James Reilly (Dublin North, Fine Gael)
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Question 69: To ask the Minister for Health and Children if she has received the Health Service Executive's service plan for 2009; if she has approved the plan; the locations at which the level of service in 2009 will be below that of 2008 or 2007; and if she will make a statement on the matter. [42893/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I received the HSE's national service plan for 2009 last Tuesday, 18 November. It is being examined by my officials and I will review it later this week. As is normal, the plan will be published after I have approved it.

Following the budget, I wrote to the chairman of the HSE on 15 October outlining my requirements for the 2009 plan. I emphasised that my priorities were to avoid service reductions, protect the least well-off and to continue the overall reform programme. I also highlighted the need for service levels in 2009 to reflect planned activity throughout the year.

Clearly, the current fiscal position demands the most careful control of public expenditure within the approved limits. However, the 2009 allocation for the HSE should allow it to continue to provide services in 2009 which are at least in line with those provided in 2008. The 2009 allocation includes €120 million to meet service pressures arising from demographic changes. It should, therefore, fund service increases in areas where there are unavoidable demographic and other pressures.

The 2009 allocation also includes €55 million for the fair deal scheme, an additional €15 million for the cancer control programme and €10 million for therapy supports for children of school-going age.

James Reilly (Dublin North, Fine Gael)
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The Minister has referred to the transfer of €77 million from the fair deal scheme to the refund scheme. Already, therefore, we have been presented with a supplementary provision. Some €70 million is allocated for the new deal with consultants, €350 million is set aside for repayment to the United Kingdom health authorities, who hotly dispute the bill they received from the HSE, and some €60 million is allocated for pharmacies, although in her supplementary budget for this evening, the figure indicated by the Minister is closer to €32 million or €34 million.

Will the Minister give us some idea of the areas in which she will curtail the roll-out of programmes in order to make the savings to which she alludes in that document? My question was how the Minister plans to maintain the 2008 service level in 2009. How will this be achieved given the cutbacks already taking place? These include the closure of the orthopaedic unit in Navan, of 31 beds in Mercy Hospital, Cork, and of orthopaedic services at Naas General Hospital. Hospitals in Galway and Blanchardstown are withdrawing services under the pressure to break even. The 12-bed orthopaedic unit in Letterkenny is to be closed and cutbacks are taking place at Mayo General Hospital.

Can the Minister give a commitment that there will be no reduction in front line services to patients in 2009 given the budget she has been allocated and the supplementary allocation she is seeking this evening?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Regarding appropriations-in-aid, as the Deputy is aware, when citizens of one country come to reside in another, the country where such a person spent his or her working life traditionally pays for health services provided. In this case it seems we were overpaid in the past which is the reason for the discrepancy. Apparently, the amount of money we received was significantly out of line according to the agreement reached concerning the services provided. I am not yet in a position to give a definitive answer on the service plan, but we will discuss it at the Oireachtas Joint Committee on Health and Children later this week. I am currently in discussion with my officials on this matter.

I want to see an increase in day activity and a reduction in in-patient activity in hospitals. I seek a move in line with best international practice in this area. I also wish to see shorter in-patient stays where such in-patient stays are required. I believe if we could move more rapidly to day stays and shorter stays in general we should be able to provide the level of service envisaged for 2009. I have stated in the House on several occasions since the budget that we face a challenge during 2009. Given the overall increase in the Department of Health and Children Vote including capital and current expenditure, the increase is less than 2%, which is the smallest increase in 13 years. The annual increase has been running at an average of 9% for each of the past 11 years.

James Reilly (Dublin North, Fine Gael)
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How will this be achieved? In 2002 and 2007 3,000 extra hospital beds were promised. The Minister delivered 1,300, but this year she reduced by 500 the number of beds and plans to reduce by 600 the number of beds next year. This amounts to 1,100 beds taken out of the system and there is no sign of any co-located hospital beds. I fail to see how the Minister will manage it.

Mary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy is aware the matter of co-location arises in the next question and we will deal with the matter then. The big issue with acute hospital beds is how they are used, it is not only the number of beds involved. There can be a significant discrepancy between hospitals in the country in the level of activity between one and another even if the budgets are very similar. That is the reason I seek more day case activity and shorter in-patient stays for hospitals. I believe with such changes we can deliver the level of service necessary in the country during 2009.