Robert Troy (Longford-Westmeath, Fianna Fail)
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Question 6: To ask the Minister for Health the steps he is taking to tackle hospital deficits; and if he will make a statement on the matter. [1195/12]

James Reilly (Dublin North, Fine Gael)
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According to the latest available information, the HSE managed to achieve financial break-even within its overall Vote last year. While it was assisted in this regard by the Supplementary Estimate of €148 million, it is important to acknowledge that €58 million of this was attributable to a shortfall in the funding provided to the HSE earlier in 2011 for the pay savings arising from the voluntary exit schemes which ran up to the end of 2010 and departmental savings on its Vote of approximately €40 million which reduced the net impact on the Exchequer.

It was recently stated in the headlines of a newspaper that the Department of Health had handed back €40 million which it had not spent. This is a technical issue. The Department of Health cannot hand over the €40 million to the HSE. It must hand that money back to the Exchequer which in turn allocates it to the HSE in a Supplementary Estimate. That is the way it works. Given the scale of the HSE Vote and difficulties that any health service faces in managing within budget, this has to be seen as a very satisfactory outcome.

Given the €750 million saved last year and the year before that and the requirement to save €750 million this year, real innovation will be required to maintain the service. We now are at a point at which we depend on real innovation to maintain the service. However, such innovation and the new clinical leadership behind it are coming to the fore. That said, I am aware the acute hospitals are entering 2012 with an underlying deficit based on their rate of spending in the latter part of last year. This clearly will add to the difficulties facing hospitals this year in managing within reduced budgets and staffing levels. The HSE estimates at this stage that the overall underlying deficit for acute hospitals is in the region of €160 million, but this is subject to revision in the light of detailed end of year figures. This is an average figure and the challenge facing individual hospitals varies. I am advised that some hospitals achieved a break-even position or are carrying forward relatively small underlying deficits, whereas others have substantial deficits. A number of hospitals are facing particularly difficult challenges in this regard and therefore must focus on maximising cost reductions, income collection and effective clinical changes.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister for his reply. Obviously I accept there is huge pressure on hospitals in the delivery of front-line services in particular. However, this goes against every statement made last year by the Minister and the Government in the context of protecting front-line services. As a fair and reasonable person, I wish to give the special delivery unit time to work to ascertain whether it is having a real impact and is effecting change. However, there is a belief abroad that there was a massaging of the figures regarding how the waiting lists were analysed in respect of a 12-month period in the first instance and, in the context of waiting lists, on what patients were waiting for more than 12 months as a part of this assessment. As for people waiting on trolleys, the claims made by the Minister that fewer people are now waiting on trolleys on a daily basis in the accident and emergency units is correct. Equally, however, if one speaks to anyone who works in the front-line services, as I acknowledge the Minister does, they also will state the wards now are being overcrowded. In other words, the issue simply is being shifted from one area of a hospital to another and there has been no real, meaningful increase in the output and throughput of patients.

James Reilly (Dublin North, Fine Gael)
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To reassure the Deputy opposite, protecting the front-line services still remains a priority and everything will be done to achieve this, notwithstanding the extremely challenging financial position in which we find ourselves. I reject any notion that there has been a massaging of figures. In a previous answer, I made clear how the figures were reached. Anyone waiting on a list before December 2010 was included as being a possible person who was still waiting and had to be treated by the end of December 2011. This amounted to 14,000 people and the fact this number now is in the low hundreds, all of which relate to Galway, speaks for itself in respect of the great efforts made by the service to achieve this goal. Moreover, as I stated, the target for the coming year is nine months, that is, no one will be left waiting for a procedure for longer than nine months.

Billy Kelleher (Cork North Central, Fianna Fail)
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As for the hospitals which are in severe difficulty and are bringing forward deficits from 2011 to 2012, I refer to the Minister's proposed changes to how hospitals charge private patients. Is there not an added incentive that in future, hospitals will prioritise private patients, given their ability to recoup the full costs from such patients? Moreover, in the context of hospitals being individualised into trusts over a period of time, could this not incentivise private patients over public patients to reduce budget deficits?

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy opposite for confirming there are fewer people on trolleys. The figures are there for people to see, and they speak for themselves. It is not good enough. I have said that.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister should not deny the facts.

James Reilly (Dublin North, Fine Gael)
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We wish to go further. By the middle of the year we wish to bring in the six hour target in respect of the patient experience. The goal is that the time from when one enters an emergency department to the time one leaves or is admitted should be six hours for 95% of patients.

The Deputy is absolutely correct. I have considered this issue and have had quite a number of discussions in this regard with both Ministers of State, Deputies Shortall and Kathleen Lynch, on the danger that public hospitals would be incentivised to treat increasing numbers of private patients. This has been accommodated within what is planned because once the hospitals pass a certain quota, they will not be allowed to keep any of the money. Consequently, there will be no incentive for them to continue to do this.

Michael Kitt (Galway East, Fianna Fail)
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Briefly, Deputy Ó Caoláin.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I note the Minister now has given assurances twice to his junior ministerial colleagues that he will be consulting them on issues and, at the outset of 2012, I am sure this will be a highly welcome development both on their parts and those of all Members.

The Minister should make no mistake but that hospital deficits have a direct impact on patient care. Never mind the long term, Members are witnessing short-term temporary closures of wards and beds. The situation is serious and part of the solution to deal with it pertains to developing real efficiencies. However, the Minister is not consistent. For instance, he has cited his appeal to the management at both Galway and Limerick to consider redirecting certain procedures, which from their perspective are non-intensive, from their respective sites to smaller hospitals in the region. The Minister instanced how hernia operations or procedures are to go to Ballinasloe or Roscommon. This is welcome because Members want to see decentralisation-----

Michael Kitt (Galway East, Fianna Fail)
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Deputy, can we have a brief question?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----to some of the smaller hospital sites. The Minister lauded and applauded the situation-----

Michael Kitt (Galway East, Fianna Fail)
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A question please, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Yes, it is a question. The Minister lauded and applauded the position in Louth County Hospital, Dundalk, in respect of cataracts. At the same time, however, why does the Minister continue to preside over closures of critical outpatient services at several hospital sites throughout this State, while signalling even further cuts in that regard? There is no consistency in the Minister's position-----

Michael Kitt (Galway East, Fianna Fail)
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Thank you Deputy. I must call the Minister for a final reply.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----only confusion, and people are suffering as a consequence. How does the Minister respond?

James Reilly (Dublin North, Fine Gael)
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In response to Deputy Ó Caoláin, it is very early in the year to be working oneself up into a rage.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Members already have had 12 months of the Minister and I can be excused for it.

James Reilly (Dublin North, Fine Gael)
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Not yet. Only ten months.

Michael Kitt (Galway East, Fianna Fail)
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We can all make good resolutions now. The Minister to reply.

James Reilly (Dublin North, Fine Gael)
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It will be 12 months, please God, and I can have my assessment then.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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God, what will that be like?

Ray Butler (Meath West, Fine Gael)
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The Deputy should check the position in the North. It is exactly the same.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Deputy should not worry.

Michael Kitt (Galway East, Fianna Fail)
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Please allow the Minister to respond.

James Reilly (Dublin North, Fine Gael)
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Equally, Deputy Ó Caoláin deliberately mishears when it suits his purpose.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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No, these are things the Minister has said.

Michael Kitt (Galway East, Fianna Fail)
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Please allow the Minister to respond.

James Reilly (Dublin North, Fine Gael)
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What I stated only a few moments ago was that I had consulted and had been consulting with both of my colleagues in government a number of times. Moreover, I will continue to so do and, contrary to what the Deputy wishes to imply, this is no new development.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am pleased to hear that.

James Reilly (Dublin North, Fine Gael)
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However, the Deputy is quite right to mention Louth County Hospital because it exemplifies what is achievable in a smaller hospital and how no longer having a 24-hour emergency department does not mean one's hospital does not remain vibrant and a source of great service to its community. As the Deputy noted, approximately 1,000 cataract operations have been carried out there where none was performed previously, as well as 3,000 colonoscopies, several thousand phlebotomies, while more care of the elderly cases have been looked after, more surgery, more day cases and so on. I perceive the future for smaller hospitals to lie in the provision of a safe service in good surroundings by caring and highly professional staff.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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However, this is not being done across the board.