Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 2: To ask the Minister for Health the status of the Health Service Executive draft service plan for 2012; if he has approved all or part of it; the process for assessment of its proposals and approval or rejection thereof; if the plan will be put before Dáil Éireann for debate; and if he will make a statement on the matter. [1360/12]

James Reilly (Dublin North, Fine Gael)
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The HSE submitted its draft National Service Plan 2012 to me on 23 December last and it is currently under consideration in my Department. In line with the Health Act 2004, the plan sets out the type and volume of services to be delivered by the executive for the moneys allocated under its Vote.

The budget provision for 2012 represents a major challenge to the HSE and comes at a time of significant reform of the public health system. The HSE will be required to deliver, at a minimum, the levels of service set out in the plan as well as operating within the limits of its voted allocation of €13.317 billion. The bulk of the reductions the HSE is required to deliver in 2012 will impact on front-line services more directly than in previous years. This is partly because of the anticipated reduction in the numbers of staff at the end of the so-called grace period on 29 February. I intend to review the plan once the impact of the grace period exits is known. This is not an exit scheme; this is a period of grace under which people can leave the service under the current terms and conditions applying to their pensions and lump sum.

The plan will be implemented in the context of ongoing radical reform of the health service and the significant restructuring of the HSE which I recently announced. A rigorous examination of budget allocations is being undertaken across the care programme areas with the explicit aim of reducing the impact on services and identifying where efficiencies will be driven. This process has involved re-prioritising funding to protect areas of greatest need and meet programme for Government commitments.

While it will be impossible to avoid an impact on service delivery in 2012, the plan will commit the HSE to minimising this impact by fast-tracking new, innovative and more efficient ways of using the reducing resources. It will reflect the need to move to models of care across all care groups which treat patients at the lowest level of complexity and provide services at the least possible unit cost. It will also include a commitment to addressing staffing levels, skill mix and staff attendance patterns within the context of the public service agreement.

Once approved, the service plan will be laid before both Houses of the Oireachtas, after which it will be published. During 2012, the HSE will provide me with monthly performance reports on all aspects of the plan.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister did not indicate when he intends to sign off on the plan. He indicated it would be laid before both Houses but he did not confirm, as my question sought, that it would come before the House for debate, and there is a stark difference. Does the Minister not accept that no matter what service plan he signs off on, the fact of the matter is that we will face significantly reduced services in the course of 2012, consequent on the cuts that the Government imposed in budget 2012? The situation that has to be faced by patients throughout the State is a very serious one. We have already seen the consequences of cuts imposed by the former Government over a series of years under its administration and we know the impact that has had on the lives of ordinary people. What we will face with cuts of some €850 million, signalled for the 12 month period under budget 2012, is an ever-deepening crisis.

The Minister's reconsideration of the service plan is interesting in itself given that the Secretary General of the Department of Health is also the chairperson of the interim board of the HSE, so it is hardly a case of the dog wagging the tail, or which way is it at present? Who is in control? Could it be that the Minister and his officials had little or no input into something that presented on the eve of Christmas Eve, just gone by?

Michael Kitt (Galway East, Fianna Fail)
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Thank you, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is a jointly worked out plan that is presented annually after substantial consultation between the Department of Health and the Health Service Executive, HSE, at the appropriate level.

Michael Kitt (Galway East, Fianna Fail)
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I am sorry, but I must call on the Minister to reply.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I will conclude with these two points. In the review of the service plan as presented to the Minister in Christmas week, will he ensure that a process of restoration of now-closed hospital beds across the acute hospital network will be a part of the plan in 2012? Will the Minister take appropriate steps to remove the recruitment embargo to ensure that we will not face an ever deepening crisis in the health service with the signalled departure of some 2,000 further HSE employees under the February pension arrangements?

James Reilly (Dublin North, Fine Gael)
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In answer to the first question on when we sign off on this - it is next Friday - Friday the 13th.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is auspicious.

James Reilly (Dublin North, Fine Gael)
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There you go. Not being of a superstitious nature I do not see any problem with that date. That is what the law requires me to do and that is what will be done. The Deputy opposite has correctly highlighted the difficulties that will arise in maintaining services. That will be especially so if it is to be business as usual, but it will not be business as usual. In reply to a previous question I mentioned some of the initiatives taking place between clinical programmes and their implementation with the help of the special delivery unit, SDU. We have seen initiatives such as the orthopaedic initiative which has resulted in savings of €6 million across orthopaedic services by insisting that patients would be admitted on the day of the procedure not the night before. If patients are admitted on the day of the procedure we pay the hospital directly. In the acute medical assessment unit in Cork we have avoided the admission of patients and saved 11,000 bed days in a six month period. That could lead to a saving in that hospital alone of more than €10 million - I am told between €15 million and €17 million - in a full year. We will have precise figures on that. Not transposing excellence across the system has been the big failure of the HSE in the past. We intend to ensure the system is transposed through the efforts of the SDU and those working within the system who are buying in to these new ways of doing business in a major way because they see that it improves patient care, the number of patients that can be treated and it makes it easier for them to do their job.

Michael Kitt (Galway East, Fianna Fail)
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Thank you, Minister.

James Reilly (Dublin North, Fine Gael)
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Nobody is more frustrated than a surgeon or physician trying to do a procedure who is not able to do the work planned for the day because of a lack of beds, personnel, nursing staff or an anaesthetist. That comes down to organisation and planning, which will be addressed.

The productive theatre initiative which applied in five theatres - that is only 2.5% of theatres - saved €2.5 million. If the initiative were transposed across the system it could save another €100 million. I agree with Deputy Ó Caoláin that if it is business as usual there will be a serious impact on services but if we change the way we operate and work the impact of the plan will be minimised.

Michael Kitt (Galway East, Fianna Fail)
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I am frustrated by the time limits. I must point that out to every Member of the House. Deputy Ó Caoláin should be brief with his supplementary question.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We accept the difficulties and that there will be real challenges in terms of delivering the level of service people need, but in terms of the service plan and given the 2,000 hospital beds that are already closed in the public hospital system and the signalled closure of 62 beds in Tallaght Hospital last week, 31 of which are in a single ward, does the Minister intend to include in the service plan a plan to restore those beds, not to go ahead with the closures in Tallaght but to restore some of the other public hospital beds in order to meet the crying need that is evident? What will the Minister do in response to the departure of a further 3,000 health care workers by the February deadline? What does he intend to do in terms of those who are entrusted with the delivery of key services on which each and every one of us depend for our health at some point in the course of our lives?

James Reilly (Dublin North, Fine Gael)
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I share your frustration, a Leas-Cheann Comhairle at the lack of time. These are important issues and I am prepared to spend as much time as can be given to them.

For the information of the House, because of meetings which took place regarding the service plan between me and my fellow Ministers and the Minister, Deputy Howlin and his Department, through a re-understanding of how to deal with superannuation - and this is contingent on how many people leave the service - we have been able to reduce that €868 million down to €750 million meaning that the impact should be less. Nonetheless, it is a serious challenge. While beds are an important part of the infrastructure of the provision of care, what is really important is the level of service and the number of patients treated and this is where the focus will be. We will protect beds where this is possible but it is far better to use these beds more efficiently than to seek to open more beds.

I refer to what Deputy Ó Caoláin said earlier. I am the Minister for Health and my fellow Ministers and I are not in a position to redraft the plan. The HSE service plan comes from the HSE which is a legal entity, headed by its chief executive who has control of the Vote. He and he alone presents the plan to me. I have to interact with him through the chairman of the board and by whatever other means possible to get what I regard as a politically acceptable form of the plan to put before this House. It is baloney or nonsense - I am not saying those were the words used by the Deputy but others have used them - to say that I am writing letters to myself, but it is not baloney to say that I have to send the plan back to the Minister because that is what I must do under the law. That is how it operates.