Jack Wall (Kildare South, Labour)
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We have been discussing putting cancer programmes in place. Unfortunately, in Kildare and west Wicklow it will be necessary to put an occupational therapy programme in place, if one takes account of the letter I received from the HSE. It states:

I am writing in response to your letter to our general Manager, Mr. Billy Quinn. As you are aware the Senior Occupational Therapist assigned to the District Care Unit in the Athy area, has been on maternity leave as of 14 9.07 and is not due to return until 6.5.08.

Under normal circumstances we would have received approval to fill her position with a temporary Occupational Therapist. Unfortunately due to the overspend by the HSE, a staff moratorium was put in place as of September 4th. We were told at that time we were not allowed to fill any previously approved new posts or replace any vacant/maternity leave posts.

On October 5th we were informed that we could make individual representations to replace vacant posts through a new derogation process. We immediately did this for the above post, and for two more upcoming maternity leave posts covering the Celbridge, Maynooth and Leixlip areas. After much follow-up by us about these posts we have been told that only one post, covering the Celbridge area, has been approved for replacement.

As Managers of the Occupational Therapy Services for Kildare/ W. Wicklow, we are acutely aware of the devastating effect this is having on clients referred to our services and the huge stress that is being placed on our understaffed Therapists.

With our present inadequate staffing levels, we simply are unable to provide a service where posts have been made vacant. Also, due to the staffing crisis placed on our service through the moratorium, our Union has informed our Therapists that they are not to take on the roles and responsibilities of positions affected by the HSE actions.

We sincerely hope this staff moratorium can be removed as soon as possible so that we can provide a fair and equitable service to all our clients.

This letter is from the occupational therapist manager. The basic issue is that there are four areas in Kildare. The first, second and third areas each made an application for a therapist, but the applications were turned down. The HSE decided to provide an occupational therapist for the fourth area, the last to make an application.

We have discussed and debated the HSE for a number of weeks but still we see occurrences such as this. Everybody agrees that maternity leave is essential and must be granted. However, there must also be a built-in service available for those in need of it. I sent my letter because a man suffered a major tumour on his brain and needed immediate occupational therapy. It was not forthcoming and will not be forthcoming because a therapist will not be available in Athy until August 2008. The HSE spent more than €20,000 on an agency to determine if top staff in the HSE should get bonuses. In Kildare, however, there is no service for the basic needs of the community. Children and senior adults need this service but it is not available.

One can see the frustration, annoyance and torment of the staff reflected in the letter, which is dated 19 November last. One seldom gets such a reply, an honest endeavour to have the matter raised in public so something can be done about the scheme. There are three positions and only one is filled. It is impossible for people in the Kildare and west Wicklow area to get occupational therapy until next August.

I plead with the Minister. Last night, I said there must be responsibility for resolving such problems. We see them every day. Every Deputy in the House, from the Taoiseach down, encounters this type of problem. I can honestly say I have never been as angry about anything as I am about this situation. The staff are crying out for assistance in trying to secure extra staff for the service. The problem is affecting the existing staff, with attempts being made to give them extra workloads. I ask the Minister to get the HSE to reconsider this matter. People in my community are suffering because of it.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank Deputy Wall for raising this issue and for giving me the opportunity to outline the current situation with regard to occupational therapy in the Kildare and west Wicklow area. 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. Staff costs make up 70% of the HSE's overall budget and must be carefully managed if the HSE is to live within its budget.

As the Deputy will be aware, a temporary recruitment pause has been put in place as part of the HSE's financial break-even plan for 2007. In any instance where a critical or essential vacancy arises it may be filled through redeployment of existing staff by the relevant line manager or reassignment of responsibilities based on assessment of priority need. Notwithstanding this, it has been recognised that during the period of this temporary recruitment pause, there are some circumstances where appointment of staff may be necessary in frontline services. Accordingly, the HSE has put a process in place to evaluate, monitor and approve requests for derogation from the general recruitment pause. A small group has been established which meets regularly to consider such applications. Of the applications received to date, derogations to the value of 520.8 whole-time equivalents have been approved throughout the entire HSE where posts have been identified as critical to service delivery.

Demand for occupational therapy in the health services has been significant, hence the substantial investment which has been provided over the last number of years. The number of occupational therapists, OTs, employed in the public health service has grown from 287 whole-time equivalents in 1997 to 1,102 in September of this year. This is an increase of 725 whole-time equivalents, which represents growth of almost 253%. The Government has also committed to further investment in disability services via the multi-annual investment plan, and in primary care services, and this will result in a further increase in the resources available for occupational therapy.

A particular priority for the Department of Health and Children and the Department of Education and Science in recent years has been to increase the supply of therapy graduates, including OTs. New courses in occupational therapy were established in three universities, UCC, NUIG and UL, with an initial intake of 25 places on each of the three courses. The UL course is at Master's level and the first cohort graduated in 2005. The first cohorts from the bachelor's degree programmes in UCC and NUIG are graduating this year. The number of training places for OTs has increased by 86, from 29 in 1997 to 115 in 2007. This represents an increase of almost 297% over the past ten years.

The House will agree that these changes clearly demonstrate the commitment of my colleague, Deputy Mary Harney, the Minister for Health and Children, the Government and the HSE to ensuring focus on patient care and the recruitment of frontline personnel.

On the matter raised by Deputy Wall concerning the provision of occupational therapy in the Kildare-west Wicklow area, the HSE has advised that the current complement for OTs in the area is 21.5 whole-time equivalents. Thirteen of these posts are currently filled and 8.5 posts are vacant. The Department has been advised by the HSE that of the vacant posts, two posts in primary care were advertised in June of this year and 2.5 posts in the area of older persons — one in the community, one in Baltinglass Hospital, and 0.5 posts as hospital liaison — were advertised in August 2007 locally and through the international recruitment programme. One OT is due to commence work in the near future, so 1.5 posts remain vacant. Two OTs are on maternity leave and the HSE is attempting to fill these vacancies on a temporary basis. One post in palliative care has yet to be advertised. A job description is being discussed and prepared in consultation with the recently appointed palliative care consultant and palliative care team. One post in the area of disability has yet to be advertised.

Working within the parameters of the current recruitment pause, the HSE has advised that it is committed to filling these posts as soon as possible. I will convey to the HSE the concerns outlined by Deputy Wall this evening.

Jack Wall (Kildare South, Labour)
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The Minister of State said that two OTs are on maternity leave and the HSE is attempting to fill these vacancies. That is not true.