Charlie McConalogue (Donegal North East, Fianna Fail)

I welcome the opportunity to speak on the HSE service plan for the remainder of 2012. It is disappointing that only at this stage, on 1 February of the year covered by the plan, are we debating and discussing this service plan.

If we look at how the plan is drawn up, we see that following the budget each year, including this year, the HSE has three weeks with which to furnish a proposed service plan to the Minister for Health. After that the Minister has three weeks to accept and approve that plan. I do not find this a reasonable or sensible way to run a health service, when only in the month of January does the HSE sit down with the Minister for Health for his approval of its service plan for that very year.

There was the charade in the early part of January when the Minister referred back to the HSE the draft service plan it had provided to him, stating he was unhappy with it. This is the same Minister for Health who abolished the HSE board shortly after taking up power. He told us he was taking charge and things would be very different under him. We had the spin of the Minister sending the plan back to the HSE. As one journalist pointed out, very appropriately, it was like sending a letter to oneself to complain about oneself. It was no more than that.

This service plan would be better described as a service reaction, a HSE service reaction to the budget it was given in December when the Minister for Finance, Deputy Noonan, outlined exactly what would be available for services for the coming year. Rather than bringing in the budget and sending it to the HSE asking it to outline what it will do with it, a much more appropriate way would be to liaise and link closely with the HSE. I would expect that in the future - I expected it this year. It should not be so difficult, considering the Minister is not only the Minister for Health but has also taken over the running of the HSE board. He could then tease through with the HSE exactly which services can be delivered in the year ahead alongside the particular budget lines given by the Minister for Finance.

Instead the budget is made and the figure given to the HSE which is then expected to come back and say what it can do with the money. This is very similar to what we have seen in the approach to redundancies, for which the deadline closed yesterday. Instead of indicating clearly what was being sought, which Departments might be exempt and which areas of the service might manage with fewer staff, there was an across the board opportunity for anybody who wished to retire, regardless of whether the HSE or the Minister believed they were needed. The only exemption given so far was to the Director of Corporate Enforcement, yesterday. He has been kept on. That is not the way to reform but at least it is consistent with the way we have seen this service plan being drawn up and implemented in the past year.

What have we seen in this plan? We have seen €750 million cut from the health budget this year and 3,300 staff due to leave the HSE during the course of this year, on top of the staff who left last year. In 2012, hospital budgets will drop on average by 4.4% from last year's allocation. This will require an expenditure reduction of 7.8% in many hospitals where overruns are being taken from the previous year. The Minister states he expects activity levels to fall by 6% as a result while the HSE believes it can keep the figure down to 3% by reordering the way it provides service. Even so, we are talking about a 3% activity drop which means less service being provided and fewer patients being treated. An activity drop means more patients waiting longer for treatments they eventually will have to have but before which they must endure, in many cases carrying their illnesses and pains around with them while they wait for their treatment.

I had direct experience in my own county with the Minister as to how this measure will impact. Letterkenny General Hospital, which serves the wider Donegal area, is calculated by the HSE to be the second most efficient hospital in the country. Nonetheless its budget has been pared back. It is in a unique position in that 90% of the treatments it carries out are non-elective. In other words they have to be done and the hospital does not have discretion to decide on them. As the budget is increasingly pared back those treatments for which one might say there is discretion, such as hip replacements, orthopaedic care, outpatient appointments, are knocked back further and the patients concerned must wait longer.

In the past year we have seen, as each Deputy in this Parliament will have seen, that many patients in that category are now waiting longer than ever. Since the National Treatment Purchase Fund was done away with, patients who, until then, would have been able after three months to access that fund and have their treatments carried out, are now, in many cases, waiting more than a year. The Minister tells us he does not want anybody to have to wait longer than nine months. That nine months is three times longer than patients had to wait when the NTPF was available. I have no doubt that other Members will have had the same experience as I have, seeing strapped families having to come together to purchase private treatment for a parent or a grandparent who simply cannot wait any longer to have it done.

The budget will also affect community hospitals. Although the Minister told us at the end of last year that he did not want to see any community hospitals closed, shortly afterwards the first began to close. This year up to 900 beds will be taken out of community hospitals. As Deputy O'Donnell pointed out earlier, patient care will naturally cost more when beds are taken out of a hospital. Overheads will be similar but the number of patients is reduced. That is then used as a rationale for arguing it is cheaper to provide this service in private hospitals leading to the shutting of the community hospital entirely. It makes no sense to close any more beds in community hospitals. The Minister needs to revisit his decision in that regard.

Budgetary cuts are inevitable in our current economic environment. However, health and education must have first priority in protection from cuts. Will the Minister show us more of the evidence of how he is going to reform the health service? So far, all we have seen are longer waiting lists and hospital beds closed. Instead of everyone receiving universal health insurance, as the Minister claimed when he took office, fewer people have private health insurance now resulting in more pressure coming on to the public health system. I cannot support the health service plan 2012 and am disappointed with the results in health service reform so far.

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