James Reilly (Dublin North, Fine Gael) | Oireachtas source

The Deputy has made his point and making it ten times will not change it. Deputy McLellan talked about job cuts. People are leaving the service. In some instances they are not being replaced, in others they are. Last year we employed approximately 700 nurses. The moratorium is being done in a flexible way. We must change the skills mix. I have said it many times. We have consultants doing work that GPs could do, GPs doing work nurses could do, nurses doing work that health care assistants could do, and all of them doing work that allied health care professionals such as physiotherapists and occupational therapists could do. Just because a few nurses leave it does not mean they need to be replaced. It might be more appropriate to replace them with a health care assistant or physiotherapist. We also want to change the way we do general practice. Before the colorectal cancer screening service came in, only consultants did endoscopies; now they are done by advanced nurse practitioners, who are perfectly able to do them. It is about thinking outside the box and doing things differently, because if we continue to do things as we always have, we will end up with the same problem.

Deputy Seamus Healy raised the issue of agency costs. This is the third time and I fully acknowledge that we said we will get back to him. We will do it, but there is a difficulty. Globally the cost of an agency nurse is slightly less than a full-time employed nurse because of superannuation, sick leave, maternity leave and everything else. A non-consultant hospital doctor, NCHD, is more expensive, but not three times or twice as expensive. They are approximately 20% to 40% more expensive because I have to get the correct grade. A first, second or third year senior hospital doctor, SHO, or a first, second or third year or a specialist registrar are all paid different salary scales. We are trying to get that out of the system, which is proving a little difficult.

We have covered the specific medical card issue Deputy Seamus Healy raised. More generally, at the end of 2013 there were 2,018,162 medical cards and GP cards. That is more than ever before. In 2013 we expected it to go to 2.1 million. In 2014 we expect it to go to 2,277,845. We are extending the number of people who can avail of free GP care year on year and we will keep doing that until all our population is covered. That is a commitment from this Government to achieve that by 2016. I am not saying it will be easy. There will be tough negotiations with the Irish Medical Organisation, IMO. In fact, it will be consultation, because under competition law the IMO is prohibited from negotiating. That does not mean we cannot consult them and talk to them about the shape of a new contract that would meet the needs of their patients and support them in the excellent work they do. I have made the point that it is an income-based scheme, not a disease-based scheme.

Later tonight I will make a statement on outpatient waiting times. It will represent real improvement in the figures people have been bandying about over the last number of weeks. Orthopaedics is a problem area. We did not reach our target but we will put a plan in place to ensure we do this year. I promised we would try to ensure nobody waited longer than 12 months for an outpatient's appointment having seen his or her GP. Only in March were we able to validate the full extent of the numbers, 386,000, more than 100,000 of whom waited longer than a year. Despite the 8% growth in population and 10% reduction in staffing levels and a 20% reduction in the budget, members will be very happy to see the improvement that has been made. I do not have the figures here now. They are being finally validated to ensure we are not misleading anyone. In certain areas we did not reach the target and I am very happy to highlight them because I am not in the business of spin or perception but reality, because reality is what our citizens have to endure, so spin does nothing for them.

Deputy Neville mentioned the €35 million. He is right, many of the posts were not filled in 2012, but virtually all of them were filled in 2013. Many of the posts from 2013 were put in place and we are continuing to fill them. Some of them are highly specialised and it is difficult to pull people into the service. Many people who retired were in the mental health sector because, like the gardaí, they can retire at 55 because of the stressful nature of the job. Recruitment of a further 477 posts funded from the 2013 allocation has been slow to date but, as indicated in the 2014 plan, the posts and other developments relating to 2013 allocation of €35 million will continue and is targeted to be completed in the next quarter in 2014. At the end of November 2013 the recruitment process was complete or in the final stages for 395, or 95%, of the 414 posts approved in 2012.

We hope to catch up this year on the slow start. We surpassed what we sought to achieve for 2013 of itself by moving through many of the people. As part of the overall 2014 budget of €765.8 million, an additional €20 million has been ring-fenced this year for 250 to 280 posts in mental health services in line with the programme for Government commitment. The other €15 million will be made available next year. It is not as fast as Deputy Neville would like. He has always been concerned about this area. It is not as fast as I would like, but the recruitment has been problematic in certain areas. Many of the posts are not nursing posts but ancillary posts such as psychologists, counsellors, etc.