John Halligan (Waterford, Independent)
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3. To ask the Minister for Health his views on whether the current moratorium on recruitment within the Health Service Executive is negatively impacting on the provision of services across the spectrum and it is only a matter of time before the entire service is irreparably damaged; if the Health Information and Quality Authority has given its recommendations for minimum requirements regarding staffing levels; if he will make them available; his views on whether it is unacceptable that in a centre of excellence such as Waterford Regional Hospital the orthopaedic department has at times been running at less than 50% capacity with at least three of the surgical posts being unfilled which is exacerbating an already over stretched service and is resulting in waiting times escalating to years rather then months; if he will acknowledge that the orthopaedic department in Waterford Regional Hospital is now forced to set aside what are considered to be elective surgeries, although they are essential, as they do not have the capacity to maintain a full schedule for both in and out patient procedures; if he will make a firm commitment to review the moratorium and the effects it is having with a view to lifting the restrictions; and if he will make a statement on the matter. [48347/13]

John Halligan (Waterford, Independent)
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Last week, an appeal went out to the people of Waterford not to use the accident and emergency department in Waterford Regional Hospital because of overcrowding. I have been told that trolleys containing very sick people were double parked in the corridors of the accident and emergency department. Will the Minister offer an explanation as to why two Indian doctors posted to the accident and emergency department in Waterford resigned last week? I have been told the HSE and the Department of Health are aware of the situation. What are the Minister's views on why Indian doctors brought into the country since 2011 to bridge the serious gap in services are not being permitted to join the Medical Council's training register and hence they are not afforded the same rights as their colleagues from elsewhere in the world to progress their training?

James Reilly (Dublin North, Fine Gael)
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The first I have heard of this is today, as the Deputy will know. I have to confirm that, as of yesterday, Waterford Regional Hospital had its full complement of eight approved orthopaedic posts in place, including two on a temporary contracts. If the two doctors to whom the Deputy alluded are the two on temporary contracts, then that is an issue I can take up with him. I will have to talk to the Department. It is primarily a matter for the Medical Council which is a statutory body independent of the Minister, and rightly so. It has its standards to meet and match. We will have to look into the situation to see what the problem is.

On the broader issue, the reduction in the size of the public service has been an essential component of the approach to addressing the State's fiscal difficulties.

This has been combined with a firm focus on improving public service efficiency and effectiveness. The Croke Park agreement and the current Haddington Road agreement have enabled health services to be sustained and improved despite a staffing reduction of 11,000 whole-time equivalents, or 10% of all staff, since the end of 2007. I acknowledge the major contribution staff have made to meeting the unprecedented challenges of recent years and putting the State’s finances on a sustainable footing for the future. It is an incredible tribute to their dedication and commitment that we have not only maintained a safe service, but improved it in terms of the number of people who have to endure long trolley waits and long waiting times for inpatient treatment.

The Haddington Road agreement provides for some 5 million additional working hours each year. It also provides for the appointment of 1,000 nurses and midwives and 1,000 intern support staff under targeted employment initiatives. These measures will enable the health service to reduce substantially levels of agency working and overtime and continue to reduce overall numbers while maintaining services and service levels to the greatest possible extent. The HIQA national standards for safer and better health care identify the need for service providers to plan, organise and manage their workforce to achieve the service objectives for high quality, safe and reliable health care. HIQA does not set minimum requirements for staffing levels on a national basis. The Deputy will be aware that public hospitals are being reorganised into more accountable hospital groups. I am confident that the group structure will allow for more efficient deployment of human resources, facilitating effective and flexible use of staff, thus allowing for a better response to service needs.

John Halligan (Waterford, Independent)
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The potential exists for a very serious crisis in accident and emergency departments. I spoke last night to some consultants who work in Waterford Regional Hospital. They told me that the HSE and the Department of Health are sending a clear message to Indian doctors that they are sufficiently qualified to provide essential services in a time of crisis, but are not wanted in our hospitals in the long term.

I would like to put to the Minister two questions which are of importance to the people. We were happy to bring Indian doctors to work in Ireland and help us to bridge the gaps in our services. Were they adequately qualified to do the job? If they were, why are they not permitted to join the Medical Council's training register, as doctors from all other countries are allowed to do? I am concerned about the implications of giving doctors from Pakistan, Britain, France and all other countries considerably different treatment from Indian doctors. It has the potential to give rise to a crisis. I will conclude by informing the House that the consultants in Waterford Regional Hospital are sending a petition on this issue to the Indian Embassy today because they fear it could lead to a crisis.

James Reilly (Dublin North, Fine Gael)
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There is no crisis in this country's accident and emergency departments. When I met Mr. Ian Carter two days ago, he took me through all the hospitals' compliance with the European working time directive, their inpatient waiting time targets and their outpatient waiting time targets. I have had discussions with the special delivery unit, through one of my colleagues, on the emergency department figures. There has been a 34% reduction in the number of people waiting on trolleys since I became Minister for Health. That is despite a 10% reduction in staff and a 20% reduction in the budget. I reiterate my gratitude to the men and women who work in our health services for achieving that. The specific issue raised by the Deputy is primarily a matter for the Medical Council. I cannot interfere in it. There should be no different treatment for people.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you, Minister.

James Reilly (Dublin North, Fine Gael)
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Qualifications are qualifications. There are differences between reciprocal arrangements in different countries. I would like to make an important point about the doctors we brought in a couple of years ago, if the Ceann Comhairle will bear with me.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I will let the Minister back in.

James Reilly (Dublin North, Fine Gael)
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Okay. I will address it then.

John Halligan (Waterford, Independent)
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The stated objective of this country's health service is that "staffing levels ... should be driven primarily by the need to achieve optimal health and quality of life". HIQA has said that the standards at Ireland's maternity hospitals, for example, are 30% lower than the standards recommended across Europe. There are 4,000 people on the waiting list and there is a four year backlog at the orthopaedic department at Waterford Regional Hospital in my city. As I have said previously, the number of consultant staff in the department was reduced by 25% over a two month period this summer. I have gone out to the hospital on a number of occasions and seen patients on trolleys. When my 86 year old father was taken to hospital two months ago, he had to wait on a trolley for 14 hours before he was given a bed. I do not know who is giving the Minister his information but it is not the case that there has been a reduction in the use of trolleys in accident and emergency departments. If the Minister goes to some of our hospitals to look at the conditions there, he will see that the contrary is the case. I am reporting and recording what is happening at Waterford Regional Hospital, which is one of this country's major hospitals.

James Reilly (Dublin North, Fine Gael)
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On the last point, I respectfully ask the Deputy to look at what the average waiting time on a trolley was four years ago. People often waited on trolleys for two, three or four days.

John Halligan (Waterford, Independent)
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I accept that. I would not argue that point with the Minister.

James Reilly (Dublin North, Fine Gael)
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It takes a while to perform miracles. The impossible takes a little longer. We are making progress. I regret that the Deputy's dad had to wait on a trolley for such a duration. Our aim is to have 100% of people treated, and either admitted or discharged, within nine hours. We are also seeking to have 95% of people treated within six hours. Those targets are proving to be a real challenge, given the circumstances we find ourselves in. Having been in practice four or five years ago, I know that it was not unusual, sadly, to have people lying on trolleys for two or three days. That was certainly the case in Dublin. I am glad to say that rarely happens now. That is only proper. We will keep striving to meet the six hour target in 95% of cases. We want to ensure everyone is admitted or discharged within nine hours.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you.

James Reilly (Dublin North, Fine Gael)
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I was going to make a point about non-consultant hospital doctors before the Ceann Comhairle advised me that I would have a further opportunity to do so.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I was just applying the time rules.

James Reilly (Dublin North, Fine Gael)
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I know the Chair will indulge me a little. All of the doctors that were brought in on that occasion were heavily screened and interviewed by consultants from this country. They were of a very high calibre. The issue of training is one for the training bodies and colleges. Neither I or anybody else can interfere in the affairs of the Medical Council, which is an independent statutory body with a lay majority. I would have said that the council is judicially and legally obliged to treat everybody the same, as long as their qualifications are of a similar type and character. We do not have reciprocal arrangements with a number of countries and that creates difficulties. I am sure the Medical Council is working hard to overcome those difficulties. It is in everybody's interest that we would have as much uniformity of training around the globe as possible.