Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health the way he will address the deep concerns of both hospital consultants and general practitioners regarding the provision of health services; and if he will make a statement on the matter. [7186/14]

Billy Kelleher (Cork North Central, Fianna Fail)
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I am asking how the Minister for Health will address the deep concerns of both hospital consultants and general practitioners about the provision of health care in this country. I tabled this question because it is an issue of major concern. Hospital consultants have expressed very strong views about patient safety, the lack of consultants and supports in hospitals, the overcrowding in emergency departments and all that flows from that. A report commissioned last year outlines the difficulty the Department and HSE are having in recruiting consultants. If we allow this to continue, we will have a diminution of services because we will not have consultants to provide those services. A crisis is evolving in general practice. That is the responsibility of the Minister of State, Deputy White, so we will blame him for this particular part of it, but it is of major concern. There is no point pretending that this issue is not beginning to gather pace in terms of young doctors leaving this country because they do not want to practice here or that practices are under major pressure and strain trying to provide the primary care the Minister talks about rolling out.

James Reilly (Dublin North, Fine Gael)
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There has been significant focus over recent weeks on the very demanding and challenging financial and resource constraints within which the HSE has been required to prepare and adopt its 2014 service plan. It is important to recognise that this focus is not particular to the preparation and adoption of this year's HSE service plan as similar constraints have applied in each of the last number of years as a direct consequence of the emergency financial situation the Irish State has had to address. At such an early hour of the morning I do not want to upset the Deputy opposite, but we all know why we are in these financial troubles.

As in previous years, the delivery of the health and social care services provided for in this year's service plan will focus on the dual challenge of protecting patient outcomes while, at the same time, reducing costs. This requires increasing emphasis on models of care that treat patients at the lowest level of complexity, providing safe, quality services at the least possible cost. I commend the manner in which the HSE and its workforce have successfully focused on how best to minimise the impact of unavoidable constraints on front-line services by utilising innovative and more efficient and effective ways of using scarce resources.

This year, the HSE needs to achieve saving measures of €619 million in order to remain within the approved 2014 health expenditure ceiling. It is important to recognise that the bulk of these required savings measures, including €268 million in pay and related savings and €172 million in reductions in pharmaceutical prices and expenditures and general practitioner fees, will not impact on the general public. These savings, allied to additional cost containment measures of €129 million in areas such as public procurement, shared services, value for money and energy efficiency savings, will allow the HSE to maintain and, in many cases, improve and build on the range of services provided to the public, as they reduce the cost of delivering such services to those in need.

Additional information not given on the floor of the House

I refer to the ongoing work of the special delivery unit, SDU, which was established in the Department of Health in 2011 in order to drive down waiting times for both scheduled and unscheduled care in Irish hospitals and to introduce a major upgrade in the performance capabilities of the Irish health system. In the case of unscheduled care, there has been an overall reduction of 14% in the number of patients waiting on trolleys during 2013. This is on top of the 23.6% reduction achieved in 2012 compared to 2011. In terms of scheduled care, at the end of December, 99.99% of adult inpatients and day cases were waiting less than eight months, 95% of child patients on the waiting list were waiting less than 20 weeks and 99% of routine gastrointestinal endoscopy patients were waiting less than 13 weeks. The number of patients waiting over 12 months for an outpatient appointment has reduced by 95% in 2013, from a high point of 103,433 in March of that year to 4,626 at end of December 2013. The SDU and health service staff across the health system are to be commended on these positive developments.

The significant increase in the number of consultants over the past five years is also of note. In the five years since December 2008, the number of consultants has increased by 295, from 2,260 to 2,555. The number of doctors on GMS contracts has also significantly risen. On 31 December 2013, there were 2,413 GPs contracted to provide services under the General Medical Services scheme. This compares with 2,098 on 31 December 2008, an increase of 315 GP contract holders over this period.

In the light of these developments, I have every confidence that, despite the unavoidable resource reductions already referred to, the HSE will maintain core services in 2014 while also supporting the growing demand for services arising from population growth, increased levels of chronic disease, increased demand for prescription drugs, higher numbers of medical card holders and new costly medical technologies and treatments.

Billy Kelleher (Cork North Central, Fianna Fail)
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We do not have time to discuss the whole budget and the provisions of health care in this country, but the feeling out there is that there is a crisis in GP services and that they are being forced to take on more complex cases. This is because of the outsourcing from the acute hospital system, the transfer of long-term illnesses and other complex conditions that are now expected to be treated in the primary setting. No additional resources have been put into GP services. GP services are under financial pressure. They are laying off staff. Then there is the added dimension of younger GPs not finding it an attractive option as a career path. That is sustainable only for so long. The budget for primary care has been consistently reduced, yet we expect GPs to take on additional responsibilities from a clinical point of view and that is unsustainable. It is time the Minister acknowledges that there is a problem and addresses it. Until he decides that, we will have major difficulty in the years ahead in terms of provision of primary care.

James Reilly (Dublin North, Fine Gael)
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Let us deal with the facts rather than the hype. There are more than 200 additional GPs in the GMS than there were when we came into government. We all know we are about to enter into - I must be very careful with the language here - consultation with general practice.

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

James Reilly (Dublin North, Fine Gael)
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The Minister of State, Deputy White, has already met the various organisations. We expect to hear a lot of noise from that section until the new contract is in place, but let us deal with the facts. There are more than 200 additional GPs in the service than when Deputy Kelleher was in government. He alluded to overcrowding in our hospitals. Coming towards the end of his term in government, there were 569 people on trolleys in a single day. We have reduced that number by 34% over 2012 and 2013. This year so far, we are already over 3% lower than last year. That is still too many and I want to see it improved.

It is important to have the facts out here. There are more consultants and GPs in the service than there were three years ago and we recruited over 700 nurses last year. The people who work in our health service face serious challenge and pressure but they are doing that magnificently and I congratulate them on the great improvements they have made.

Billy Kelleher (Cork North Central, Fianna Fail)
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We can have this debate again and again but the Minister is in his fourth year in government. He can only shelve his responsibility for so long.

James Reilly (Dublin North, Fine Gael)
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We are not in government three years yet.

Kathleen Lynch (Cork North Central, Labour)
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Former Deputy Batt O'Keeffe must have taught Deputy Kelleher mathematics.

Billy Kelleher (Cork North Central, Fianna Fail)
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He is going into his fourth year and it is time he would believe he can stand over his policies and decisions. There are serious difficulties in the acute hospital setting. It is difficult to get people out of hospitals. Step-down facilities are not available. We are having difficulty trying to transfer people from the acute hospital setting to step-down and then home. That is happening day in day out in hospitals across the country and this adds to the difficulties at the front end in emergency departments.

Alex White (Dublin South, Labour)
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Does Deputy Kelleher have any proposals about anything on health?

Billy Kelleher (Cork North Central, Fianna Fail)
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I am making those points because if the Minister wants to deny the facts and the realities and what the clinicians at the coal-face are telling us, then he should deny them.

Alex White (Dublin South, Labour)
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It is ten years since Deputy Kelleher had a policy on health. He has no policies.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Government does not have any either.

We are still waiting for the White Paper on health insurance. They could not even do the sums on it - the arithmetic, the mathematics, the logarithms. The logarithms were not even on that White Paper.

James Reilly (Dublin North, Fine Gael)
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What did Fianna Fáil do?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Do not forget the progressions.

Billy Kelleher (Cork North Central, Fianna Fail)
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And the progressions.

James Reilly (Dublin North, Fine Gael)
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Fianna Fáil has been wonderful at describing the problem but not terribly good at dealing with it, as we all know. Despite a 10% reduction in staff, 20% reduction in budget and an 8% increase in our population, we have reduced the number of people waiting over a year for an outpatient appointment by 95%. The august Members of Fianna Fáil who were in government for 14 years did not even deign to count the number of people on outpatient waiting lists because they did not want to know.

Billy Kelleher (Cork North Central, Fianna Fail)
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We had the Minister for the hyperbole on this side of the House then.

James Reilly (Dublin North, Fine Gael)
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It was very handy because my predecessor was not a member of the Fianna Fáil party, so it could leave her to deal with all the consequences.

Billy Kelleher (Cork North Central, Fianna Fail)
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We never abandoned our colleagues.

James Reilly (Dublin North, Fine Gael)
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Out of 103,000 people who were waiting longer than a year for an outpatient appointment in March 2013, there are now only 4,500 people. I accept it is still too many but we continue to address it.

Billy Kelleher (Cork North Central, Fianna Fail)
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Half those people-----

James Reilly (Dublin North, Fine Gael)
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Deputy Kelleher is into the old Fianna Fáil way of hype and spin. I deal in facts because-----

Billy Kelleher (Cork North Central, Fianna Fail)
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I am being a responsible Opposition Member.

James Reilly (Dublin North, Fine Gael)
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-----I am interested in reality and the reality our citizens have to endure every day. I want to improve that experience for them. We will continue to improve the patient experience and, at the same time, continue our reforms.

Deputy Kelleher is correct that the universal health insurance White Paper will be out very shortly.

Billy Kelleher (Cork North Central, Fianna Fail)
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Will the sums be on it this time?

James Reilly (Dublin North, Fine Gael)
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I look forward to his comments on it. I invite himself, Deputy Ó Caoláin and others to feed into that process because it will be about all of our health service. I want all of us to feel part of it and to have an input into it.

Alex White (Dublin South, Labour)
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Even you Billy.