Brian Walsh (Galway West, Fine Gael)

It is important to recognise from the outset the scale of the challenges faced by the Minister, the Department of Health and the HSE in framing this service plan against the backdrop of required savings of €750 million. I agree with the Minister's analysis that this level of saving can be achieved this year without a reduction in the level of service activity. From this perspective the service plan is to be commended. I also commend the Minister on the progress he has made in the short term in which he has held office, especially in reducing the time people spend on waiting lists and reducing the numbers of patients on trolleys in accident and emergency units throughout the country. His initiative to introduce special delivery units has assisted greatly in this regard.

Let there be no doubt, however. We are not going to solve the problems of our health service in one year. I respectfully suggest that notwithstanding his expertise in the area of health care and his obvious competence in health provision, the Minister is not going to be in a position to fix the health service in one term, especially given the legacy he has inherited and the challenges presented by that legacy. There can be no doubt that the scale of budgetary reduction our economic circumstances demand will impact on delivery of services in certain areas of our health service. In particular, the imposition of savings outlined in the service plan will have serious consequences for organisations reliant on HSE funding to deliver services in communities to those who can be counted among the most vulnerable in our society. For these invaluable organisations the true extent of these cuts is in many ways disguised within the pages of the action plan because, by virtue of the Croke Park agreement, they are very much constrained in determining which areas of the budget should sustain these required cuts. The care provided by these organisations, such as the Brothers of Charity in Galway, with which the Leas-Cheann Comhairle will be familiar, is by nature labour intensive. As much as 80% of their budgets can be pay-related. On the face of it, therefore, a 3.7% reduction in funding for such an organisation may seem manageable or even modest but if 80% of that organisation's budget is protected by the terms of the Croke Park agreement, that 3.7% cut must be applied to non-pay items. It then becomes a cut of in excess of 18% in non-pay expenditure which will have grave implications for the ability of that organisation to continue providing services.

There is no fat left for these organisations to trim. The HSE cleaver is already touching the bone for many. If the terms of the Croke Park agreement continue to protect the pay packets of public servants without any of the promised efficiency improvements the totality of the burden will be shifted to the non-pay element of these organisations' budgets. Vital services will be compromised. The reality is that the Croke Park agreement is not achieving the efficiencies promised. I hear regularly from health care professionals and consultants in my area, Galway, as I am sure other Deputies do in theirs. They provide us with examples of archaic procedures which are still being used, for example, in document management. There appears to be a resistance among some staff in the HSE in our hospital services to embrace new technologies which would encourage and introduce the efficiencies that are required under the agreement.

Separately, I wish to highlight a measure contained in the service plan which is likely to pose serious difficulties for one organisation that is very close to the hearts of many of my constituents. A 3.7% reduction in funding for palliative care in 2012 will impact severely on the Galway Hospice Foundation which already receives a lower proportion of funding per bed than any other hospice in the State.

I previously outlined to the House the inequitable distribution of funding for palliative care services across the country which has resulted in an historic core funding deficit for Galway Hospice Foundation, an issue with which the Leas-Cheann Comhairle is familiar and about which he has been active. The shortfall in the State subsidy to the Galway hospice has been supplemented traditionally by generous donations from the public, a testament to the high regard in which this facility is held in the west. However, a 10% fall in fund-raising last year, coupled with a 7.3% reduction in HSE funding over the past two years, has left the Galway hospice in a position where any further cuts to its budget could result in the undermining of the viability of its services.

On a positive note, the health service plan notes it will be necessary this year to prioritise some services over others to meet the most urgent needs. I hope the Minister will agree the Galway Hospice Foundation, as well as the Brothers of Charity operating in the west, are two such services. It is also noted in the plan that HSE managers will have the scope to vary the level of reduction that will apply to individual care providers to achieve overall savings. I hope due cognisance will be taken in the case of those providers which have already made significant efficiency savings in recent years and are less well able to sustain further budget cuts.

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