Mary Harney (Dublin Mid West, Progressive Democrats)

The recruitment process will take place this year. As the Deputy is aware, it sometimes takes a while to carry that out. Recruitment for some posts has been taking place, but it is intended to recruit the consultants. The cost of new consultant posts must come from a reduction in the amount of money we spend on non-consultant hospital doctors, of whom we have 4,900. Deputy Reilly made the point earlier that doctors should not work such long hours. I mention in passing that the overtime bill was €347 million and the allowances negotiated in various negotiations amounted to €700 million. The total for both is €1 billion. Clearly, people cannot be paid more for working fewer hours than they were paid for working longer hours and that is the issue currently being negotiated through the industrial relations machinery of the State.

I will get the information the Deputy requires on the €4 billion. Some 78% of the money spent on health in Ireland is from the public purse, at €16.2 billion, while 22% is private. That includes, in addition to the VHI, the other insurers — the Garda, the ESB, Hibernian and Quinn. It also includes people who pay fees to their general practitioner, money paid for drugs and a host of other things, such as outpatient charges, etc. However, I will get the data for the Deputy on the matter. I do not have it to hand.

With regard to Deputy O'Sullivan's question and the reconfiguration of hospitals, even if there was no extra money available, this must happen. It is a patient safety issue and a priority. The manner in which we organise the delivery of acute hospital services does not deliver safe care to patients. Approximately two weeks ago, I said in the House that we are moving to a scenario, on foot of the recommendations from the patient safety commission, where all health providers, beginning with the acute hospital sector, will require licensing not just for the hospital, but also for the activities within it. We know that no licensing system would licence many of the activities in our hospitals because we are not in a position to deliver quality care given the configuration of our acute hospital services. Therefore, we are moving to a scenario where hospitals will be networked together with a specialist hospital at the centre and the less acute activity happening in the smaller hospitals.

This is the model of care that will be replicated around the country. It is the only model of care that can deliver safe care. It is happening very successfully with breast cancer, where 60% of the transition has now occurred. The rest will occur this year. This has been highly successful and great credit is due to Professor Keane. As he said to the Cabinet sub-committee, which I mentioned publicly last night, when that happens, it will put Ireland in the top three countries worldwide as far as the organisation of breast screening and breast cancer services are concerned. We must emulate that with lung and prostate services and move on to colon and colorectal screening and so on.

With regard to Mallow, the HSE must submit a revised service plan to me for that hospital. I wrote to the chairman of the HSE in the past week in response to his letter and asked for a response. However, in advance of the Government's determination, in the context of the forthcoming measures to be brought to the House in early April, clearly they are not in a position to finalise the changes that might take place until we see the actual scenario. As I said at the outset of my comments earlier, we are premature to the extent that there will be budgetary changes on spending and taxation brought before the House in three weeks time. Clearly, health, given it accounts for 25% of budgetary spending, will be affected.

The effects of the growing level of unemployment on both the levy on the appropriation side and the medical cards on the cost side will be considered by the Government, but in advance of any Government determination, which has not happened, I am not in a position to deal with that issue here.

We are not discussing the closure of hospitals but the reconfiguration of hospital services around the patient safety agenda.

See this speech in context