Jan O'Sullivan (Limerick East, Labour)
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Question 35: To ask the Minister for Health and Children if she has received proposals from the Health Service Executive for the cuts it proposes to make to achieve the savings in its budget required of it by the Government in 2009; the action she will take to protect patients from the effects of these cuts; the estimated number of bed closures envisaged in these proposals and the timeframe; and if she will make a statement on the matter. [13183/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The HSE is facing significant financial pressures. These are due to a range of factors, including the implications for the HSE of the broader economic circumstances of the country. There have been intensive ongoing discussions between the executive and my Department regarding the executive's emerging financial position. Based on figures for the end of January and the end of February, the best estimate of the shortfall in HSE funding for the year was in the order of €480 million, including a shortfall of €100 million in health contributions. Subsequent to this overall assessment, the Department of Finance has notified an increase in its revised figure for the shortfall in health contributions from €100 million to €160 million. This figure is being kept under review in the context of the overall economic circumstances.

All projected overruns are influenced by the difficult circumstances we are in and subject to the limitations of forecasts. I wrote to the chairman of the HSE earlier this month and emphasised that it was crucial that the HSE manage the costs in its control. I indicated that under the circumstances, the HSE should focus on the measures required to be implemented to deliver on the service plan as outlined to me. As I have indicated to this House, the challenge to the HSE to break even within its financial allocation, while still protecting services, will present major difficulties. The board had previously agreed measures amounting to some €133 million and was asked to further examine how it could achieve another €72 million in savings.

I have indicated to the board that issues such as the income loss in health contributions, extra costs associated with the long-stay repayments scheme or the extra costs arising from increased medical card numbers will have to be considered by the Government in the context of the supplementary budget, which will introduced to the House next Tuesday.

The board of the HSE met yesterday to further consider its financial position. I understand a revised service plan will be submitted to me within the next five days. It will include proposals to save the further €72 million. I will consider the proposals contained in the revised service plan when it is submitted for my approval in accordance with the Health Act 2004.

Jan O'Sullivan (Limerick East, Labour)
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I thank the Minister for her reply. I understand she has not yet received the revised plan. When she does, will she establish a bottom line as regards the services she will protect? What will occur if she does not agree with the plan? Will she be in a position to reject it or will she make alternative proposals if she feels it is too harsh on health services?

Is it true that the cuts will include cuts to the home help service and cuts in respect of acute hospital beds, as reported in a newspaper today? If true, will the Minister approve the cuts? It is clearly policy that people should be catered for in the community or their own homes, where possible, and it is clear that cuts to the home help service will affect that. What is the Minister's bottom line with regard to health cuts and the protection of the patient?

Did the Minister state, in respect of the levy, there will be a shortfall of €160 million rather than €100 million? Where will the €60 million be found? We were only aware of a shortfall of €100 million the last time we received answers.

I do not know whether the Minister wants to refer to the cystic fibrosis issue given that it will be discussed on the Adjournment tonight. It is the cause of serious concern. I realise the problem relates to 2010 but money pertaining to 2009 is obviously involved.

Charlie O'Connor (Dublin South West, Fianna Fail)
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That issue is referred to in the next question. I call the Minister.

Mary Harney (Dublin Mid West, Progressive Democrats)
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In deference to Deputy Reilly, who tabled a question on cystic fibrosis, I will reserve my comments on it until we take that question.

The sum of €160 million arises because of the emerging economic circumstances in March, according to the Department of Finance. I said at the committee last week that the shortfall was €160 million rather than €100 million. Furthermore, I stated in my reply to Deputy O'Sullivan's question that, in the context of the budget next week, the Government is considering the shortfall. It has a considerable impact on the HSE because it affects appropriations-in-aid and the consequent increase given the level of unemployment and the number of medical cards.

Even accepting all that, the HSE clearly has a budgetary challenge. The HSE spends approximately €1.2 billion each year on what I would call some archaic work practices. I refer to junior doctors getting paid for their lunch and to live out of the hospital. These are practices that would never be negotiated in current circumstances. The priority for dealing with the financial constraints must be in the context of that envelope of very rigid work practices whereby we cannot deploy people from where they may not be needed to where they are needed.

When the HSE submits its service plan to me, I will want to ensure it is dealing with issues such as travel and subsistence, work practice issues and legal issues. The HSE spends an enormous sum each year on legal issues. Since we are reducing professional fees to doctors, dentists and pharmacists by approximately 8%, I hope the HSE will be in a position to do the same in regard to legal fees. My priority will be to ensure we minimise, if possible, the impact of the financial constraints on services to patients, either within the hospital or the community, and that we maximise the potential to live within budget on the basis of some of the sources to which I referred.

Jan O'Sullivan (Limerick East, Labour)
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Will the Minister answer my question on whether she has a bottom line on what she would consider to be going too far in terms of affecting patient care?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The bottom line is that the use of the money allocated to the HSE which, in gross terms, amounts to approximately €15 billion on the current side, must be maximised in the interest of patients. Therefore, any restrictions must hit hard in areas such as travel and subsistence, work practices, overtime issues, redeployment and legal costs.

Jan O'Sullivan (Limerick East, Labour)
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It will be very hard to get those kinds of cuts in those areas.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have the power to reject the proposals submitted and suggest alternatives.