Billy Kelleher (Cork North Central, Fianna Fail)
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To ask the Minister for Health his assessment of the new Health Service Executive regional service plans; and if he will make a statement on the matter. [13934/13]

James Reilly (Dublin North, Fine Gael)
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Under the Health Act 2004, the Health Service Executive must prepare a service plan and submit it to me for my approval following publication of the Estimates. The national service plan which was submitted to me in December sets out the quantum and type of health services to be provided in 2013 within the overall level of funding provided. In accordance with the Act, I approved the national service plan and laid a copy of the plan before both Houses of the Oireachtas on 9 January this year. At the end of February, the executive prepared and published its operational plan and the regional service plans which underpin the national service plan. The HSE has responsibility for the delivery of services set out in these regional plans and ensuring services are delivered within budget. The director general designate of the HSE, Mr. Tony O'Brien, has provided a full briefing on the regional service plans to the regional fora.

Billy Kelleher (Cork North Central, Fianna Fail)
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When one breaks down the regional service plan, specifically in respect of the number of whole-time equivalent staff in services for older people and mental health and disability services, one finds that a significant reduction in staff numbers is envisaged. For example, in HSE west, HSE south, HSE Dublin-midlands and HSE Dublin north east, the number of whole-time equivalent staff is expected to fall by 267, 382, 446 and 277, respectively, giving a total reduction in whole-time equivalent staff of 1,372. Given that staff are under serious pressure as matters stand, does the Minister agree that further reductions in staff will result in a reduction in services? The Minister's view that fewer staff can continue to provide more care is not sustainable because one reaches a breaking or tipping point at some stage. It is evident that it will not be possible to sustain the level of service required in services for older people and mental health and disability services with the reduced number of staff envisaged in the regional service plans.

James Reilly (Dublin North, Fine Gael)
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A reduction in staff does not necessarily mean less service. We are seeking to reduce the cost rather than level of service provided. This policy forms part of the Government's general approach to public services. We must reduce our cost base because we became uncompetitive. We are, however, becoming more competitive and we must secure further reductions across the board. Everybody understands that we cannot continue to spend more than we raise in taxes.

There is room for major improvement in certain areas of the health service. I refer specifically to community nursing home units where we are struggling in many cases to achieve a nurse to health care assistant ratio of 1:1. The Royal College of Nursing in England has indicated the ratio should be 2.5 health care assistants per nurse. Moreover, consultants are seeing patients who could be treated by general practitioners and GPs are seeing patients who could be cared for by nurses.

Nurses are looking after patients whom health care assistants could be looking after. A prime example is provided by a study conducted at St. Mary's Orthopaedic Hospital in the Deputy's county of Cork.

Billy Kelleher (Cork North Central, Fianna Fail)
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Yes.

James Reilly (Dublin North, Fine Gael)
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The study showed that, if physiotherapists were able to screen referrals to orthopaedic outpatient services, 50% of cases would not need to be seen by orthopaedic surgeons and could be dealt with by physiotherapists.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister has just reminded me of another broken promise as regards St. Mary's Orthopaedic Hospital, namely, that it would retain orthopaedic services. However, they have been moved to the South Infirmary Victoria University Hospital. However, let that be the case.

Jerry Buttimer (Cork South Central, Fine Gael)
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Did the area not get the urgent care centre, which is doing great work? Is the Deputy against it?

Michael Kitt (Galway East, Fianna Fail)
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Deputy, please. This is Question Time.

Billy Kelleher (Cork North Central, Fianna Fail)
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I supported that move, but the current Government opposed it. In fact, I was the only one who supported it. I welcome the fact that the Minister came to Cork to open the urgent care centre, which is working well.

When discussing the reduction in services, it is evident that a tipping point must be reached. It has been reached with the attempt to provide the same level of service this year as last despite a reduction of 1,732 in staff numbers. Something will give at some stage. When it does, older people, people with disabilities and people with mental health issues will suffer.

James Reilly (Dublin North, Fine Gael)
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I will make two points. First, the building and funding process in the case of St. Mary's Orthopaedic Hospital had more or less been completed by that point. It would not have made sense to start reversing the decision. We were left with something that was as good as a fait accompli.

Billy Kelleher (Cork North Central, Fianna Fail)
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I tried to tell the Minister that, but he would not listen.

James Reilly (Dublin North, Fine Gael)
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Second, and if I may answer the Deputy's question on the reduction in staff numbers, an additional 884 new staff have been provided for mental health services.

We are reviewing the nursing home support scheme with a view to determining how the money might be better spent supporting people at home. I have no wish to engage in political point scoring, but we were left with a situation in which different criteria were used in various parts of the country to assess people's needs for long-term care. As a result, in one third of cases people need to be in nursing homes, that need is questionable in another third and, in the last third, they should definitely not be in homes.

We have invested heavily. I wish to put on record a note of gratitude for Atlantic Philanthropies, which supported us with a couple of million euro in the development of a new single assessment tool for older people to determine whether they need long-term care or what sort of home care packages might keep them at home for longer.