John Halligan (Waterford, Independent)
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Question 5: To ask the Minister for Health the number of whole time equivalent positions that have been reduced at Waterford Regional Hospital since the recruitment moratorium was introduced in March 2009; the amount that has been spent on agency staff at Waterford Regional Hospital in that same time period; the target of the recruitment moratorium by the end of 2012; if he will consider lifting the moratorium for frontline staff if that whole time equivalent downsize is reached in 2012; and if he will make a statement on the matter. [8864/12]

James Reilly (Dublin North, Fine Gael)
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I have explained in an earlier reply that reducing public service numbers is an integral part of the Government's drive to reduce public expenditure. Health service employee numbers must be reduced to approximately 102,000 by the end of this year and further reductions will be required over the coming years. The regional service plans are currently being finalised and the exact ceiling for each service has not yet been determined. However, Waterford Regional Hospital is subject to the same restrictions as the rest of the health service.

Expressed as whole time equivalents, there were 1,851 employees in Waterford Regional Hospital in March 2009. By December 2011 this figure had reduced by 131 to 1,720. A significant portion of the reduction is accounted for in the management administration and general support staff grades. The hospital is aware of a further 41 employees, whole time equivalent, who will be leaving during 2012. This equates to 2.43% of current staff and is well within the national target of 3%.

The total amount spent by the hospital on agency staff was €800,000 in 2009, €3.1 million in 2010 and €3.2 million in 2011. Medical agency costs, which accounted for the bulk of agency expenditure, were €300,000 in 2009, €1.9 million in 2010 and €2 million in 2011. However, I am informed that since October 2011 the hospital has eliminated its expenditure on medical agency costs through a combination of cost saving measures and the recruitment of non-consultant hospital doctors. The remaining agency costs are largely for paramedical and support staff. In 2012 the challenge for the hospital is to address its remaining spend on agency costs in the same effective way in which it has tackled the issue with medical cover. The HSE national service plan commits to a reduction of up to 50% in agency costs.

Additional information not given on the floor of the House.

The 2012 employment control framework will be finalised shortly. I envisage that the HSE will still have discretion to decide on exceptional appointments to minimise service, quality and safety risks. I am not suggesting there will be wholesale replacement of staff or that there are easy options. Part of the solution must be to implement the national clinical programmes to improve efficiency along with quality, manage performance relentlessly, contain costs and investigate all available options, including redeployment of staff.

John Halligan (Waterford, Independent)
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I requested the figures in light of the retirement of approximately 60 service workers by the end of February and the rising waiting lists for elective procedures at Waterford Regional Hospital that will inevitably follow the closure of two operating theatres. I have been advised that staff shortages will also lead to the closure of a further 30 beds.

Thousands of health graduates have left Ireland since the introduction of the moratorium yet the HSE has increased the amount of money spent on agency workers by 75% over the past three years. Between March and October 2010 alone it spent €67 million on temporarily filling full-time posts, including 167 non-consultant hospital doctors and 489 agency health care assistants.

May I ask the Minister the following question?

Michael Kitt (Galway East, Fianna Fail)
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Please do.

John Halligan (Waterford, Independent)
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Under the terms of the temporary agency worker directive the HSE must offer agency staff the same pay and terms as direct employees. The cost does not end there, however, because it must also pay the wage cost commission, which ranges from 5.5% to 11.75%.

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

John Halligan (Waterford, Independent)
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This is important and I have one supplementary question. It also pays PRSI at a rate of 10.75%, holiday and public pay at 12% and VAT at 21%. It has been estimated that in employing this workforce the HSE must pay a premium of between 30% and 40% on top of wages. These figures point to the fact that the recruitment embargo is failing.

James Reilly (Dublin North, Fine Gael)
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It is not true to say the embargo is failing. The Deputy is right to point out the additional costs that agency staff incur. The agency staff directive, which insists that they be given the same terms and conditions as permanent staff, equally indicates that the base rate for agency staff will have to fall. The reason they were paid more was because they did not have the same rights. They cannot have it both ways.

John Halligan (Waterford, Independent)
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I have no argument.

James Reilly (Dublin North, Fine Gael)
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The reliance on agency staff has been reduced considerably by the increased use of non-consultant hospital doctors.

Waterford Regional Hospital is working with the National Treatment Purchase Fund and the special delivery unit to focus on the strict chronological management of patients. It successfully reached a 12 month maximum waiting time at the end of 2011 and it is making reasonable progress this year. Like many hospitals, it will need to redouble its efforts between now and the end of March to maintain the 12 month maximum and avoid triggering the penalty mechanism but it is expected to meet its target. It is doing very well in regard to trolleys. The trolley count yesterday morning was six, with no long waits.

Unlike many other hospitals, it does not incur significant expenditure on agency nurses. Between December 2010 and December 2011 medical and dental staffing increased by 15 whole time equivalents. Nursing staff has decreased by 14, or 1.84%, which is below the national average.

I recognise it faces challenges but hospital management are on top of the situation and I expect it to deliver on its targets of ensuring that, by the end of the year, nobody will have waited longer than nine months for inpatient surgery and, from May onwards, anybody who attends its emergency department will not be waiting longer than nine hours before leaving for home or a ward. For 95% of people the figure will be six hours.

John Halligan (Waterford, Independent)
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May I ask a brief supplementary question?

Michael Kitt (Galway East, Fianna Fail)
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I gave the Deputy a lot of time.

John Halligan (Waterford, Independent)
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The Leas-Cheann Comhairle did not give me a lot of time.

Michael Kitt (Galway East, Fianna Fail)
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I gave him the same amount as everybody else.

John Halligan (Waterford, Independent)
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My question concerns what will happen after 60 people leave the service in February. The regional manager has stated the departure of such numbers from the public service at Waterford Regional Hospital will inevitably lead to the closure of beds. I do not think the Minister answered that question.

James Reilly (Dublin North, Fine Gael)
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The note before me does not indicate how many, if any, beds are going to close but the closure of beds will not necessarily result in a reduction in services.

John Halligan (Waterford, Independent)
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The regional manager has indicated how many beds are going to close.

James Reilly (Dublin North, Fine Gael)
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I am trying to explain to the Deputy that the hospital can make increased use of existing beds, day case surgeries and theatres. The productive theatre initiative in Cork and elsewhere has resulted in a significant increase in the volume of work that theatres can manage. It saved €2.5 million in one year across five theatres. That is only 2.5% of the total number of theatres.

I have criticised the HSE in the past for its inability to transpose excellence across the system. Initiatives which were successful in one area were not being mirrored elsewhere. The special delivery unit and the clinical programmes are ensuring successful initiatives are implemented across the system. This takes time but we will no longer have islands of excellence, such as the ophthalmology service in Waterford, which are not transposed elsewhere.

We are operating under financial constraints in the context of a considerable budgetary reduction of €750 million. However, I have made sure that we do not have a linear reduction in services alongside budgets. A 7% cut does not lead to a 7% reduction in service. The maximum service cut in any hospital should be 3% and in most cases it will be considerably less than that. I am very confident that with the clinical programmes, the special delivery unit and co-operating with the excellent people on the front line, this will be achievable.