Brennan said he had to apply the same non-relevancy rule.

Contributing to the debate on the Bill, Feargal Quinn (Ind) urged the Minister to canvass opinions from Singapore on health provision reform. That state had achieved beneficial outcomes for well under the level of expenditure here, he said.

A reported change of policy by the HSE to restrict access to common surgical procedures represented “crazy economics, crazy medicine and administration gone mad”, John Crown (Ind) said.

It was apparently being proposed that general practitioners refer fewer patients for possible surgery involving hip replacements and removal of skin abnormalities, among other treatments. This State had the smallest number of surgeons per head of population in the western world, with the result that waiting lists had ballooned. “Chillingly, in a country where the incidence of malignant melanoma and the mortality from it has doubled between 1998 and 2008 they are also talking about curtailing people being referred for assessment and removal of skin lesions. I am very troubled by this.”

Responding, Dr Reilly said that, as someone who had practised medicine for 25 years, “there is no way that I would remove the clinical decision-making from the clinician”.

The continuing refusal of the British establishment to investigate itself could lead only to the conclusion that solicitor Pat Finucane had been murdered “at the behest, with the acknowledgement and with the approval of senior people in the British government”, Mark Daly (FF) said.

It would be useful to consider enlisting the support of US secretary of state Hillary Clinton in the efforts to get a public inquiry, Fidelma Healy-Eames (FG) suggested.