Seán Fleming (Laois-Offaly, Fianna Fail)
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I appreciate the opportunity to raise the issue following a report which appeared in The Irish Timesrecently, which showed that the number of senior management staff in acute hospitals has increased from 273 in 2011 to 303 in 2014. That is a rise of 11%.

The number of senior managers has increased by that amount over the three and a half years even though there has been a significant reduction in the budgets over the same period. According to an internal HSE report, the increase took place at a time when the number of nursing and support staff reduced. The report was presented by the HSE to a joint committee chaired by an official in the Taoiseach’s office. The committee includes a representative from the Department of Public Expenditure and Reform and the Department of Health. The reason the group exists is because the Taoiseach decided more than a year ago to take “a hands-on approach” to the dysfunctional Department of Health. That was the beginning of the process to side-step the Minister of the day. The Taoiseach has ultimately seen that through and we have a new Minister. Perhaps the new Minister will be able to rescue the Department of Health from the Department of the Taoiseach.

This is one issue I know the Minister will wish to raise himself. He will want to know why there is an increase in the number of white-collar staff at the expense of nurses and doctors in white coats. I would like the Minister to respond to a point. I am told a number of hospital managers have made requests for top-up payments and that 85 cases have been referred to the Department of Health for a decision. Could the Minister provide an update not just on the increased numbers, but the requests for top-up payments for managers as well?

Billy Kelleher (Cork North Central, Fianna Fail)
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I will be very brief. The point is quite clear. The programme for Government outlines the dismantling of the HSE and the establishment of another agency to deliver health care and to bring it under the auspices of the Department of Health. When Fine Gael was in opposition, it was very clear that it wanted to dismantle the HSE. It said it was bureaucracy gone mad and wholly inefficient, and other terms were used to describe it on a continual basis to make political capital out of the HSE. However, we now find that, in government, not only has the bureaucracy the party so much reviled not been reduced, but it has increased.

The figures, as outlined by Deputy Fleming, are quite shocking. Senior hospital management has increased by 11% at the same time as there has been an attack on front-line services right across the health service from consultants down. Could the Minister refocus and reprioritise in order that a recruitment process could be initiated for consultants and others involved in the delivery of key health services that are most needed, namely, front-line services, and that we would stop the feathering of senior hospital management, which is something Fine Gael was opposed to only four years ago? Could the Minister outline the actions he is taking to ensure funding is available for the delivery of priority front-line services and not for the recruitment of senior hospital management?

There has been a reduction in staff among the lower clerical grades of 4% at the same time as there has been a huge increase in the number of senior hospital management grades. There has been an increase in that staff cohort from 273 to 303, an increase of 11%. The Minister’s priorities have gone askew, which exposes the hypocrisy of what his party said it would do and what it is doing.

Leo Varadkar (Dublin West, Fine Gael)
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I welcome the opportunity given by Deputies Billy Kelleher and Sean Fleming to address this matter. At the end of 2014 there will be approximately 97,000 whole-time equivalent, WTE, employees working in the health service. The figure rises to 102,000 when home helps, graduate nurses on the nurse graduate programme, and staff participating on the support staff intern scheme are included.

In March 2009, in response to the financial crisis, the Government of the time decided that the numbers employed across the public service must be reduced in order to meet fiscal and budgetary targets and introduced a moratorium on recruitment and promotion in the public service, which the Minister for Public Expenditure and Reform, Deputy Howlin, has now ended.

In order to mitigate the impact on front-line services of the overall reduction in employment numbers, the priority was and is reform of how health services are delivered in order to ensure a more productive and cost effective health service. The revised working arrangements provided for in the Haddington Road agreement are a pivotal element of that.

I will outline the facts in that regard. There has been a significant reduction of 15,893 employees or 14% of the workforce in the HSE since 2007. The reduction in the number of staff working in management and administration roles was even higher at 18%. In contrast, the number of midwives and doctors has gone up since 2011. The number of nurses has certainly reduced. We have lost far too many of them, but not as many as might appear to be the case, when one includes the graduate nursing programme and the very large number of nurses who are now employed through agencies.

Senior management roles, that is to say, roles at grade 8 and higher, have fallen since September 2007. It is important to say that this group of managers represents just 1% of all health sector staff and approximately 6% of management and administrative staff. Numbers employed in middle management roles in the HSE have also fallen since 2007.

The Haddington Road agreement made provision for the regularisation of long-term acting posts. Under the agreement, employees who had been working in an acting capacity at a higher grade for a period of two years up to 31December 2012 were to be appointed to these posts on a permanent basis as long as certain conditions were met. Close to 400 staff in the management and administration category have been regularised in this process, including the 30 senior managers referred to in the article in The Irish Timesyesterday. What was not said in the article is that applying the exact same principles, an additional 848 nurses and midwives, 248 social and care professionals, and 26 doctors and dentists were regularised in the exact same way. Very many more doctors and nurses had their positions regularised than managers or senior managers.

In return for the Haddington Road agreement, significant change was sought with regard to how posts of a promotional nature would be covered during periods of future absence. With effect from 1 October 2013, no payments are made to staff who take on temporary acting-up appointments to cover annual leave, sick leave, special or other leave, or to allow for the completion of a recruitment process. Instead, staff are expected to take on the role and responsibility of the higher post for such periods without additional pay, provided this period does not exceed three months.

While it is a matter for the HSE to determine the composition of its staffing complement, it is important not to underestimate the significant role that management staff play in the direct support of front-line services.

Seán Fleming (Laois-Offaly, Fianna Fail)
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I thank the Minister for the information he supplied. Essentially, I am wearing my hat as spokesperson on public expenditure.

I am shocked to hear that the Haddington Road agreement seems to be increasing costs in the public service. The agreement was intended to lead to a reduction of €1 billion across the public service, one third of which was to come from the HSE because it employs approximately one third of all public service employees. Perhaps the Minister will be able to provide some indication of the actual savings in the Department of Health and the HSE as a result of the Haddington Road agreement on a year-by-year basis for the period 2013 to 2015, as the agreement is due to expire in 2016.

I note the Minister did not deal with the issue of the top-up payments for senior managers. Up to 85 such cases have been referred to the Department of Health for decision. I ask if the Minister would provide that information later in a written reply.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister has referred to the years 2007 and 2011, in order to support his argument. Taking the base year of 2007, there has been a pro ratalarger increase of senior management compared with the recruitment of front line staff. As the Minister is aware, commitments were made by this Government to protect front-line staff and that the numbers would be increased where such was needed. It is evident that there is pressure on all of the major front-line services, such as accident and emergency departments, maternity and theatre services. In view of the fact that the HSE's funding has decreased, one would think that priority should be given to the recruitment of front-line staff.

Leo Varadkar (Dublin West, Fine Gael)
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The Haddington Road agreement has resulted in significant expenditure savings in the public service and the health service but the agreement contained an amount of give and take; it was not all take from the public servants as some things were given back. Among the things given back was that people who had been acting up and working in a post above their official posts were upgraded into those posts and this included more than 800 nurses, just under 30 doctors and 30 senior managers. This provision was part of the agreement and it was applied across the board, it was not some form of special deal which only applied to senior managers.

In reply to Deputy Fleming, I do not have the year-on-year figures for the agreement but I can make them available to the Deputy's office. Deputy Kelleher may be interested in the figures for the difference between September 2007 and October 2014, which are the most up-to-date figures. The number of directors has decreased from 218 to 195; the number of senior managers has decreased from 1,013 to 975; the number of middle managers has decreased from 3,736 to 3,516; and the number of general administrative staff has decreased from 13,253 to 10,268 - that is 3,000 of the famous 5,000 middle managers who are now gone. In that period the number of doctors and midwives has increased but I accept that the number of nurses has decreased and it is an issue I intend to reverse in the coming year. The recruitment embargo is gone, thankfully, but that does not mean we are awash with cash but it means we have more flexibility within our payroll budget and we can move some of the agency staff back into regular posts, in particular, nursing posts. I hope to improve the graduate nursing programme to make it more attractive to nurses to encourage more of them to take up those positions and to stay in the country. If we can agree pay scales with the IMO, we hope to be in a position in the new year to advertise for more than 200 consultant posts. It will make a big difference if we can agree on the salary.

The number of top-ups started with about 200 cases and this number has been reduced to 85 over which there remains an argument. It appears that the people are contractually entitled to those payments. The alternative is to go to law but the HSE must ensure that it does not incur significant costs in legal fees only to lose the case. It would make much more sense not to end up spending a fortune on legal fees if the HSE is contractually obliged to make those payments. That is the current consideration.