Mr. Tony O'Brien:

On the hospitals issue, and Mr. Ian Carter will also respond on this, in regard to hospital consultant recruitment, as the Minister said, the changes have had an impact to some extent on the bringing back of consultants who were in established or senior posts elsewhere and, as the Minister indicated, he intends to do something to support us in that. There has not been an overall generalised problem in regard to the recruitment of consultants. Competitions have been successfully concluded but it has always been the case that between a vacancy arising and a replacement being in post, there can be a significant delay. That is because of the recruitment process, the vetting process and the need for a colleague who is coming into our service to free himself or herself up, often with an extended notice period from elsewhere. There can be intervals of a year or more and sometimes that impacts on the capacity of a team of consultants in any given location to provide outreach services and sometimes they have to pull back in order to maintain the overall quality of service. While I am not speaking to the specific instances that the Deputy has raised it is not an unusual feature that from time to time they have to do that. Mr. Ian Carter may be able to comment further on that.

On the issue of billings, one of the key objectives we set for 2013 was to get to a position where, by volume and value, between 70% and 80% of claims throughout the public hospital system would be through claims sure system. As outlined in the answer, we have got to about 76% by the end of 2013. We have also significantly reduced the volume of claims that are pending submission. Unfortunately that seems to be matched by a corollary increase in the number of claims being pended for payment. While it is crucial for all of us that private health insurers satisfy themselves as to the validity of claims that are pending submission, because that follows through on to the overall cost of private health cover, which is a significant concern, it none the less remains the case that the vast majority of claims will ultimately be paid. We are currently engaged through Mr. Tom Byrne in a process with those insurance companies to come to a different way of paying. There should be no reason, given that all these claims are ultimately paid, that we do not have a majority of the payments made within 30 days. They will always owe us a sufficient amount but if individual claims are found not to be valid, they can be dealt with in the round as we would with any large training entity. It is also of concern that if the effect of the new legislation that I referenced earlier, which came into effect on 1 January, follows through, we will have an increased dependency. We are expecting €40 million more from private health insurance this year. If we continue to see long delays in payment and long pending times, that will have an increased adverse impact. Private health insurers are not subject to the prompt payment legislation, to which a public body is subject. Clearly, by negotiation and perhaps with ministerial support, as required, we need to bring them forward to a different way of doing business with us because it has an adverse impact on the overall performance of a health system.

Before I pass on to Mr. Ian Carter who will deal with issues related to the European working time directive and the use of the pressures fund, I wish to respond to Deputy Healy who asked me about the broader reconfiguration issue. It is important to stress that one of the recommendations from the HIQA report into the care provided to maternity patients in Galway last year was a recommendation for a strategic review of maternity services. One of the possible outcomes of that could be to examine the number of locations and the size of those locations. The minister has already referenced the Tallaght review which had a specific recommendation about the number of emergency departments - 24-7 - in the greater Dublin area, which by international standards is excessive and probably has an adverse impact on optimal quality and certainly could have an impact on costs. When we talk about reconfiguration, we mean that there will be changes in the way that some services are provided but they will be done following appropriate reviews and with reference to international evidence. It is not the case that by the end of this year or next year one would expect everything to remain as it is. That is not sustainable both from a quality and a cost point of view. I will pass over to Mr. Ian Carter to comment on the specific issues that relate to his area.