Kathleen Lynch (Cork North Central, Labour)
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Question 37: To ask the Minister for Health and Children her plans to change the governance of the Health Service Executive on the retirement of the Chief Executive Officer; and if she will make a statement on the matter. [45548/09]

Róisín Shortall (Dublin North West, Labour)
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Question 47: To ask the Minister for Health and Children the progress made in the restructuring of the Health Service Executive providing regional structures and interaction between acute services and primary, community and continuing care services; and if she will make a statement on the matter. [45559/09]

Mary Harney (Dublin Mid West, Independent)
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I propose to answer Questions Nos. 37 and 47 together. The recruitment of a new chief executive officer is a matter for the board of the HSE, as are the internal governance structures of the organisation. However, I can confirm that certain changes are being introduced in the management structures of the HSE to enable it to better manage and deliver hospital and community services in a more integrated way and to strengthen the role of clinicians in the delivery of services.

In October 2009 the chief executive officer announced that four regional directors of operations were being established. They are accountable and responsible for the delivery of all health and social care services in the existing four geographical areas. In addition, the National Hospitals Office and the primary, community and continuing care directorate were being replaced by an integrated services directorate with two national directors; one responsible for reconfiguration and the other for performance and financial management.

The HSE is also in the process of appointing care leaders – one each for mental health services, disability services, children and family services and services for older people. The appointees will set out operational plans and delivery targets for their areas of responsibility and will be the key link with the Department and external stakeholders.

A new national director of quality and clinical care, Dr. Barry White, has been appointed. His role is to strengthen clinical leadership, improve clinical performance and ensure care is delivered in a way that maximises quality while minimising expenditure. This will involve the development and implementation of care pathways, protocols and standards for different disease programmes, particularly chronic diseases that have a high impact on the health system. In addition, support functions such as ICT, procurement and estates have been amalgamated into a single directorate. The posts which I have mentioned are being filled from within the existing complement of staff.

The aim of the new management arrangements is to deliver excellent health outcomes for the population by driving the integration of hospital and community services, ensure more efficient use of resources, ensure clear lines of management accountability and support its strategy of shifting the balance of activity towards prevention and community-based care and away from hospital-based care.

Jan O'Sullivan (Limerick East, Labour)
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On 1 January next, the HSE will have existed for five years. Everyone acknowledges that its layers of administration are top heavy. Will some posts be taken out at that level? When Professor Drumm took up his position, he brought in what has been described as a kitchen cabinet in addition to those already in the health boards. Will the Minister streamline the governance of the HSE?

At the estimates meeting of the Oireachtas Joint Committee on Health and Children last week, the Minister told us she planned to reduce the numbers working in the HSE by 6,000 by removing 8,000 in some way or another and adding 2,000 for development of services. Now that the talks with the unions have broken down, does the Minister still expect to achieve that reduction and, if so, how? Will there be involuntary redundancies or has she had time to think about how she might achieve this?

Mary Harney (Dublin Mid West, Independent)
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In response to the last question, the Minister for Finance will make announcements about public service numbers in the course of his budget speech tomorrow. If the changes in the health service suggested last week, the five over seven, 8 a.m. to 8 p.m. day, redeployment and flexibility can become the norm, as most people seem prepared to accept, they will have a major impact on the capacity to make things happen speedily-----

Jan O'Sullivan (Limerick East, Labour)
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It could have been achieved if the Government had reached an agreement last week.

Mary Harney (Dublin Mid West, Independent)
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-----particularly as we seek to integrate community and hospital services in a more orderly fashion than ever before. We want to move staff from providing the service in the hospital to providing it in the community and redeployment within a reasonable geographic radius provides that opportunity. One if not two of Professor Drumm's advisers have already left the HSE. The contracts of employment of the remaining two will cease when Professor Drumm is no longer chief executive officer from next summer. The board is advertising this week or shortly for a replacement.

The number at directorate or senior management level in the HSE will not change with the new arrangements. There is scope to take people out. There has been a significant interest in early retirement from the public sector, not least the health sector. We had a supplementary budget last week partly because of the increase in those numbers. A large proportion are from the management, administrative or support staff. With the moratorium, those who retire at that level will not be replaced apart from in exceptional circumstances so, for example, one replaces the CEO. Where there is scope for efficiencies, people will not be replaced in what is broadly called the front line services.

James Reilly (Dublin North, Fine Gael)
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The Minister said earlier last year that she would pursue redundancies, yet when she was asked about it at the end of last year, she said it was a matter for the Minister for Finance. Today again, having told us last week that there would be redundancies, she has put it back into the lap of the Minister for Finance. Who will take responsibility for the HSE? What has changed that makes the Minister believe she can achieve redundancies? In the past she has said that the unions were not co-operating and that there was very little uptake. Will the new posts result in increased salaries or will they be the same or lower, given that everybody else is taking a cut?

Mary Harney (Dublin Mid West, Independent)
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The Minister for Finance is responsible for the public service. That is factually correct. Of course we can reduce numbers within the HSE and I have said before, including last week, that the intention is to reduce the number by 8,000 but recruit back 2,000, making a net reduction of 6,000. We want to recruit consultants, specialist nurses and health care therapists and other specialists that we require in the service. A voluntary redundancy scheme for the public service was announced in last year's budget. We did not implement it in the health sector because it cannot be applied without redeployment. It would not be possible, for example, to have a large number leave from one hospital without being able to redeploy people from another. At present, it is not possible to redeploy from one part of a hospital to another. Any voluntary redundancy scheme must be accompanied by a redeployment scheme; otherwise, we would not achieve the savings envisaged and the voluntary redundancy scheme could be quite expensive. The people who have retired are those who were close to retirement age. That is why the number was higher this year.

The Minister for Finance will enunciate pay policy in his budget speech tomorrow. Any pay reductions that apply to Ministers, politicians and public servants will apply to posts within the HSE and the wider public service.

Jan O'Sullivan (Limerick East, Labour)
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Does the Minister agree it is very disappointing that the talks broke down, particularly in respect of the health service because of the likelihood of achieving agreement on redeployment, flexibility and an 8 a.m. to 8 p.m. working day? Following the breakdown of the talks, will it not be very difficult for the Minister to achieve what she wants to achieve with regard to streamlining the HSE? Is it correct to say that only 16% of those who opted for early retirement were in the administrative or management grades?

Mary Harney (Dublin Mid West, Independent)
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That would be a higher proportion. One must include support staff too.

It is a great disappointment because we were discussing last week everything that had been sought for the past five years and which is central to the transformation of our health service, including a longer working day, a five over seven working week, different rostering and particularly redeployment. These are all central if we are to move from hospital-based services to community and primary care and to have the appropriate staff ratios and so on. I hope we will be able to resume that agenda very quickly. When everybody has had an opportunity to reflect and perhaps have a break because there were a lot of all night meetings over the past few weeks-----

James Reilly (Dublin North, Fine Gael)
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A change is as good as a break.

Jan O'Sullivan (Limerick East, Labour)
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There is small chance of that happening.

Mary Harney (Dublin Mid West, Independent)
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I hope we can return to that agenda very early in the new year. I am delighted to have the Deputies' support for that agenda. That applies to other aspects of the public service.

Jan O'Sullivan (Limerick East, Labour)
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The Minister will find it very hard to do that.

Mary Harney (Dublin Mid West, Independent)
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I believe public servants are in favour of change and they know the kind of change that is necessary. I believe they are willing to respond.