Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

The HSE national service plan 2012 implements the continuing regime of cruel cuts begun by the Fianna Fáil and Green Party Government, and now continued by the Fine Gael and Labour coalition. This is a plan for the wholesale destruction of services across all sectors of our health care system. It is no wonder that the Government will do anything to avoid a referendum on the EU austerity treaty because this plan and the widespread cuts to vital services represent austerity in action.

When Minister for Transport, Tourism and Sport, Deputy Varadkar, insulted the intelligence of the people by asserting that a referendum would be undemocratic, he said it would focus on issues not related to the referendum question. Of course he and his colleagues know very well that a referendum debate will rightly focus on the cuts imposed by the Government because, if the austerity treaty is adopted, the State will be locking itself into an economic straitjacket that will mean years of further cuts to our services in health, education and social protection.

This service plan spells misery in 2012 and beyond for people who use our health services and the staff who deliver those services. These are the public health services on which we all depend, the public services that must still be provided while the private sector can pick and choose which services it will provide based on the profit motive. The health budget reduction of €750 million as a result of budget 2012 comes after the €1 billion reduction in 2011. The Minister for Health, Deputy Reilly, has claimed that front line services can be preserved through greater efficiency. This is directly contradicted by the plan which states "the bulk of the reductions that the HSE is required to deliver in 2012 will impact increasingly directly on frontline services".

We now know that 3,500 staff are leaving the HSE at the end of this month and we also know that there is no plan to ensure that the services affected by this exodus will not be drastically curtailed. The Minister for Public Expenditure and Reform has tried to portray the redundancies as almost a technical industrial relations matter. In truth this is all part of the drive to drastically reduce public services and the public pay bill in pursuit of the Government's doomed austerity programme. The key point is that the recruitment embargo remains in place, with some exceptions, and that this further and dramatic exodus from the public health services will deal a body blow to the provision of services to patients. The service plan states that it will have to be reviewed later this year depending on the numbers of staff leaving the service. In other words we may be prepared for more cuts later in 2012.

Again the plan contradicts the Minister's repeated assurances that front line care can be protected. The plan states that "efficiencies will not compensate for the loss of frontline healthcare delivery staff in such large numbers". The scale of these departures of staff from the HSE will mean a major blow to health services in this State. Front line services cannot be maintained with such a scale of redundancies. The loss of nurses in particular will mean a serious reduction in services for patients.

Meanwhile, as the 3,500 staff depart, the Minister has signalled his intent to tinker with the bureaucracy at the top of the HSE, but without reducing the 110 senior managers on annual salaries of more than €110,000. He should reduce these salaries and ring-fence all front line health service posts, lifting the recruitment embargo so that vital patient care can be provided. In his contribution earlier, the Minister stated that he intends creating consolidated management structures. I have no issue with less management given that we need more front line service providers. However, he did not say earlier when he would announce the hospital groupings.

Under this plan we face the loss of nearly 600 beds in public nursing homes which will be a devastating blow. I am certain that communities will increasingly resist these cuts of beds and the threatened closure of homes across this State. Last Saturday, along with Deputies representing all political views in this House, I addressed a rally in Ardee, County Louth, where St. Joseph's public nursing home is threatened with closure under this plan. The Minister has put public nursing homes of 50 or fewer beds on notice. They are told they are uneconomic and that they face closure. At a recent meeting of the Oireachtas Joint Committee on Health and Children, HIQA representatives confirmed, when questioned by my colleague Deputy Colreavy, that there are no inherent safety or quality issues with homes of fewer than 50 beds. This is purely a budgetary measure.

However, I believe it goes further. There is clearly a move to close public nursing homes altogether. The HSE can barely disguise its desire to abandon care of older people completely to the private sector. The current accelerated trend began with Loughloe House in Athlone in 2010. It has continued with other homes, including St. Brigid's in Crooksling, County Dublin, which has considerably more than 50 beds. The Minister has ordered a brief moratorium in that case, but the intention of the HSE to close it is very clear. It is a dangerous precedent that, if allowed to proceed, would spell the end of public nursing home provision in this State. The cuts imposed in this service plan can only accelerate that process. I remind the House of the statistics. From 2001 to 2010 long-stay public nursing home beds for the elderly dropped from more than 10,000 to just above 6,000.

During the same period the private nursing home capacity rose from well below 10,000 to over 20,000, supported by tax incentives.

Repeatedly, we hear the assertion from the Minister and others that the emphasis in care of older people is switching from residential care to care in the home. Yet, almost unbelievably, this service plan imposes cuts to home help hours. We are told this is only by 1.2% but this is coming from a low base with existing provision of home help totally inadequate to meet the need that exists. Given public nursing home bed closures, the pressure will increase to provide support for older people in their homes but this plan offers less, not more.

The attacks on services to older people range from complete closure of facilities to the meanest of cutbacks in existing services. For example, in the Minister's constituency the HSE is proposing to stop the preparation of cooked meals at Lusk Community Nursing Home and instead to transport meals from St. Ita's Hospital, Portrane, which will be reheated or refrigerated in Lusk. I believe this contravenes HIQA standards and I call on the Minister to put a stop to it and not to allow yet another such precedent to be set.

The same story of cutbacks is true for people with disabilities. The plan will impose reductions in day services, residential services and respite services. We all know that these services are inadequate as they stand and that there is a growing burden on people with disabilities and on carers. Much is made of the additional €35 million allocated to mental health, but last week at the Committee of Public Accounts the HSE chief confirmed to committee members that while he intends to take on 400 mental health staff, at least 500 mental health staff will leave the health service at the end of the month as part of the mass redundancy. In mental health, as in other sectors of our health services, the Government has no plan to address the loss of numbers, the loss of experience, the loss of skill and the inevitable gaps that will appear in the front line in this unplanned and arbitrary redundancy programme. I shudder to think of the consequences of this plan and of the mass exodus of staff from our acute hospitals. Every Deputy can cite examples in his or her constituency. Recently, management of Cavan General Hospital sanctioned cutbacks of 25% to its outpatient department staffing and it has begun radically reducing elective surgery at the hospital as and from last week.

Members of the Irish Nurses and Midwives Organisation said they were appalled that management drew up such plans in the absence of any consultation or discussion at local level. They said the plans will lead to excessive waiting times and the extension of waiting lists for patients in what is already an over-stretched service. The limiting and reduction of elective surgery at Cavan General Hospital will mean longer waiting lists and further unnecessary suffering for patients awaiting surgery. Late last year, we called for an inquiry into the disgraceful overcrowding in the accident and emergency department at Our Lady of Lourdes Hospital in Drogheda. Cavan and Drogheda continue to suffer and face a worse situation in 2012 thanks to this service plan.

Last October, I asked the Minister during an exchange between us if he agreed that more beds closed meant more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations. Deputy Kelleher referred to this earlier. The Minister replied: "I do not agree that more beds closed means more patients on trolleys and more people waiting". Then, I pointed out that in May 2010 some 33 beds were closed in Beaumont Hospital but the Minister stated in the House: "More beds closed means more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations". Those were the Minister's words. The record shows it and it stands. I make no apology for reminding the Minister and the Dáil of that contradiction and I will continue to do so.

Do the members of the Labour Party remember what their then health spokesperson, Deputy Jan O'Sullivan, said almost one year ago on 8 February 2011? She said in an interview in The Irish Times: "In the first months of government, we will lift the moratorium on replacement of frontline staff where beds or operating theatres are closed because of a shortage of nurses". There are people of conscience within the Labour Party and on the Labour Party benches in the House and I appeal to them to examine this service plan, to examine the austerity treaty and to ask themselves if this is what they wish to inflict on the people for the next decade and beyond.

When it was put to the Taoiseach last week that leading obstetricians held that the exodus of staff and the cuts would put lives in danger, the Taoiseach responded by portraying that statement as an attack on the staff who are leaving. Naturally, it was no such thing. Dr. Sam Coulter-Smith, Master of the Rotunda Hospital, one of the State's largest maternity hospitals, has stated that the hospital's midwife to patient ratios are already severely compromised. He told the Irish Examiner: "You reach a point when you can't stretch the service any further, and we are at that point now". He said he absolutely agreed with concerns raised by consultant obstetrician Dr. Gerry Burke, based in Limerick, that some women and babies may pay "with their lives" as midwives leave the service in droves. Dr. Burke had stated that St. Munchin's Regional Maternity Hospital in Limerick, which caters for more than 6,000 women and 5,200 newborns annually, will have lost 47 midwives from a staff of just over 200 through retirement.

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