Charlie McConalogue (Donegal North East, Fianna Fail)
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We are seeing a repeat of a trend in the health service since the Government and, in particular, the Minister for Health, Deputy James Reilly, took office. There has been almost a 50% increase in the cost of health insurance for families. At the start of the year the Minister announced a 40% increase in the health insurance levy charged to health insurance providers. The levy was to ensure the companies would not increase their prices, but VHI increased the cost of cover for older people by up to 12.5%.

The Minister said he would not be closing any hospitals. This was the same promise given during the general election campaign with regard to Roscommon County Hospital and other hospitals, yet when the HSE service plan was published just a few weeks ago, up to 900 community hospital beds were to be closed across the country.

The Minister stated the retirement of staff under the early retirement scheme would not result in a diminution of services or have an adverse impact on patient treatment times. This week, however, he has admitted that elective treatments may have to be postponed or delayed, for which he makes no apology, despite having tried to create a mirage in the past few weeks by saying there would not be an impact on services.

The one area in which treatment is not elective is maternity services. Babies will continue to be born; the Minister cannot apply the brake and tell people to hold off in terms of the number of babies born in the State. However, as of last week, staff were leaving maternity units across the country and the Government had no plan as to how the situation would be dealt with. The Taoiseach has announced that transition teams will be in place, but how will the Government ensure services for newborn babies and their mothers will be in place?

I refer to comments made by some of the professional staff working in maternity services. The director of the HSE obstetrics and gynaecology programme, Professor Michael Turner, said staff reductions and cuts to HSE maternity service programmes could result in an increase in maternal and infant mortality rates. His concern is that unless we prioritise maternity services, we will see an increase in the number of maternal deaths if resources are cut too severely. That is the price that will be paid.

I refer to staff reductions in the Mid-Western Regional Maternity Hospital which will occur next month. Consultant obstetrician Gerry Burke has stated a huge exodus of the most experienced midwives from the hospital is taking place. He has also said that if the HSE has a comprehensive plan, it is not sharing it with staff. The Rotunda Hospital is losing 11 midwives, while eight are due to leave Holles Street Hospital. One in four midwives is leaving the maternity hospital in Limerick. How can the service be maintained? Will the Minister of State outline the plans in place and how this most non-elective of services will be maintained to ensure newborn babies and their mothers are given the service they require and expect? I hope she can give the House some information on the transition teams and how maternity services will be protected.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this matter to which I am replying on behalf of my colleague, the Minister for Health, Deputy James Reilly.

The question put to the Minister by the Deputy was: "To ask the Minister for Health if he will publish the plan for dealing with midwifery services, particularly in Holles Street, which may be affected by retirements at the end of the month". There is no indication in this question of the additional issues raised by the Deputy. I ask him, therefore, to excuse me if I do not respond to them. Any additional information required will be provided for the Deputy.

The Minister is aware of the impact the early retirement package will have on the provision of maternity services and all services nationally. He has requested the HSE to prioritise the safety of patients and the avoidance of risk in the delivery of services for them. Planning for the delivery of health services is undertaken within the context of the annual national service planning process which ensures all factors, including budgets and staffing levels and any other emerging issues, including the impact of retirements, are factored in in the plan for the services to be delivered within the coming year. In parallel with this process, each of the HSE's four regions is required to develop a more detailed regional service plan. Managing the specific risks associated with the forthcoming retirements has been undertaken within this planning context and will form part of the soon to be published regional service plans.

It is anticipated that 9.16 whole-time equivalent midwives and nurses will retire from Holles Street Hospital.

The hospital is planning to take a number of steps to minimise the impact of these retirements and to ensure the ongoing delivery of safe services for mothers and babies. Some of the posts affected are in the management area and their duties will be reallocated among other staff. The hospital is examining options around re-organisation of wards and rosters to minimise the impact on services to patients. Contingency plans and measures are in place at service level and will continue to be refined in advance of the end of February deadline and will focus on staff redeployment, streamlining and cross-cover arrangements. In addition, revised staff rosters and skill mix options are also being utilised.

The accelerated implementation of the national clinical programmes are key strategic supports to the risk management process which is in place around these retirements. The related work of the special delivery unit on emergency departments, surgical and outpatient waiting times and reorganisation of specialist medical services and bed utilisation will also be critical in supporting the achievement of overall resource management in the coming year. The national service plan recognises that certain positions may need to be filled, subject to the overall pay and number targets for 2012 being met. Agency staff may be used where there is a critical requirement. However, any reliance on agency staff will be in the context of the HSE's objective to reduce overall agency costs by 50% in 2012. The Minister is determined to ensure the measures being taken now will lead to a smooth transition in services for patients following the retirement of staff at the end of February. I again thank the Deputy for raising the matter.

Charlie McConalogue (Donegal North East, Fianna Fail)
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Unfortunately, the response of the Minister of State does not give me any heart or additional assurance-----

Kathleen Lynch (Cork North Central, Labour)
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In fairness, the Deputy did not ask.

Charlie McConalogue (Donegal North East, Fianna Fail)
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I know. I refer to how the Minister for Health and the HSE has prepared for the retirements. The Minister of State referred to how the HSE's regional service plans will deal with the situation, yet the HSE's national service plan was only published in mid-January, two weeks into the year. As of last week it became clear what the retirement levels would be at the end of next month, but we have now to wait on the HSE's regional service plans to deal with that. What advance planning has taken place? What effort has been made to ensure cover for those critical services that cannot be replaced overnight, such as midwifery? I got no reassurance in that regard from the response I received.

It is one mirage after another with the Minister. He said there would be no cuts to the number of beds, no increase in health insurance premia and no reduction in services as a result of retirements. That is the mantra we get from the Minister, yet when it comes to the crunch that is not the case. When it comes to the crunch in terms of retirements, the Minister has said we will have to cut back on elective procedures and we will probably have longer waiting lists. The need for midwifery services does not fall into the elective category. One cannot simply click one's fingers and get new midwives in overnight or the next week simply because a number of them have retired.

I see no evidence to date, nor in the response today, that the HSE or the Minister is on top of the issue or has any grasp of how we will deal with it. Consultants have said that if there is a plan, they have not seen it. That is not good enough. There has been a failure in terms of advance planning. Today's response does not in any way address the issue. I hope that in the coming days remedial action is taken to ensure the health of new babies and mothers is not put at risk in any way by this failure by the Minister and the HSE.

Kathleen Lynch (Cork North Central, Labour)
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The regional service plans are completed. Every region must make its submission to the national service plan and, therefore, most of the work has been done. Despite the fact that the bulk of what happens in midwifery is the delivery of babies, not all of it relates to the delivery of babies. The remit is a little wider than that. I will not go into detail but, nevertheless, more is involved than that.

It is difficult to put a plan in place when one inherits a country that has been wrecked. The scale of what the Government has to deal with is enormous. As Deputy McConalogue's colleague, Deputy Calleary, is aware, I do not go in for the rhetoric of blame. We are busy enough trying to sort out the problem. The depth of the recession that this country is in dictates that we must make hard choices in the future. We must manage how we go forward. I agree entirely with Deputy McConalogue that the safety of mothers and babies is paramount. We must examine where we can plug those gaps. That is being considered as we speak. No one should underestimate the scale of the trouble this country is in.