Michael Creed (Cork North West, Fine Gael)

I welcome the opportunity to speak on the HSE service plan for 2012, in particular as it relates to my own constituency, Cork North-West, and the HSE South area. There is no doubt it is a challenging time to deliver health services, with a reduction of €750 million in funding for the HSE for 2012. However, it is a challenge which, with goodwill, we are capable of rising to. There will still be in excess of 100,000 staff charged with the responsibility of delivering a package of health services across critical areas such as community care, acute hospitals, mental health services and a host of other areas, including services for people with disabilities. If we can park the politics and point-scoring and address how we can use the very significant financial resource, we can do more with less funding, particularly if there is a willingness to do so across all areas of service delivery.

I want to particularly address the issue of care of the elderly, which is one of the issues that has received much media coverage recently. As a result, there is much anxiety among that section of the community about, in particular, community nursing units. I am glad there will be no closure of any of the community nursing units in the HSE South area, notwithstanding much public comment to the contrary from people whom I sometimes wonder might wish there would be closures so they could make more political capital out of it. I recently attended a meeting in Macroom on the issue of the local district hospital, and I am glad to say it will in 2012 continue to deliver, as it has in the past, an excellent service in the community it serves, as will other hospitals in my constituency such as those at Millstreet, Kanturk and Dunmanway district hospitals.

Notwithstanding this, there are critical issues we need to address. The fundamental issue is that it is cheaper for the State to buy beds in private nursing homes than it is to fund them under the current regime in its own hospitals. Interestingly, I received an e-mail today from the Impact trade union, as I am sure other Members did. The Impact e-mail made reference to the fact the Croke Park agreement was delivering and stated that one recent example has been finalised at Our Lady's Hospice, Dublin, where changes to rosters and breaks are expected to deliver annual savings of €220,000. The e-mail stated that the changes will free up 3.5 staff members to work elsewhere in the organisation, leading to an annual €175,000 reduction in spending on locums and agency staff, and a further €47,000 will be shaved from spending on premium payments which reduce earnings for staff concerned. Bravo.

The real challenge for the HSE management, however, is to get into the trenches. Why is this information from Impact newsworthy? It is newsworthy because it is not happening across the sector and is an isolated example. HSE management will have to get into the trenches in terms of negotiating issues such as overtime rates. It would be far better not to cut the amount of overtime hours and to instead cut the rates and protect the service. Premium payments, overtime rates, rosters - if all of these issues were addressed uniformly across the service, developments such as have happened at Our Lady's Hospice in Dublin would guarantee the future of public health nursing units throughout the country.

Given their cost base, such units are now under close scrutiny. I would encourage staff representatives, unions and management at local level to get into the trenches in terms of negotiating the cost base and ensure that these units are viable. It will not serve the public interest in the long run to place all of our eggs excessively in the private nursing home basket because once we have done that and closed facilities, we will be held to ransom by the private nursing home sector. It is an issue that needs to be examined.

We need to consider the appropriateness of placing people in long-stay facilities, whether private or public, given there are intermediary care options which are less expensive. The optimum solution for as long as it is practical is to keep people in their own communities. However, providing people with assisted living is capable of providing a far more cost-effective option to the State as opposed to inappropriately placing them in either community nursing homes or private-run nursing homes at greater expense to the State.

There is a challenge ahead in terms of meeting the reduced budget but it does not necessarily have to mean a straight line reduction in services across the board. It is a challenging time. I urge all sides, in particular union representatives and management, to get into the trenches in terms of ensuring that Croke Park delivers. Otherwise, there will be very harsh consequences for consumers of services as well as for those working in the service.

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