Thomas Pringle (Donegal South West, Independent)

I propose to share time with Deputy Mick Wallace. The HSE service plan should be renamed the lack of service plan. It is being prepared to meet the €750 million reduction in the HSE budget, amounting to a total reduction of €2.5 billion in the past three years. It is past the point where we should ask ourselves whether we will have a health service in the future. We cannot continue to keep cutting and the Government cannot expect more efficiencies can be found. Efficiencies mean treating more people with less every year. It simply does not add up.

The executive summary of the service plan puts things in black and white. It is certainly true that it will be impossible to avoid an impact on front line service delivery in 2012. We all know we cannot continue to cut services and staff, yet operate a service safely. In the past few days we have learned the plan is out of date. The announcement that almost 4,000 staff will leave the health service by the end of February and the news that 47 out of 200 midwives will leave maternity services shows the real effect of the embargo and the continued reduction in front line staff. The public have known since day one that the front line was the target and now at least HSE management is recognising it.

It appears the removal of staff has not been planned for. In the past few days the Minister said the plan will be put in place, four weeks before staff are due to leave. There is no doubt the HSE will not act as quickly as the Cabinet did when the Office of the Director of the Corporate Enforcement announced his retirement because front line staff are leaving and only treat ordinary working people. More and more of the elites are the only people who will have health insurance and will continue to get preferential treatment. At least the service plan has recognised some of this in trying to address the unstructured nature of the downsizing, but it clearly shows no thought has been put into it.

Much has been made of the ring-fencing of €35 million for mental health services but in real terms this is a reduction of 1% in the overall budget for mental health services. Once again they will be the poor relation of the health service and the most distressed people will continue to suffer.

In terms of services for older people, we will see the closure of over 550 beds in community nursing homes across the country. In Donegal many beds in community hospitals are under threat, from Lifford to Dunloe and Ballyshannon.

The plan refers to maximising elderly people's ability to live in the community rather than taking up closed beds. The number of home support packages will be maintained at the same levels as last year. Where will people denied a bed get support? The number of home help hours will be cut in HSE west by 115,000. There will be no home help for those who cannot get home support. This makes a lie of the plans of the Minister and HSE.

Letterkenny General Hospital is the second most efficient hospital in the State. Over 90% of its patients are non-elective. Yet, the Government still cut its budget by millions of euro. There will be reduced service levels this year which will mean waiting lists will grow and non-elective patients will not be treated. What incentive is there for a hospital to be efficient? Last year the Minister announced Tallaght hospital will have its deficit written off but what about Letterkenny?

With the reduction in activity levels in hospital services large numbers of staff will also leave primary care. The service plan states patients should be treated in primary care rather than hospitals. How does the HSE expect this to happen? Surely staff are needed somewhere if one area is needed to pick up the slack when another service is reduced.

The HSE is already cutting out of hours GP services in Donegal and a reduction in primary care will be caused by retirements. This is combined with the cuts in home support, which is servicing the same number of patients as last year. The burden of home help hours will have to be taken up somewhere. We will see the blocking of hospital beds because many patients will simply have nowhere to go. This will lead to further reductions in treatments and place a bigger burden on primary care. The vicious cycle will continue. There is no doubt the HSE service plan and lack of services will take up many hours of debate in this House as the full effects of the cuts are felt across the country.

See this speech in context