Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health the consultations he has had with the Departments of Public Expenditure and Reform, and Children and Youth Affairs with regard to the recruitment embargo in the health service; and if he will make a statement on the matter. [21598/14]

Billy Kelleher (Cork North Central, Fianna Fail)
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The purpose of the question is to elicit information about discussions the Minister has had with the Minister for Public Expenditure and Reform and the Minister for Children and Youth Affairs with regard to the recruitment embargo and its impact on front-line services. We all accept that when the downturn of the economy came upon us abruptly, there was a necessity to try to stabilise the public finances. The embargo on recruitment is always a blunt instrument but it becomes more blunt as time goes on. I would like the Minister to inform us about the discussions he has had to replace front-line services in particular.

James Reilly (Dublin North, Fine Gael)
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The Government has decided that the numbers employed across the public service must be reduced to meet fiscal and budgetary targets. The Deputy acknowledges this. The health sector must make its contribution to that reduction. The recruitment embargo, or moratorium, has achieved substantial reductions in employment in the public health service.

The number of staff employed by the health service has reduced from 111,770 wholetime equivalents, WTEs, at the end of March 2009 to 99,959 WTEs at the end of December 2013, a reduction of 10.6% or over 11,800 WTEs. The reduction in employment numbers was monitored by my Department in conjunction with the HSE and the Department of Public Expenditure and Reform through the joint employment control monitoring committee up until the end of 2013. The functions of that committee have now been subsumed into the work of a joint monitoring committee on finance, performance and employment which has representation from the HSE, my Department, the Department of Public Expenditure and Reform and the Department of An Taoiseach.

The recent establishment of the Child and Family Agency resulted in over 3,000 WTEs being transferred from the HSE to the Child and Family Agency on 1 January 2014. The new Child and Family Agency will also be subject to the recruitment embargo or moratorium. The health service is further required to cut employment levels to 94,209 WTEs by the end of 2014 from a work force of 96,582 WTEs at the end of January 2014 and the HSE national service plan provides for an additional 500 WTE development posts, primarily in primary care and mental health services as well as the filling of development posts funded and approved in previous years.

In order to mitigate the impact on front-line services of the reduction in employment numbers, the priority is to reform how health services are delivered in order to ensure a more productive and cost-effective health system.

Additional information not given on the floor of the House

Therefore, the HSE has been using the provisions of the public service agreements to bring about greater flexibilities in work practices and rosters to achieve more efficient delivery of services. The Haddington Road agreement provided the health service with over 5 million additional employee hours. These hours are being used to replace staff who have left, to allow for further employment reductions and to reduce spending on agency staff and overtime. The agreement also provided for the employment of up to 1,000 nurses on the graduate nurse initiative and 1,000 interns under the support staff intern scheme outside the HSE’s employment ceiling.

Nearly 500 nurses and midwives have commenced employment in recent months on the graduate scheme, with over 200 others currently going through the recruitment process. Almost 250 support staff interns have commenced employment with approximately 700 going through the recruitment process.Subject to approval by senior managers, arrangements are in place in the HSE to allow the recruitment of staff where it has been established that there is an urgent service requirement.

Billy Kelleher (Cork North Central, Fianna Fail)
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We all accept that the health sector must make its contribution to national recovery but we should not expect those who rely on our health services to make sacrifices over and above what would be considered reasonable. The impact this is having on the broader provision of services is now at a critical stage. The INMO has indicated that current staff to patient ratios in maternity units range from 1:32 in Mayo General Hospital to 1:55 in the Midlands Regional Hospital in Portlaoise which, as we know, is the subject of an ongoing investigation by HIQA into a number of infant deaths. That is an issue of grave concern.

We have seen the leaked report of the review of maternity services in the north west which has set alarm bells ringing, particularly in the context of midwife-led services in some hospitals and obstetrics-led services in others. The dearth of staff in our maternity services is an issue of major concern. We need to see the embargo being lifted in the critical areas. We do not want to see appointments made on a one-on-one basis, but rather a policy reversal in key front-line service areas.

James Reilly (Dublin North, Fine Gael)
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In the short time I have, I wish to address some inaccuracies. The INMO may have its own figures but we have figures which were given to me last week on the ratio of staff to patients at Portlaoise. It is 1:48, which I acknowledge is far too high. We have a task force on nursing and midwifery which will address this issue in terms of getting the skills mix right and determining safe ratios.

The so-called "leaked report", which was addressed by me in this House a number of months ago in the context of maternity services in the north west and west, has no standing of its own. It will feed into the national review of maternity services and there are no plans to close any maternity unit. I want to make that clear on the floor of the House.

Colm Keaveney (Galway East, Fianna Fail)
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That is not what the report suggests.

James Reilly (Dublin North, Fine Gael)
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The Deputy raises an important point but the moratorium is being used in a focused fashion here. We employed 750 additional nurses last year. We want to have the nurse ratios and the skills mix done properly. We have a situation where we have some model four hospitals with nine nurses per health care assistant and others with 2.8 nurses per health care assistant. We have doctors doing nurses' work, nurses doing work that health care assistants could do and a whole mismatch of peoples' skills sets to the jobs they are being asked to do. That is where the future savings and efficiencies are.

Billy Kelleher (Cork North Central, Fianna Fail)
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The issue of maternity services must be addressed. We all accept that the national review is ongoing but in the meantime we are reduced here to arguing about whether the ratio is 1:48 or 1:55 in the Midlands Regional Hospital. The bottom line is that whether the ratio is 1:48 or 1:55, it is still too high. That issue must be addressed. I do not mind being slightly inaccurate but the Minister must also acknowledge that a ratio of 1:48 is unacceptable by any standard.

The recruitment embargo is a blunt instrument. We need a change in policy in the context of front-line services. Rather than the HSE seeking permission to appoint on a one-on-one basis, there should be a policy reversal in key areas to ensure the safe delivery of services.

James Reilly (Dublin North, Fine Gael)
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I assure Deputy Kelleher that there will be no policy reversal. What is being done is what I have just described. A far more refined approach is being taken by focusing the staff in the places they are needed and getting the skills mix right. I already acknowledged that 1:48 is far too high but we must examine the roles of those working in our hospitals and determine how we can make better use of the staff we have. We must find ways to support staff using other staff so that we can provide the safest possible care for patients. That has been my absolute priority in the national service plan.

I have no problem with people pointing out the difficulties that are in the system because I want to know about and deal with them. However, I want to deal with them in a planned, evidence-based fashion. I hope that Deputy Kelleher will accept that the situation in the midlands in particular is one we inherited and which has been festering away for decades.