Sandra McLellan (Cork East, Sinn Fein)

I welcome the opportunity to speak on a matter with far reaching implications. It is impossible to address the financial constraints within which this service plan was drawn up without mentioning the Government's economic policy. At least €750 million will come out of the HSE's budget this year, following two years in which a total of €1.75 billion was removed. Staff levels are down by over 8,700 since 2007, while demand on services continues to grow. This is happening even as the Government willingly pumps billions of euro into the cavernous remains of Anglo Irish Bank in an attempt to keep international onlookers satisfied that we can behave ourselves. We went mad all right, but just for a while. We hope and pray that a European recovery will raise all boats. It is subservient economics 101 and the population at large suffers.

The dance that took place to get us to this point is telling. Starting with the Minister's kite flying in advance of the budget, the rejection of the earlier version of this document and the early new year media intervention, it looked and sounded like damage limitation. The details of the plan indicate why damage limitation might be an appropriate course. It is a plan that is difficult to accept and even more difficult to believe. It contains a litany of ambitious targets, many of which are to be welcomed, such as those relating to efficiencies and performance. However, other targets will have a detrimental effect on the quality of life of thousands. In a year that will see €750 million taken out of the system, equating in some instances to a 7% or 8% cut, I wonder how the Minister, his Department and the HSE expect to achieve these targets. Sound bites about working faster, harder or better will not be enough.

The headline issues arising from this plan have been highlighted. It is clear that the heart will be torn from our public nursing homes. The plan states:

The challenges associated with the continued provision of residential care in public facilities as a result of staff reductions and the National Standards for Residential Care Settings for Older People in Ireland will lead to a continued reduction in the numbers of public beds in 2011. In the absence of reform, this would increase the cost of caring for older people within the public system, undermine the viability of public community nursing units, and reduce the overall number of older persons that can be supported within the budget available for NHSS. It is anticipated that a minimum of 555 residential beds will close in the course of year.

The figure could be as high as 1,000 beds, however.

We have already seen the ball starting to roll in Laois, Athlone and Dublin, to name but a few areas. In my area of Cork East, facilities and beds are under threat in Youghal and Fermoy. Youghal Community Hospital is in danger of losing eight beds, with the result that vulnerable elderly people and their families are left at their wits end. Home help hours are being cut at the same time as the State seems to be abandoning its duty of care. The work carried out in our local public nursing homes by carers and community nurses is essential. This national service plan will see a further erosion of this service.

Likewise, an aspect of the health service which has gained prominence in my constituency and, indeed, in the entire Munster area over the past 12 months is the so-called reorganisation of pre-emergency care. Ambulance response times for 2011 were below target across the board yet the HSE somehow expects to improve the system by redeploying the same staff over longer periods in less sophisticated vehicles. Rural areas are up in arms. Youghal has been fighting for the retention of its ambulance service in the face of proposed downgrades. The plan as outlined will cost lives and needs to be resisted. I commend the work of the Save Youghal Ambulance Committee in this regard.

The percentage of clinical status one echo incidents responded to by first responder vehicles in eight minutes or less was 49% last year, compared to a target of 75%. This year's target of 75% seems to be arbitrary. A mere 26% of delta cases were responded to in the same period. It appears the target figures were plucked out of the air with little or no consideration for what the service means to people.

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