Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I will answer as many of the questions as I can. The Minister of State will take some and Mr. Tony O'Brien may wish to respond to some of the questions specifically put to him.

In regard to the emergency departments, I mentioned that I have visited about 14, two in the past five days. I visit with notice, at short notice, and also with no notice at all. What Deputy Billy Kelleher said is entirely correct. It is true that for any Minister going anywhere, not just to hospitals, he will know from his experience that there will be people who will put the best foot forward and they want to make things look their best. One will also find the opposite. There will be people who will turn up who have a particular problem or a particular issue and know the Minister is coming and will want to confront him or her with it. I am wise to that. I am not so naive to think that people do not know when the Minister is coming and do not plan for it in their own way.

There is, of course, much variation in emergency departments, some are very over-crowded all the time with patients on corridors and in the middle of floors and on clinical areas, which is very risky. In other areas it occurs in cubicles and in private side rooms where at least there is a degree of privacy and people have access to monitors and medical gas and pretty much everything they would have on a ward. Of course, there are other departments where over-crowding only occurs at certain times and at certain periods. All 28 emergency departments are different. While we have done some of the generic things that can help everyone, such as turning over the fair deal more quickly and a few other things, we are at the point where we really need to have bespoke solutions for each different department because they all have different issues. About 11 different factors can cause over-crowding and they happen to different extents or not at all in different emergency departments. Once again, Mr. Tony O'Brien and his team are going around to those departments to see what can be done, not necessarily in the departments themselves but in the hospital and also with community services to ease the position.

I was very clear about the budget last year. It provided the first increase in seven years but it was based on the existing level of service and some improvements such as Hepatitis C drugs, GP care fees and a few other things. We also made it very clear - Mr. Tony O'Brien specifically pointed it out on the day - that the service plan published did not include, for example, provision for demographic demands. We did not hype it up. We made it clear on that day that there were certain risks. That question was specifically asked and answered honestly. We also pointed out that there were some savings that were going to be difficult to achieve and many of them were not achieved. We are still going to try to achieve them nonetheless.

However, things did change during the year and we decided to do more. The Irish Medical Organisation got a better deal out of us than we had anticipated on the under sixes that had to be funded. We decided to go ahead with the diabetes cycle of care to show that we meant business in terms of moving chronic disease into the community. The decision was made on the fair deal scheme. A decision was made on the winter initiative and also some new drugs appeared that turned out to be very expensive and they had to be paid for. These things can happen and they did. There will be a Supplementary Estimate as a result, in addition to unplanned overruns in other areas, but it is a combination of the two.

The additional beds being in place before the end of the year are funded to be in place from 1 November. Everything is being done to get them open by then. About 100 beds are closed at the moment for various other reasons, such as wards being renovated and so on, and we are keen to get them opened as soon as possible in October-November. They are in addition to the 300 extra beds that are being opened that do not currently exist. They are across about 29 locations. Sometimes they are in the acute hospital and sometimes in a district hospital nearby. Some 26 of those 29 are on track, three are delayed. It is inevitable when one is opening up new wards and new beds in 29 departments that three or four of them will run late. I can already say that the Deputy's prediction is correct in that not every single one of them will be opened. We will run into some issues somewhere, whether it is a building issue or a staff equivalent issue but the intention is to get them all open and they are funded to be opened from 1 November.

On the emergency task force implementation group, it is important to point out that it is no longer a task force but an implementation group. It will meet regularly but implementation is not going to be achieved at meetings in Dublin. Its purpose is to oversee implementation at this stage. Implementation has to happen on the ground in hospitals and in community services which are interdependent. I have every confidence in the staff on the ground that they will pull out all the stops to do everything possible to get us through the winter.

I was asked about universal health insurance. The position is that we have the research that has been done by the ESRI and KPMG on the costings in particular and also the outcome of the public consultation. I intend to bring that to Cabinet to publish it and, while publishing it, to outline the next steps towards universal health care, of which UHI is just one potential model.

In regard to the consultant vacancies, the 170 that I mentioned, pretty much all of those are covered by a locum. At the moment it is unusual to have an actual vacancy that is not covered by somebody and almost all of those 170 are covered by a locum. In addition, there are people in temporary posts and short-term contracts, that is, where people are taken on for a year or two years. They are not considered to be vacancies. People are on temporary or short-term contracts. That happens for all kinds of reasons to encourage people to take up a post or just to fill a vacancy where it is important to do so. That is not particular to consultants or the health service.

With regard to the facts on GPs, there are 2,300 GPs who currently have a contract with the HSE. That is a stable number and has been much the same for the past couple of years. The number of GPs on the Medical Council's specialist register is at an all time high. The number of doctors registered in the country is approaching an all time high at almost 20,000. For all the doctors that are leaving the country there is a greater number who are either coming in, coming back or graduating and that is often not appreciated in some of the commentary. Currently, there are about 20 vacancies for general practice posts, which is about a 1% vacancy rate, and there are particular difficulties in some rural areas and also in some urban deprived areas. Sometimes when people talk about a particular rural vacancy, the list has already been taken on by a GP in a neighbouring village or a neighbouring town, yet it is still referred to as a vacancy even though it is not going to be filled. It sits there on a vacancy list indefinitely. Maybe after a certain point, rather than just describing it as a vacancy we accept the fact that the area is being served by the neighbouring village or neighbouring town instead.

GPs are aging. That presents a very significant challenge in the coming years. Also we will need more of them if we are to extend GP care without fees to other children or if we are to bring more services into primary care. Therefore, we will need a significant increase in the number of GPs in the coming years. The number of training posts has been increased this year. As part of the contract discussions with the IMO, the first module is on rural practice and phlebotomy and the third module is on urban deprived areas. These are specific topics that are being negotiated with the IMO. It might not be a case of just going back to the incentives of the past, we may need a new set of incentives but it is a matter that is currently under negotiation.

Deputy Mary Mitchell O'Connor asked about other types of health professionals. Her question is very pertinent. We have health care assistants who do a very important job and do many things that nurses or orderlies would have done in the past. Beaumont Hospital is piloting what is called physician assistants who can do many of the things that doctors or doctors in training currently do. Other countries have theatre assistants that do many of the things that Irish theatre nurses do. That is something we need to explore and develop. It does cause concern as does any change in the health service. It causes anxiety when people see their jobs and roles being threatened, therefore it has to be done in a planned way and with sensitivity. Similar to interns, so far as I know, nurses have to stay for what is called their pre-registration year. It is not a full year, it is a certain period of time, but they have to stay for a certain period and I would not hold the view that we should impel any health care worker to have to stay in the country. Many other people are trained at the cost of the Exchequer and they migrate too for all kinds of reasons.