Jerry Buttimer (Cork South Central, Fine Gael)

I am happy to speak in this debate on the Health Service Executive's national plan. We spend in excess of €13 billion per annum on health. If the transition year students in the Visitors Gallery were to listen to some of the Members opposite, they would say we spend nothing on it. We spend in excess of €13 billion on the public health service per annum. Can we put that in the context of our current position? There is an economic downturn, called a recession, which means there is a reduction in the public and private money available to the nation. Undoubtedly, the budgetary adjustment and legacy deficit make it inevitable that there will be a major challenge for the HSE this year.

It is necessary that all stakeholders involved in the delivery of public health services, including the HSE and the Department of Health, work together to ensure budgets are met, that reform is delivered and, most important, that the service is not compromised. It is undoubtedly a challenge but I heard not a single alternative proposed this morning and yesterday. If one had listened to Deputy Pringle, one would have believed the world was ending in Donegal, but that it is not going to happen.

We must prioritise patients and patient care. The health service is not an administrative system or an accountancy practice. It is not just a question of balancing books and having a cold computer printout; the service is about patients, the delivery of services and the women and babies in maternity units about which Deputy Wallace spoke. None of our debates should be about political point-scoring, ranting and raving or whipping up hysteria. We must be honest about the delivery of a health service that is accountable and manageable and which delivers for the patients.

I compliment the Minister of State, Deputy Shortall, and the Minister, Deputy Reilly, because they are both empathetic and sincere and have a vision. Their actions are to be seen on the ground, they do not simply engage in rhetoric. They operate under budgetary constraints. The special delivery unit has worked. Last Friday in Cork, I attended the HSE's launch of a retinopathy initiative. Dr. Diarmuid Quinlan has screened 3,500 people suffering from diabetes to bring about change regarding availability and how the system operates. The Minister of State, Deputy Shortall, pioneered primary care. This will have a profound and lasting impact on society. Mental health has been designated a priority.

Let us examine the trends set by the Government in just 11 months. We have seen the Minister unfurl a plan for seven new directorates in respect of which accountability will be the key. We have changed the management structure regarding the grouping of hospitals.

There are a number of trends about which we ought to be worried as a nation. These include the obesity level, including the childhood obesity level, and the level of alcohol misuse. I was very pleased that the Joint Committee on Health and Children published its report last week on the misuse of alcohol. I very much look forward to the report of the independent steering group and to working with the Minister of State, Deputy Shortall, in bringing about a new culture and attitude to the misuse of alcohol and tobacco.

Deputy Wallace referred to staffing. How is it that there has been a 45% increase in the number of consultants employed between 2002 and 2011 in the health service? Consultants create traffic; they have patients, theatre lists and outpatients. I look forward to seeing this year a complete realignment of the Health Service Executive. The Minister of State stressed the need to mitigate the impact of budgetary changes on front line services. We all accept that. I call on the HSE to ensure that the allocation of staff across front line services does not mitigate against the patient or compromise patient safety. This is the duty of the HSE because it is the accountable body in this case.

Deputy Wallace stated front line staff have been hit more than others in essential services. He may well be right but the reality is also that the Health Service Executive did not have all the relevant figures until some days ago. When I hear eminent people stating otherwise on the public airwaves, I wonder about megaphone diplomacy and advocacy in that regard. The last thing we need to do is create hysteria and panic, compromise safety and increase uncertainty.

There is a commitment in the programme for Government to reduce public service numbers. As we move towards the fulfilment of the criteria in the programme and those set by the troika, having due care in respect of the patient on the part of the Health Service Executive should be deemed essential.

Just last week, I met representatives of the INMO, front line staff, a group of consultants and some non-consultant hospital doctors. All of them understand the economic restraints and none is going public. Each expressed concern over staff reductions, which they fear will have an impact on the delivery of services, particularly front line services. It is critical that the HSE understands the genuine concerns of many regarding front line staff and puts plans in place to cope with the impending changes. I look forward to the HSE representatives appearing before the Oireachtas Joint Committee on Health and Children to deal with this issue in a couple of weeks.

The Minister of State, Deputy Shortall, and the Minister, Deputy Reilly, have asked the HSE to brief them on the staffing allocations in respect of each budget. I heard the Taoiseach's remarks on this topic in the Dáil yesterday. I urge the Minister of State to impress on the HSE the need to preserve the front line positions and ensure the safe delivery of services. It is important that the HSE spell out the tax savings and efficiencies achieved in the administration of the health service.

While the national service plan does not deal specifically with the budgets for specific hospitals, it indicates the overall budgetary reductions that hospitals face. The absence of this detail has caused concern for some of us in government. Those engaged with front-line staff are also concerned. However, the purpose of the national service plan is to provide an overview, and I hope the direct communications between the HSE and hospitals will provide clarification in this regard. I call on the HSE to be sincere in its negotiations with hospitals, particularly acute hospitals.

Over the past six months, hospitals have worked closely with the special delivery unit, which is one of the key reforming initiatives of the Government that has succeeded and delivered results. I very much welcome the targets being set by the Minister, which I hope will deliver further improvements in the delivery of service. We need to manage and review the operation of the special delivery unit and ensure that achieving the target is not at the expense of other areas.

The health system delivers integrated services. Each element of it needs to function if we are to review the level of care. The Minister has suggested another efficiency, the grouping of hospitals, which I welcome. This has the potential to achieve tangible results and can facilitate the pooling of resources and a sharing of facilities to deliver for patients. In Cork city, it can be used to deliver integrated surgical services and co-ordinated services across all the city's hospitals. If this model returns some local control to the system and gives those who deliver the service a greater input, it can achieve the results the Minister wants.

Deputy John Paul Phelan spoke about fair care. It is important we consider this in the totality of the way we treat the elderly. I will conclude by addressing the area of reform. As the Minister, Deputy Reilly, and the Minister of State, Deputy Shortall, have said, this is a year of reform. There are challenges facing the health service and these are recognised by all of us in Government. I challenge the Members of the Opposition to live in the real world and face up to the challenges and responsibilities which being a Member of the Oireachtas brings. It is not about megaphone diplomacy and shouting and roaring. They should be real about this.

In facing the challenges, it is important to ensure quality services are delivered where they are needed. I hope the Minister and the HSE will work together throughout that reform agenda because our country is spending in excess of €13 billion. This requires accountability and putting patients at the heart of the system. I am confident in this regard. We have a reforming Minister of State, Deputy Shortall, with us in the House and she has two reforming colleagues. It is about the patients. I am happy the Government will bring about that reform, which will deliver real change in our health system.

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