Louise O'Reilly (Dublin Fingal, Sinn Fein)
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4. To ask the Minister for Health the status of recruitment processes for all grades, groups and categories in the Health Service Executive; if there have been budgetary impediments to the recruitment processes in specific areas; if there has been a problem with recruitment because of budgets; where has this occurred, by area, hospital and location; how he will meet staffing needs; and if he will make a statement on the matter. [14021/16]

Simon Harris (Wicklow, Fine Gael)
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An easing of restrictions on the employment of additional staff was announced by the previous Government in budget 2015. Under this new approach, public sector organisations can obtain delegated sanction to recruit within the parameters of their pay budget once they obtain approval for their pay and numbers strategy from their parent Department and the Department of Public Expenditure and Reform. This change allows for greater autonomy to be delegated to Departments and agencies to manage their staffing levels within allocated pay frameworks. It also provides for further recruitment flexibility, for example, where it is determined that offering permanent contracts can achieve more economical service delivery than agency usage. This practice is evident across the health service.

The Health Service Executive is working with the Department of Health on the finalisation of its 2016 pay and numbers strategy. This has involved the development of detailed workforce plans at hospital and community service level. Rather than HSE head office telling health service entities what their recruitment requirements are, the strategy involves a bottom-up approach to recruitment requirements. Meanwhile, the HSE has emphasised to service providers that they must operate within their pay budgets. This does do not impact on a hospital’s ability to recruit where there is funding available to facilitate recruitment, for example, in the case of funded replacement posts or where additional funding has been allocated for new positions under the HSE service plan. Mental health is one very important area in that regard, but recruitment can also take place in the areas of critical care and emergency services. I was pleased to be able to provide assurances for the Irish Nurses and Midwives Organisation in that regard this week.

The HSE has continuously increased staffing levels since the beginning of 2015. By the end of April this year, overall health service employee numbers had increased by more than 6,000 whole-time equivalents since the start of last year, with an extra 1,600 whole-time equivalent staff in the first four months of 2016 alone. The vast majority of these employees are in front-line positions. Numbers in the medical and dental category increased by almost 600 whole-time equivalents or 6.5% since the start of 2015, while nursing figures rose by more than 1,700 or 5% during the same timeframe. Let me be clear that the number of staff working on the front line of the health service increased this year and last year and will increase every year under the Government.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Let me be equally clear - activity levels in the health service are increasing but staffing levels are not matching them. The Minister can deny that there is a pause in recruitment, but I have in writing from the office of the assistant national director for oral health a statement that there is a pause in temporary recruitment pending the outcome of cost containment discussions. No one will contradict me when I state there is not a hospital or health facility in the State that is staffed to adequate levels. Is the Minister aware that between January and April 2016 the HSE spent €68 million on 2,379 whole-time equivalent agency staff? I sincerely hope I do not have to convince him that agency workers are less cost-effective than directly employed labour. If it is established that agency workers are less cost-effective and money is the main issue, why is more direct labour not being employed? Doing so would be a much better utilisation of budgets. I have a statement that there is effectively a pause in recruitment.

Simon Harris (Wicklow, Fine Gael)
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No, the health service must be cognisant of its budget. I am sure many areas of the public service need more front-line staff. I am aware that the public service went through an extraordinarily difficult time and that an increase in the numbers of front-line staff is needed. We increased staff numbers in 2015 and will increase them again this year and in subsequent years. However, if the Garda Commissioner wants 1,000 more gardaí tomorrow morning, she has to be cognisant of the budget available to her. Equally, hospitals must be cognisant of the budgets available to them. However, exemptions apply to emergency departments and critical posts and more autonomy is available at local level. This relates only to the pay budget and is not to offset overspending in any other area.

The Deputy makes an important point on agency staff. These posts can continue to be converted into permanent posts. Agency staff conversions continue in the health service and it is possible to recruit staff. As the Deputy is aware, it is not always possible to recruit staff in certain parts of the health service and certain locations. I am not suggesting there is an adequate number of employees on the front line of the health service. Approximately 12,000 health service posts were lost in the deep recession, of which approximately 6,000 have been reintroduced. I acknowledge, however, that we have much more to do.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Given that activity is increasing, even returning to the staff levels that applied before they were decimated will not cut it. The Minister referred to the Garda Commissioner. As he will be aware, we have had carnage and a great deal of blood spilled in the north inner city. Is this what we are waiting for before the budget will be increased? The Garda Commissioner sought an increase in the Garda budget and €5 million was provided. It is not acceptable to claim that staff levels are increasing when clearly they are not keeping up with demand. Activity levels are increasing month on month and year on year, but staffing levels are not matching the increases. I do not know if the Minister speaks to front-line staff, but I have spoken to nurses, porters and home helps and they are at crisis point. They have heard from the Minister and other Cabinet members that some recovery is under way, but they do not see one when they look around.

Simon Harris (Wicklow, Fine Gael)
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Of course, I speak to front-line staff. No one here has exclusivity on speaking to them and I will continue to speak regularly with them, as will, I am sure, Deputies from all sides. While staff accept that the economy is recovering because more money is being invested in the health service, they would be the first to tell me and I would be the first to agree that we must do much more to improve the health service. The only reason the previous Government was able to increase the health budget was that we had money available to do so. We could not increase it when the troika was in town. I find myself in my new position as Minister for Health at a time of reinvestment in the health service and there is much in which to reinvest. The health budget increased and will increase again. While we will continue to invest in the health service, we cannot fool people or pretend something is the case when clearly it is not. There are recruitment issues. There are vacant nursing posts which are funded and could be filled and we need to persuade more nurses to return from the United Kingdom. This can be done by a variety of means. I speak to nurses on the front line and representatives of nursing organisations. We also need to attract consultants from abroad and, as the Deputy correctly pointed out, we must continue to convert agency posts to front-line permanent posts. While a significant job of work remains to be done, let us not promote the myth that staff numbers are being reduced when the figures clearly show they are increasing.