Billy Kelleher (Cork North Central, Fianna Fail)
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Question 1: To ask the Minister for Health if he will publish the contingency plans for dealing with the public sector retirements; the effect the retirements will have on frontline services; and if he will make a statement on the matter. [8730/12]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 2: To ask the Minister for Health if he will confirm the final number of persons who will have retired from the public health services between September 2011 and the end of February 2012 under the current retirement scheme; if he will outline the dynamic contingency plan to deal with the loss of such large numbers of staff to which he has referred; and if he will make a statement on the matter. [8729/12]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 1 and 2 together.

The most recent information available to me indicates that approximately 4,200 individuals will have left the health service between September 2011 and the end of this month. The corresponding wholetime equivalent figure is about 3,700. These figures are subject to change for various reasons, one being the time lags involved in collating data at national level. However, management at local and regional levels have full details of the staff who have already left or will leave by 29 February. Over 2,000 individuals had already left by the end of January. The figures are subject to further change because those who have indicated their intention to leave can change their minds right up to 29 February. Others may choose to leave who have not indicated this to date.

Planning for the impact of the end of the grace period began last autumn and a formal transition team for the health service, chaired by an assistant secretary from my Department, is in place. It comprises key HSE national and regional directors. Contingency plans have been developed locally for hospital and community services, reflecting risk assessments undertaken by each hospital or community manager. These have been reviewed at regional and national levels to ensure appropriate contingency measures are in place across all services.

I am satisfied that suitable arrangements are in place at national, regional and service-specific levels to manage proactively the impact of staff exits on front line services. The focus is on protecting and maintaining critical front line services such as emergency department, maternity, critical care and neonatal services.

The recently approved HSE National Service Plan 2012 acknowledged that there will be an inevitable and unavoidable reduction in services this year because of the scale of the financial and staffing challenges facing the health service. Obviously, I would prefer to have more funding available for our health services but the reality is that this is not possible right now. There is, therefore, an onus on all of us working in the health services to be as innovative and flexible as possible in order to mitigate against the impact on services of reduced budgets and staffing.

The mitigation measures in place include the backfilling of certain critical posts. However, the main focus is on reform and achieving greater productivity. The national clinical programmes are already delivering improvements in day-of-surgery admission rates, increases in the proportion of care that can be delivered on a day-case basis and other productivity improvements designed to provide a better quality service to patients at less cost. I very much welcome the clinical leadership that is being provided in this regard. I acknowledge and welcome the improvements in productivity that are being delivered by staff at local level through the Croke Park agreement. Examples pertain to staff redeployment, streamlining of management structures, including clinical management roles, changes in skill mix and more cost-effective rosters.

The national service plan has already been published and the regional service plans are in the process of being finalised and published. However, the need for dynamic and proactive management of the impact of reduced budgets and staff will remain and will continue beyond 29 February.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister for his reply. The publication of a contingency plan was raised on numerous occasions on this side of the House. The plan would not only give reassurance to us but also to the public and those involved in health services.

In response to questions from the leader of Fianna Fáil and other Deputies, the Taoiseach was unsure whether there was a plan. He stated at one stage we can take it the HSE has a plan. However, when we asked for further detail and specific information, it became very evident that a plan was only being put in place. The Minister has known since taking office that a large number would be retiring on 29 February 2012, many of whom will be highly skilled specialists in front line services. Merlin Park hospital in Galway should have 21 nurses but it will have only 11 at the end of February. Clearly, there will be considerable difficulties faced by the HSE and hospital services in providing front line services. Does the Minister agree with some eminent professionals at the coalface in maternity services who say people may pay with their lives because of the lack of highly qualified midwives?

Why will the plan not be published? Does the Minister agree that the efforts of the Department and HSE in ensuring adequate front line cover for those retiring are an indication that the plan was not well thought out?

James Reilly (Dublin North, Fine Gael)
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In response to Deputy Kelleher, the Taoiseach is very clear, as am I, about the presence and completeness of the contingency plans in place. As I said, the situation is dynamic. We do not expect significant change between now and the end of the month but there has been much change heretofore. We had a very long meeting last night at which the CEO and four regional directors of the HSE were present, along with members of the clinical programmes. A comprehensive plan is in place.

Let me address specifically the issue raised in regard to the inflammatory and very upsetting remarks made by a leading professional which caused needless upset and anxiety among women looking forward to the birth of their babies. There is a very coherent, stringent, clear plan in place to deal with identified risks, including midwifery. In Limerick, 16.5 wholetime equivalents are to leave and there is provision for 15 to be in place when that happens. The clinical lead there is quite happy about safety.

When going through our contingency plans for different hospitals, as we did last night, we noted that, in some cases, one third or half the staff are being replaced and that, in other cases, perhaps only one fifth, one sixth or one seventh of the staff are being replaced. The service can be delivered with different types of rosters and skill mixes than we have at present. This must be achieved when there is a restricted budget and a moratorium on recruitment and a ceiling on staff levels.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I have to hand a copy of the Dublin North East Service Plan. I find no more dynamic contingency planning within this than I did within the national service plan, which was introduced a couple of weeks ago. It is important to deal with this because it is the only specific information we have. I expect it will be replicated in the other three regions of the HSE. It actually demonstrates that, by 29 February, we will witness the retirement of a further 400 staff. Worryingly, we also learn, for the first time, that a further 551 staff "will need to leave the service this year". It is not a case of voluntary retirements but it is stated very definitely that they will need to leave the service. Will the Minister acknowledge that the departure of 961 health service staff within one region will have devastating consequences for service delivery and, make no mistake about it, for patient safety, which is something the Minister is not happy to address?

Will the Minister confirm that what we are looking at in this plan is what presents across Dublin mid-Leinster, the west and south? The plan states there will be no replacement in terms of recruiting priority staff who will have left until such time as the entirety of this exodus is achieved.

James Reilly (Dublin North, Fine Gael)
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I see Deputy Adams is at Deputy Ó Caoláin's side. I was here this morning when he made his contribution. It seems to me when words such as "there will be a devastating effect" are used, it is almost as if Sinn Féin wished for there to be a disaster.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Far from it.

James Reilly (Dublin North, Fine Gael)
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It is as if they hope there will be some sort of calamity or catastrophe so they can continue on shroud waving. The reality is that Dublin north-east, Dublin mid-Leinster, west and south have all got their contingency plans. Individual hospital managers have their contingency plans and are fully conversant with the number of staff leaving, as well as what must be done to maintain a safe service. In each case they are acutely aware that not alone are they responsible for formulating that plan, but they must also be prepared to go on local radio to explain its effects to the public. I am confident that a comprehensive piece of work has been done. I congratulate all those involved and thank in particular the staff for the flexibility they have shown concerning the required changes, including rostering issues. I am confident we will be able to maintain a safe service, particularly in areas of high risk we have identified, such as emergency departments, maternity services, intensive care and paediatrics.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister's reply did not address the questions I posed. Government Deputies from the north east will be shocked to learn for the first time that this report has signalled the departure of those taking up the early retirement option by 29 February. In addition, following that, there is a requirement for a further exodus - "need" is the word used - of 561 staff across the health service. Is that also the case in the service plans for the other three areas? If so, I ask the Minister to withdraw these service plans which are a recipe for disaster. We already have a crisis of untold proportions in our health services, so at the very least, the Minister should indicate that he will set a date for lifting the recruitment moratorium. In that way we could replace essential front line staff.

Billy Kelleher (Cork North Central, Fianna Fail)
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The director of the HSE's obstetrics and gynaecology programme, Professor Michael Turner, said staff reductions could have an impact on Ireland's maternal and infant mortality rates.

Róisín Shortall (Dublin North West, Labour)
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Could.

James Reilly (Dublin North, Fine Gael)
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He said "could", but the Deputy should finish the professor's sentence.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am just making the point. The Dublin north-east service plan and the projected number of maternity cases presenting this year, indicate that maternity hospitals will be under huge pressure in that region and elsewhere across the country. Will the Minister publish the detailed plan for emergency and maternity services so we can have some idea of where we are going with those services? There is concern among both the public and staff who are working at the coal face and are trying to provide safe services.

James Reilly (Dublin North, Fine Gael)
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As regards Deputy Ó Caoláin's question about the three other service plans, there is not a need for the same number of exits. The lowest number of exits is from Dublin north-east. The contention that this is a recipe for disaster is utterly untrue - in fact, it is a formula to prevent any such disaster and ensure a seamless transition. We have put in place several different contingencies to allow for any problem areas that might arise unexpectedly. A comprehensive study has been undertaken of all people leaving the health service, including their grades and posts, so that replacement staff can be put in place where they are needed. In some places, one may find that where 16 people leave, they will all be replaced. In other places, however, where 35 leave only six have been replaced which is due to the nature of the service and the areas of expertise involved.

We are not lifting the moratorium but I have greater flexibility around it, by agreement at Cabinet, so we can examine specific areas where there is a risk and replace people accordingly. That is exactly what we are doing in this contingency plan.

Deputy Kelleher quoted Professor Michael Turner, but he will note that the word "could" is in there. If the Deputy was prepared to read the remainder of Professor Turner's statement he would find there is a big "if" there also. The statement said it could be a serious problem if proper measures are not put in place. However, the plans are in place and the measures will be in place also. Maternity is an area we were particularly concerned with, but the Deputy will find that many of the midwives leaving our service will be replaced.

Billy Kelleher (Cork North Central, Fianna Fail)
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The staff are not saying that.

James Reilly (Dublin North, Fine Gael)
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I have talked to the people in charge who have responsibility, including the national director and regional director of the operation who are in charge of hospital directors and managers. The contingency plans are in place and there is no way we will have an unsafe service. We have had two major meetings on this matter and will have a further one before the end.