Séamus Healy (Tipperary South, Workers and Unemployed Action Group) | Oireachtas source

I welcome the Minister and his Department staff, as well as Mr. O'Brien and the HSE staff. I compliment the HSE staff throughout the country who provide services, as well as related staff, services and communities funded through this budget. They are under significant pressure and work above and beyond the call of duty on a daily if not hourly basis.

It is important that we understand that. We compliment the staff on the work they are doing under such pressure. This is the third year in a row we have been presented with an unsustainable budget and service plan. It is clear even at this early stage that additional funds will have to be made available later in the year, as happened last year and the previous year. The figures Mr. O'Brien has given indicate a reduction of €4 billion in funding from 2008 to 2014 and a reduction in staff numbers by 12,500. That means staff on the ground are under huge pressure. People find it difficult to be seen at outpatient clinics and to get into hospital. For the first year in a few years we have had an increase in the trolley count in emergency departments.

I seek clarification from Mr. O’Brien of the figures under discussion. What is the total amount envisaged in savings or cuts? It would appear from Mr. O’Brien’s submission that we are talking about more than €1 billion in cuts. I support the request by other speakers for an indication of what the sum of €108 million relates to. Mr. O’Brien said a number of times in his submission that the health service would not be able to meet all the demands placed on it. I would like him to elaborate on what he means.

The sum of €56.5 million relates to cost containment plans for hospitals. To what does the global figure relate? Reference is also made to savings of €7.5 million on hospital reconfiguration. Could Mr. O’Brien indicate to what that figure relates? Some chairpersons have been appointed for hospital groupings and CEOs are in the process of being appointed. Is there a timeline for the appointment of the boards?

Before Christmas I inquired about the cost of employing agency nurses and junior doctors. I would like to know the figure relating to agencies that is part of the plan. I am interested in hearing the cost of employing agency nurses and particularly junior doctors. I have not yet received a reply to the request I made before Christmas. I urge that there be a review of the central recruitment process because it has given rise to difficulties at local level right across the country. There is scope for local recruitment of staff given the evident difficulty at central level.

Probity and medical cards have been dealt with by previous speakers. There has been a change of policy with regard to the granting of discretionary medical cards. I see it every day in my constituency office and hear about it every day from colleagues on all sides of the House. There is no doubt that families who have held full medical cards for years are now losing their cards. They have been targeted and their cards are being withdrawn as we speak. That is happening on a daily basis.

In the course of his opening statement the Minister referred to medical card limits. The limits for medical cards have not been increased since 1 January 2006. They are now out of date. Furthermore, there was a reduction in the limits last year. Will the Minister reinstate the amount allocated for travel to work and home improvement loan entitlements for medical card holders? The former is required in particular where there is no public transport or very little provision. The withdrawal of the provision is most unfair. I urge the Minister to reintroduce such entitlements.

I welcome the commitment to community-based services such as home help and services for those with disabilities. I hope that what we see on paper will be evident on the ground in practice. I concur with other speakers on what has been said about mental health.