Paul Connaughton (Galway East, Fine Gael)

I welcome the opportunity to speak on this very important issue. The provision of health services in what is a very difficult economic situation must be the top priority of this Government and, to this end, there are many initiatives contained in the HSE service plan introduced by the Minister which must be welcomed but concerns remain at a local level as to how these changes will impact on the day to day working of our health service.

The plan provides for the spending of just over €13 billion, a reduction of €750 million in the health spend. As the Minister said previously, the removal of that money will result in an inevitable and unavoidable reduction in services but great efforts have been made to shelter front line services from the full impact of these savings and instead focus on cost-saving across all sectors.

Welcome initiatives in the plan include proposals to protect the viability of community nursing homes, to strengthen primary care services and to enhance community mental health. Mental health, in particular measures in terms of suicide prevention, is especially important at this present juncture given the high rates of suicide and self-harm.

Any householder or small business owner will tell one of the importance of ensuring all income is collected and thus the increased focus on tackling uncollected hospital income is very welcome. I note that very ambitious targets have been set in this respect and an increased rate of collection will result in great savings in the health service generally.

One very successful initiative introduced by the Minister is the special delivery unit, SDU. It is hoped the success experienced to date, where the number of people on trolleys has fallen by 27% since the introduction of the SDU, will be mirrored throughout the country, including in University College Hospital Galway where patients have experienced long delays due to the high volume of patients presenting at its emergency department. The change instituted in emergency departments by the SDU is one example of how harnessing the knowledge and expertise of the medical personnel at the coalface can result in common sense and cost effective changes to what are long-term practices.

This is a very difficult time for people working in the health service and that fact must be recognised. A large number of staff will leave the health service this year and remaining staff will be faced with requirements for greater flexibility in terms of work practices and work rosters. To this end, implementing the public service agreement will be crucial.

In terms of health service provision in the west of Ireland, great care must be taken in respect of changes instituted only last year. The downgrading of the accident and emergency department in Roscommon County Hospital has created great difficulty for many people in east Galway and Roscommon and has put considerable increased pressure on the services in Portiuncula hospital in Ballinasloe with no increased resources. Hospitals, such as Portiuncula hospital in Ballinasloe and UCHG, must be strengthened to ensure they can provide the type of service demanded in the current HSE plan. I very much welcome the Minister's recent appointment of a new CEO to cover the four hospitals in the region but, as someone who is very clearly linked to one of the smaller regional hospitals, we want to see a very clear plan on how Roscommon, Portiuncula and Merlin Park hospitals will work with the larger UCHG to provide the best care possible for the patient, which is what this is all about. UCHG is a fantastic facility but it is suffering from delays. We are sending too many people there when we have these other hospitals which have management and staff who are more than willing to change their work practices to keep those hospitals viable. That is crucial in terms of the way forward.

I note that hospital budgets for this year will be down by an average of 4% on last year's allocation. This, added to existing deficits, will mean a reduction in expenditure of 7.8% as the hospitals endeavour to get their spending back on track and yet it is expected that inpatient numbers will reduce by only 3% on the 2011 figures.

Cancer continues to be a scourge faced by thousands of families and individuals in 2012. It is disappointing to see an anticipated increase of 3% in the incidence of cancer but it must be remembered that an element of this increase relates to better and earlier detection of cancers which, in turn, results better outcomes. However, dealing with an increase of 3% at a time when cancer care services are already extremely busy will create more pressure on oncology services.

I welcome the fact home care packages, which allow dependent older people to remain at home, will not experience any reduction, even though the cost reduction for the budget for older persons, excluding the fair deal scheme, is 2.3%. Of much greater significance is the reduction of 4.5% in home help hours, even if this reduction will only see a number of people in receipt of home help hours have their allocation reduced by 1.2%. For those critically ill older people who are being cared for at home, the level of home help available could be a determining factor in whether the family members feel able to cope with caring at home. Such cuts could put even greater pressure on the fair deal scheme in the future.

Often dry facts and figures mask the real impact the reductions will have. One example of this is the provision for disability services. I note the allocation will be reduced by 3.7% nationally and that it is hoped that this will be achieved through greater efficiencies, procurement changes and pay reduction savings as well as the rationalisation of back office costs. In recent weeks, I have met many people in regard to this issue, among them members of Ballinasloe Advocates Group, a group of parents concerned about the level of services their children will receive in 2012 and in the future. Members of this group have been understandably very anxious about the consequences those cost reductions may have on the lives of their loved ones, whether in the provision of leisure activities or transport. They are very anxious that the huge progress made in the area of services for disabled persons is not damaged by the cuts the country must make in order to balance its budgets.

The Minister stated that this reduction will result in some small reduction in day and respite services but I urge him, in conjunction with HSE management, to ensure that any such measures are kept to an absolute minimum, in particular cuts to respite services which provide an invaluable service to parents, such as those in the Ballinasloe Advocates Group.

At a time when cuts are being instituted right across the board in terms of health, education and other vital services, it is very welcome to see an additional spend of €35 million on improving child, adolescent and adult community mental health teams as well as suicide prevention and counselling services. The opening of a number of inpatient child and adolescent units is also welcome.

While the switch away from psychiatric inpatient beds to care in the community is very welcome, it has reflected a historical model of the psychiatric services which had become outmoded. I note the loss of staff in the mental health services in recent years will result in a further reduction of inpatient beds but this needs further investigation. Increased use of psychotropic drugs and recreational drugs has led to increased incidents of psychosis and, in many cases, inpatient services are the appropriate way to deal with patients who present with psychosis as opposed to sending them home in the company of family members who have neither the professional knowledge nor skill to deal with such situations. This issue may require further discussion in future years as we see an increased number of patients presenting with psychosis as people, young and old, continue to purchase psychotropic drugs from illicit sources, including over the Internet.

I again welcome the extra spend of €35 million which has been ring-fenced for this area. However, for many years, we always considered the health service could be fixed by increasing funding to it. That was the only way for the Government to prove it was fixing the health service. We need to see how this €35 million will be spent, whether in the community or through hospitals or organisations. That is the key here. It is welcome news but now we need to see how the Minister will spell it out. How will it affect such people and their families to fight the problem of suicide in the community? At a time when social workers face immense workloads and the public becomes increasingly aware of child protection issues, a reduction of 7% in child and family services is disappointing. Social workers are dealing directly with the children most in need in our society. Every care should be taken to ensure that children are not endangered by this significant funding cut.

A reduction of €750 million in this budget will cause great difficulty for people using the health service, as well as those working in it and others making the difficult decisions on funding cuts. Given the country's financial situation, such cuts are unfortunately unavoidable. I note that every effort has been made in this service plan to achieve a significant proportion through increased efficiencies and changes to procurement processes.

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