James Reilly (Dublin North, Fine Gael)
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Question 74: To ask the Minister for Health and Children if, in relation to her statement at the Irish Nurses Organisation annual conference on 21 September 2007 she is still of the view that patient care will not be affected by the ban on recruitment or the cost cutting measures imposed by the Health Service Executive; and if she will make a statement on the matter. [24453/07]

Jan O'Sullivan (Limerick East, Labour)
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Question 75: To ask the Minister for Health and Children if she is still of the view that the embargo on recruitment of staff by the Health Service Executive is not affecting patient care; the level of involvement she and officials in her Department had in decisions with regard to staff issues, including the increase in grade eight managers from ten in 2000 to more than 500 at present; the way the embargo is impacting on the implementation of Government health policies; and if she will make a statement on the matter. [24088/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 74 and 75 together.

There are close to 130,000 people employed in the delivery of our public health and personal social services, the vast majority of whom provide direct service to patients and clients. The current pause in recruitment must be viewed in this context. It is a temporary measure put in place by the HSE to live within its budget. It will be reviewed at the end of October and it is being monitored by the HSE on a week by week basis.

The HSE must be able to manage within the resources made available to it by the Government and voted by the Dáil. It should not come as a surprise to anyone that managing the budget in the health sector means managing staff. Staff costs make up almost 70% of the HSE's overall budget. It is unreasonable to suggest that in a service of this scale and with an employee cohort of this size, every vacancy which arises must be filled immediately and, if not, dire consequences will result. Living within budget and making the best use of the available resources is an essential task of any sound organisation. Reforming our health system is not just about extra funding and extra posts, it is about ensuring that the extra money which has already been invested by the Government on behalf of the Irish people is being used wisely and efficiently.

The gradeeight title was first introduced in 2000 as a result of an industrial relations agreement. Staff would previously have held other titles such as hospital managers, disability service managers, accountants, industrial relations officers and IT personnel. This explains why the numbers of posts categorised as grade eight was very low in 2000. However, I share the concerns about the growth in posts at grade eightfrom 521 to 713 between late 2005 to June 2007. As part of a new employment control framework introduced in December 2006, the HSE is now required to get my Department's approval for the filling of posts at grade eight or above. Despite the controls that are in place now, the numbers are running ahead of expectations. I am awaiting a report from the HSE on this.

Many of the actions taken by the HSE to control its rate of spending in the last three months of this year have demonstrably no effect on frontline services. Some of the claims made about alleged effects on services are without justification. For example, the cancellation of foreign travel and the release of temporary summer holiday cover staff cannot mean a reduction of services. Claims of this nature should be assessed in the context of the HSE's overall activity levels. For each of the last three months of this year, there will be more than 100,000 patients treated as inpatients or on a day case basis in publicly-funded acute hospitals. That will continue to be the case.

However, the HSE recognises the importance of staying within annual budgets and staffing levels, as well as managing activity throughout the year so that planned annual service increases are achieved in an orderly manner over the whole year. It is ultimately no service to patients if hospitals or any other cost centres overrun budgets and staffing levels in the early part of the year, causing a slowdown of activity in their own service or in any other service later on. Any postponement of an operation or service arising is naturally very disappointing to individual patients and clients.

James Reilly (Dublin North, Fine Gael)
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I have listened to the Minister's response and it is nothing more than what we have heard before. The reality for people comes from the effects of the cutbacks which the Minister promised on "Newstalk" would not happen. When these cutbacks were exposed, she denied they would have any effect on patient care. Both these claims have been found to be false. People in Ennis have had their facilities cancelled so that they can be referred to a centre in Galway, but because of the cutbacks cancer services there have been reduced from five to three days. The Minister cannot tell us that those people will not suffer. Hours are being reduced in Beaumont Hospital, and in St. Joseph's Hospital beds have been occupied due to the detection of Legionnaire's disease in a nursing home, the consequence being that beds for elective surgery are occupied and surgery lists are being slashed.

Brendan Howlin (Wexford, Labour)
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Has the Deputy got a question?

James Reilly (Dublin North, Fine Gael)
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The question is about the home care packages for the elderly that have been taken away, about the stroke care in Merlin Park Regional Hospital that has been taken away and about the removal of 22 beds that were to be transferred to a community facility to free up beds in the National Rehabilitation Hospital. Why will the Minister not take control or responsibility?

The HSE will not answer Deputies. When we ask questions we get facetious responses. I asked a question on ambulance services and trolleys and I was given an answer which made absolutely no sense. There is no transparency in the HSE and not even the Comptroller and Auditor General can get a response. Where is the evidence of the increased productivity of this large number of bureaucrats in the HSE? When will the Minister take responsibility for this?

Mary Harney (Dublin Mid West, Progressive Democrats)
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There are quite a few questions to be answered. When I was commenting on the freeze on recruitment at the conference of the Irish Nurses Organisation, it was in the context of an increase of 2,500 in the numbers employed by the HSE during the course of 2007. There has not been a reduction in staff, but an increase. One of the challenges facing us is to make sure that staff numbers are in line with approvals from my Department and the Department of Finance.

I also spoke specifically about some hospitals. Where 40 nurses are taken on to cover holiday relief, when the holiday period is over there is no need to keep those nurses. Why is it that in Sligo General Hospital there are 1.8 nurses per bed but only 1.3 nurses per bed in Waterford Regional Hospital? We need to look at some of these wider issues.

In our health system, about 16% of the staff are in administrative roles, a figure which is at 18% in the NHS. The HSE is currently carrying out an audit of management and administration, which I support. I am not saying we have the right balance. There is scope for a voluntary redundancy programme and I hope that can be discussed in the new health forum that will be established.

James Reilly (Dublin North, Fine Gael)
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What about the cancellation of operations in the orthopaedic department at the hospital in Navan? Up to 180 patients are being operated on per month in that hospital, but the Department has stated that a mere six operations have been cancelled.

Damien English (Meath West, Fine Gael)
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The Minister must clarify that.

Brendan Howlin (Wexford, Labour)
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This is Priority Question time and it is restricted——

Damien English (Meath West, Fine Gael)
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This is a priority issue.

Brendan Howlin (Wexford, Labour)
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——to the nominated spokespersons of each party.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have been informed that six patients were given appointments for the month of December. I have also been informed that there has never been a month at that hospital when 200 procedures were carried out.

James Reilly (Dublin North, Fine Gael)
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I said 180 operations were being carried out.

Mary Harney (Dublin Mid West, Progressive Democrats)
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They carried out 1,600 in the first nine months of the year so the Deputy should divide that. It would be remarkable if the hospital carried out more operations in December than in any other month.

James Reilly (Dublin North, Fine Gael)
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Was the hospital not shut for January and February?

Damien English (Meath West, Fine Gael)
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The Minister is misleading the Dáil.

Brendan Howlin (Wexford, Labour)
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Allow the Minister to answer the question. The nominated spokesperson of the Fine Gael Party is the only Deputy allowed to speak during Priority Questions.

Damien English (Meath West, Fine Gael)
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I want clarity, not untruths.

Brendan Howlin (Wexford, Labour)
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When we get to other questions, every Deputy can pose a question. These are the rules that you have laid down. I would now like to call Deputy Jan O'Sullivan, who has also tabled a Priority Question.

Damien English (Meath West, Fine Gael)
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That is unfair. Will the Minister please clarify whether she believes the information about the six patients? This is very serious. Is it true or not true? Is this House not about truth?

Brendan Howlin (Wexford, Labour)
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The Deputy will have some respect for the Chair.

Damien English (Meath West, Fine Gael)
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I will have respect for the Chair, but there should be respect for the truth as well.

Brendan Howlin (Wexford, Labour)
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Will the Deputy have some respect for the Chair? When the Chair is speaking——

Damien English (Meath West, Fine Gael)
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I have no problem with respect. You and I both know it will not come up in later questions.

Brendan Howlin (Wexford, Labour)
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I call on Deputy Jan O'Sullivan to ask her question.

Jan O'Sullivan (Limerick East, Labour)
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The Minister set up the HSE nearly three years ago to centralise the system so that bureaucracy could be reduced and more funding could be released for direct patient care. What monitoring does the Minister carry out on the HSE? The growth in senior management numbers is extraordinary, in spite of her explanation today. What hands-on relationship does she have with the HSE to ensure that we do not spend scarce health money on bureaucrats when it should be spent on patients? If she can give me a clear answer we might have some understanding of what is going on.

Does the Minister think it makes sense that patients who are ready to go home are occupying specialised beds in the National Rehabilitation Hospital? Patients who need to come in, such as a man who received serious head injuries in a farm accident, cannot do so because other people who are ready to go home are occupying beds. Can the Minister comment on this crazy use of funding for specialised health services?

I received a copy of a letter sent to the Minister by 93 general practitioners in Sligo. With regard to the HSE embargo, they say, "To state that these moves will have no effect on patient care is dishonest and wrong and is insulting to the professionals involved". Are these 93 doctors wrong when they say that patients are directly impacted upon by these cuts? Will the Minister use her power to ensure that the HSE does not continue with this embargo, which is hurting patients?

Mary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy is aware, much analysis of our health system was done in the run-in to the reform programme. The Prospectus, Brennan and other reports all made the central recommendation that the fragmentation of services was not delivering efficient health care. That is a view I strongly share. We would never have established 11 boards to administer health care in a population of 4.3 million. We could not have introduced the cancer control programme if we had that kind of fragmentation.

The role of the HSE is clear. It is responsible, with the chief executive officer as Accounting Officer, for the delivery of services. The Minister remains responsible for policy and has overall responsibility for health. I take an appropriate role. I am not involved in operational issues.

Jan O'Sullivan (Limerick East, Labour)
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Surely there are policy issues in how money is spent.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I meet with the CEO and chairman of the HSE at least once, and sometimes twice, a month. There is also a Cabinet sub-committee. The CEO does not report to me but to the board of the HSE. The chairman reports to me.

The HSE is required to get prior approval from my Department and the Department of Finance before an employee is given grade eight status.

Jan O'Sullivan (Limerick East, Labour)
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Must the Minister approve these posts?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Yes, we must approve them. That has been the procedure since December 2006. Notwithstanding the need for that approval, the numbers seem to be ahead of expectation. I have asked for an explanation of that from the HSE.

We must be fair to those hospitals which are currently living within their budget. Hospitals such as the National Maternity Hospital, Holles Street, notwithstanding the huge increase in births, the Mid-Western Regional Hospital in Limerick and Waterford Regional Hospital can live within their allocated budget. We expect other hospitals to do so. The ratio of nurses to patients in Sligo is 1.8 per bed while in Waterford it is 1.3 per bed. Perhaps the general practitioners should look at some of these issues.

Spending on health has increased by 370% in the past decade, which is seven times the rate of inflation. The British Government is talking about a targeted increase in health spending of 4% above inflation. Unless we live within budgets, the health system has the capacity to be unsustainable and to damage the economy. We must all recognise that point. This should not be incompatible with providing services.

If patients are fit to leave the rehabilitation hospital and others need to go in there, it does not make sense for that not to happen. The HSE has confirmed that homecare packages will be made available so that patients can return home from the National Rehabilitation Hospital and others can be admitted there.