Jimmy Devins (Sligo-North Leitrim, Fianna Fail)

I move amendment No. 1:

To delete all the words after "Dáil Éireann" and substitute the following:

"acknowledges the continued increase in funding for health services over each year of the last decade and the associated expansion of a wide range of frontline services, including in 2007:

the allocation of over €15 billion across Health Votes in 2007, an increase of 11.35% over the 2006 level;

the increase of €245 million in services for older people, enabling the additional provision of step-down beds, long-term care, home-help hours, home-care packages and nursing home inspections;

the increase of €100 million for services for persons with a disability, including intellectual disability services, physical and sensory services, implementation of Part 2 of the Disability Act 2005 and a range of services within the mental health services remit;

the provision of €70 million additional funding in the acute hospitals sector, allowing for the opening of new acute hospital units, improvements in neurology/neurophysiology services, and a further €10 million for the national treatment purchase fund;

the provision of over €20 million for cancer control, including screening, acute services and research;

the additional €22 million in primary and social cohesion programmes, including funding to continue the investment in primary care teams, sexual assault treatment units and social inclusion initiatives; and

the continued commitment to the personnel management and development programmes with an additional €25 million, including funding for both medical and nursing training and education;

notes the high satisfaction levels with front-line health services shown in Insight 07, the most comprehensive, objective survey of public opinion on health services which was published last week;

reaffirms the statutory requirement that the Executive should manage its budget within the Vote approved by Dáil Éireann and acknowledges that the Executive has taken measures to ensure that it meets this objective in 2007, by means of its Breakeven Plan; and

notes that it is the intention of the Executive that these measures will not impact on planned frontline services, which will be maintained in line with the National Service Plan, and that provision is being made that where critical or essential vacancies arise, they may be filled by re-deployment of existing staff."

I wish to share time with Deputies Flynn, Dooley and O'Connor.

As a background to this debate, I will mention some positive aspects of our current health services. On life expectancy, according to the European Health For All database the life expectancy at birth in Ireland has increased steeply since 1999. In that year the life expectancy at birth was reported to be 76.12 years, while the latest figures for 2005 show it has increased to 79.59 years. This continuous increase for a six-year period seems to be unique in Europe. The latest life expectancy figures show that Ireland has closed the gap with the old European Union 15 member states and has life expectancy considerably higher than the new European Union 27 member states average.

A recent survey of customer satisfaction was the first large-scale representative survey of customer satisfaction undertaken by the Health Service Executive. The information from this survey can provide opportunities for learning which will assist the HSE in planning responses in areas which matter to the users of services and the results make interesting reading.

Generally speaking, there is strong satisfaction with the health care services by a majority of respondents and a high degree of confidence and trust in health professionals. Emerging from the results are areas which are positive for health service provision and the HSE. A majority of respondents were admitted to hospital in a timely manner. There is relatively little evidence of any GMS/non-GMS divide in experience as reported by respondents. The level of confidence and trust in the care received in hospital and community settings is rated highly. There is a public perception of good hygiene in health care settings, although there is an age effect evident, which suggests that younger users of the services are less tolerant of poor hygiene.

A majority — 78% of inpatients, 67% of outpatients, 86% of GP patients and 78% of other community service patients — expressed definite or complete trust in the health professional they encountered. Overall, rating their experience as excellent or of very good quality were 58% of outpatients and 84% of GP patients.

According to the OECD, health spending in Ireland grew in real terms by an average of 9.1% per year between 1999 and 2004. By comparison, the OECD average was 5.2%. Alongside Norway, Ireland has the highest level of public capital investment in health as a proportion of national income. At 0.6% of GNP, this is twice or more times the level of most OECD countries.

The public voted funding for the Health group, including the Vote for the office of the Minister of Children, is €15 billion for this year, an increase of 11.35% on last year. Expenditure on the health sector has increased almost fourfold since 1997 to approximately €15 billion for the current year. All service areas have benefited from this greatly increased funding.

In the past six years gross current funding for the health services, excluding the office of the Minister for Children Vote, has increased by over €7 billion to €13.9 billion in the current year. When account is taken of the increases required to fund items such as general pay increases, benchmarking and other pay awards as well as non-pay inflation and increases in drugs costs, approximately €2.5 billion has been provided for additional investment in services. The extra investment has provided for significant improvements in our health system across all the main service areas, including acute hospitals, primary care, disability, older people, mental health and child care.

Most activities have exceeded the target levels in the HSE service plan. This does not mean that all such activities have in turn exceeded their budgets. However, some services have exceeded their budgets. Therefore, Professor Brendan Drumm, as Accounting Officer, and given his statutory responsibilities to contain spending within the limits voted by Dáil Éireann, has implemented a breakeven plan. Specifically, the HSE has determined that measures in the breakeven plan should not impact on planned front-line services.

I will refer briefly to some of the points raised by Members of the Opposition regarding the acute hospital sector. I will refer particularly to the hospital in Sligo. The Health Service Executive has informed the Department that Sligo General Hospital is reducing temporary staff in some nursing, medical and catering posts. This does not involve any withdrawal of the core services provided by the hospital. The circumstances are specific to each staff category and I will explain these to the House.

On nursing staff, as in previous years, in the summer months additional temporary staff were employed, mainly to cover annual and other leave. Thirty people were employed on a temporary basis for this reason. This compares with a total permanent nursing staff of over 700 at Sligo General Hospital in whole-time equivalent terms.

On medical staff, four temporary consultant posts, which were contracted for specific temporary purposes and time periods, have recently come to the end of their contracts. These posts were in addition to the permanent consultant complement of the hospital, which is not affected and remains the same. In orthopaedics, one of the three permanent consultants was a member of the Medical Council until his recent retirement. To maintain full orthopaedic services a locum was employed while this consultant was away on Medical Council business. Following his retirement a new permanent consultant was appointed and has taken up full-time duty in Sligo General Hospital. Therefore, there was no requirement to maintain the locum position.

In obstetrics and gynaecology, one of the three permanent consultants retired in July last, his replacement having taken up duty prior to this. In order to ensure a smooth transition, the retiring consultant was contracted on a short-term locum basis following his retirement. This arrangement can now be discontinued and the specialty has its full complement of three permanent staff.

On surgery and ENT, a temporary additional consultant was employed in both of these specialties during 2006 to help reduce waiting lists. They were not intended as permanent appointments. The hospital has had the benefit of these temporary appointments in reducing waiting lists and seeing more patients. However, within its overall funding the hospital has to make choices regarding which service pressures most need to be addressed from time to time, and therefore it was decided by the management to discontinue these temporary contracts so that the funds could be used for other service priorities. For example, the recently opened neonatal intensive care unit, which provides a much better facility for newborns, required and received more nurses to staff it. However, I am pleased to state, as Deputy Perry outlined, that the consultants in general surgery and ENT will remain in position until the end of the year so that they can complete their necessary work.

On overall consultant staff at Sligo General Hospital, additional appointments have been made in paediatrics and radiology. Further consultants in emergency medicine, pathology and radiology have been approved, and a consultant neurologist will take up his post on 1 January 2008.

From what I have outlined, it is clear that these measures do not entail a reduction in the hospital's core services. Neither will they adversely affect the quality and safety of patient care. Every effort is being made to ensure the hospital's resources are managed in an efficient and effective manner to protect core services and activity, and to deal with emerging service pressures.

This year our health services are seeing significant increases in funding, staffing and patient services. That is the record so far, and will be the overall outcome at the end of the year. In this context, the Government is clearly committed to the provision of services at Sligo General Hospital. The HSE is fully aware that it must remain within the employment ceiling negotiated with the Department of Finance.

The strategy for the future of Galway's university hospitals allows for the continuation of the development of University Hospital Galway as the major emergency and complex treatment and tertiary referral centre for the region, while Merlin Park University Hospital will be developed largely as an elective hospital with planned interventions, rehabilitation, dialysis and outpatient clinics.

The decision to suspend recruitment temporarily was taken as part of a financial break-even plan developed by the HSE national management team to ensure it remained within its Vote for 2007. I emphasise the temporary nature of this measure. As Deputies may be aware, it was reviewed by the HSE national management team yesterday. Based on this review, the HSE has decided that the financial situation is such that it is necessary and prudent to continue the overall pause in recruitment to the end of October, after which the matter will be reviewed again. I emphasise the importance of appropriate budget management by the HSE.

Since 1997 the level of expenditure on mental health has trebled. This year approximately €1 billion will be spent on mental health services. This includes an additional €51 million which was allocated in 2006 and 2007 for the development of mental health services in line with A Vision for Change and for the implementation of Reach Out, the national strategy for action on suicide prevention.

This strategy was published in September 2005 and represents Government policy. The implementation of the strategy is a top priority for me and the Government. Additional funding of €3.05 million was provided in 2006 and 2007 which brings the total funding available to support suicide prevention initiatives in 2007 to €8 million. The funding is being used to complete the availability of self-harm services in accident and emergency departments. Self-harm services are in place in the vast majority of accident and emergency departments whereby in addition to medical care, people presenting with deliberate self-harm also receive a psycho-social assessment following which they are admitted to the treating hospital, to a psychiatric hospital or discharged. Another initiative is a national positive awareness campaign which will be launched next week.

A key component of Reach Out is to develop and implement national training programmes. The National Office for Suicide Prevention is engaged in a significant level of training including the ASIST, applied suicide intervention skills training, programme and has already trained 91 trainers and delivered over 200 two-day workshops to more than 5,000 people around the country.

Concern has been raised about the cancellation of these training courses. According to information available to me, three training courses have been cancelled with a view to being rescheduled and eight courses have been rescheduled. The national office is committed to the ongoing delivery of training which has the potential to reach and inform significant numbers of people.

In light of the increased information around suicide and self-harm it has been agreed with the National Office for Suicide Prevention that an interim target for a 10% reduction in suicide be achieved by 2010. In addition, a target has been set of a 5% reduction in repeated self-harm by 2010 and a further 5% by 2016. Deputies will agree these are ambitious targets but I am optimistic they will be achieved within the allotted timeframe.

Between 1997 and 2006, additional revenue and capital funding of €851 million has been invested in health-funded support services for people with disabilities, of which €549 million was provided for persons with an intellectual disability and those with autism and €302 million was provided for people with physical or sensory disabilities. An additional sum of €75 million for revenue purposes was provided for disability services in the 2007 budget. This sum incorporates the 2007 element of the Government's multi-annual investment programme for the national disability strategy, which is committed to providing some €900 million capital and revenue funding over the period 2005-09.

I am pleased to say dental services for children in Inchicore and Bluebell have not been cancelled. A vacancy arose for a general dental surgeon and this vacancy will be filled in early November. Dental services for children in the target groups of second, fourth and sixth classes will continue from that date.

An additional €255 million was allocated in budget 2007 towards improving services for older people and palliative care for 2007. This is in addition to the €150 million package that was put in place in 2006. In two years the Government had added in excess of €400 million to services for older people. Almost three quarters of this is being allocated to develop further the community-based services that help older people remain in their homes and for additional residential long-stay places for those who can no longer live in the community.

From 1 January 2007 there are no longer three separate rates for subvention. Persons who apply may receive any amount up to a maximum of €300 per week. Additional funding of €55 million was provided for this purpose in budget 2007. In addition to the increased rate of basic subvention, additional funding of €30 million has been made available in 2007 for enhanced subvention.

The Government has delivered unprecedented levels of investment in the health service. In the past six years gross current funding for the health service, excluding the Office of the Minister for Children Vote, has increased by over €7 billion to €13.9 billion in 2007. When account is taken of the increases required to fund items such as general pay increases, benchmarking and other pay awards, as well as non-pay inflation and increases in drugs, costs of approximately €2.3 billion have been provided for additional investment in services.

We must look to developing a system that provides a real incentive for good performance, by the HSE itself and all other service providers so that these major funding increases translate into visibly better services for patients, the most important people in the health service, and all service users across the country.

See this speech in context