Imelda Munster (Louth, Sinn Fein)
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I am disappointed that the Minister for Health, Deputy Simon Harris, is not in the Chamber to be accountable in respect of the serious issue I wish to raise. Is the Minister of State, Deputy Catherine Byrne, aware of plans by the Health Service Executive to cut primary care services in the Louth-Meath area? The HSE has instructed management in the health service to save €1.5 million by way of staffing cuts between now and the end of the year. These measures will lead to serious cutbacks in services provided by occupational therapists, physiotherapists, public health nurses and, in particular, home help support staff. Is the Minister of State aware that last Friday week, the HSE called a meeting at Our Lady of Lourdes Hospital in Louth at which it informed management there that the contracts of nine full-time clerical and administrative staff and one part-time clerical worker were to be terminated with immediate effect?

It beggars belief that at a time when we are seeing services, especially primary care services, cut to the bone, further cuts are being made just as we come into the winter months. I know of many elderly people throughout Louth and east Meath, people who are sick and frail and have serious mobility issues, who are currently receiving only 15 minutes of home help twice a week, if they are lucky. These are people who need help to get out of bed and get washed and dressed every morning. Now the service will be further cut. That is totally unacceptable and amounts to neglect of patient care.

The sacking of nine full-time clerical and administrative staff and one part-time worker at Our Lady of Lourdes Hospital in Drogheda will have an adverse effect on patients. If there are insufficient numbers of clerical and administrative staff, there will be delays in patients getting notice of appointments, receiving referrals and obtaining doctors' and consultants' letters. It beggars belief that this is being done. Moreover, Our Lady of Lourdes Hospital is one of the worst in the country for overcrowding, being often top of the list in this regard. Yesterday, for instance, 29 patients were on trolleys there. I am calling on the Minister to reverse those cuts as we approach the winter.

The situation is compounded by the fact that 18 beds assigned to services for the elderly in Louth have been closed and lie empty because of nursing staff shortages. I realise there is an overall nursing recruitment plan in place but a significant part of the problem in my constituency is the serious delays by the HSE management nationally, not locally, in approving the filling of staff vacancies. It was known for months before the 18 beds were closed that there was a need to recruit staff. Those approvals were left on a desk or shelf gathering dust in the full knowledge of the crisis we were facing. It was only when it was brought into the public domain several weeks ago that the beds were closed that there was an undertaking to fill the roles. Will the Minister implement a fast-tracking process to fill these vacancies? The delay in so doing is compounding the problems in the Louth-Meath area.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am taking this issue on behalf of the Minister for Health, Deputy Harris, who apologises for having to attend another engagement. The HSE has advised that Louth primary care services have not applied staffing cuts during 2016. Department officials have, however, been advised by the Royal College of Surgeons in Ireland, RCSI, hospital group that its cost containment plan for the Louth hospital group, which comprises Our Lady of Lourdes Hospital and Louth County Hospital, included the release of 9.5 agency staff from various administrative and clerical roles within the two hospitals. Senior management in the hospitals sought to retain two of those agency staff for a short period to facilitate an efficient transition of work duties to other staff within the hospitals. At this time, 7.5 agency staff have been released, with the final two to follow at a later stage.

The HSE has advised that community health organisation area 8, which includes Louth and Meath, is projected to run €1.5 million in excess of available funds for primary care services for 2016.

This overspend is across the six counties of the CHO. Each service manager has been tasked with exploring ways in which efficiencies and savings can be achieved. As I have already advised the Deputy, Louth primary care has not applied staffing cuts during 2016. The HSE has advised that where vacancies arise, applications are made by individual service departments to fill them.

Significant additional resources have been invested in recent years in primary care and disabled services with a view to enhancing therapy service provision. In particular, additional funding of €20 million was provided in 2013 to strengthen primary care services and to support the recruitment for prioritised front-line posts. Over 260 additional posts for primary care teams have been filled as part of this initiative.

More recently, €4 million was provided under the HSE's national service plan 2016 to focus specifically on addressing speech and language therapy waiting lists in primary care and social care for children up to 18 years. This funding is facilitating the HSE to appoint 83 new full-time and recurring posts in primary care to address waiting lists, prioritising the longest-waiting children. I am advised that three posts have been allocated to Louth under this initiative.

Alongside services provided through primary care teams and networks, Louth has a Community Intervention Team, CIT, in place to facilitate early discharge from hospital. The 2016-17 winter initiative provides for the expansion of CIT services in Louth and Meath with the potential to support additional patients through the winter and during 2017.

I also understand that there has been increased investment in addiction services across the Louth and Meath area during 2016, with three additional clinical posts coming on stream. Additionally, there have been improvements in podiatry and dietetics services as part of chronic disease management. Furthermore, budget 2017 provides additional funding of €18.5 million for the further development of primary care services. This funding will support the Government's commitment to a shift towards primary care so that we can provide better care close to home for communities around the country.

Imelda Munster (Louth, Sinn Fein)
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The first question I asked was whether the Minister for Health would reverse the €1.5 million in cuts to primary care services. I did not get a response to that question. The Minister of State said that 9.5 clerical and administrative staff were "released" from their posts. That is a first. I have never heard of anybody who had a contract terminated with immediate effect going home to his or her family and saying, "I was released from work today". They were sacked.

I will go back to the questions and hopefully the Minister of State will give me an answer this time and not just the usual HSE spiel. Does the Minister intend to implement a fast-tracking process for the filling of nursing vacancies within the HSE? The filling of those vacancies was not approved by senior HSE management which has resulted in the closure of 18 beds in the elderly services in County Louth. Will the Minister give a commitment to introduced a fast-tracking process?

On the issue of recruitment more generally, is there any forward planning at all? Does the HSE put any thought into the age profile of its staff and planned retirements? Is there any sort of planning at all? This crisis was allowed to develop due to inaction by HSE senior management at national level and, as a result, the patients and the staff suffer. The staff suffer greatly. I know there is a problem with the recruitment of nurses nationally but that stems from the deliberate running down of our public health service. Nurses are leaving in their droves due to the stressful working conditions. I read recently of nurses who have moved abroad-----

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Thank you, Deputy.

Imelda Munster (Louth, Sinn Fein)
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-----who have found again the love that they had for their profession because they are respected in the countries in which they are now working. They have a proper, decent working environment.

Again, I ask the Minister of State to answer my question about fast-tracking the approval process for the filling of vacancies. I also ask her to answer the question about reversing the €1.5 million in cuts to vital primary care services.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Thank you, Deputy. We are way over time.

Catherine Byrne (Dublin South Central, Fine Gael)
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I understand that the Deputy is very frustrated with my reply. Unfortunately, I cannot give her any assurance that the €1.5 million in cuts will be reversed. I cannot answer that particular question because I do not have the details in front of me. However, I will pursue the matter with the Minister for Health on Deputy Munster's behalf.

Imelda Munster (Louth, Sinn Fein)
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That was part of the question I tabled.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I appreciate that but the Minister of State is only standing in for the Minister for Health. I do not want to interrupt the Deputy but there is a procedure whereby the questioner has four minutes, the Minister four minutes and then each has a further two minutes.

Catherine Byrne (Dublin South Central, Fine Gael)
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The second part of the Deputy's question related to the 18 beds that were closed in Louth. Unfortunately, I do not have any information on that either. However, I will come back to the Deputy on it. I will make a commitment to the Deputy to revert to her on it because I do not have the relevant information in front of me now.

In the reply I have in front of me, it is made very clear that the €1.6 million was actually an overspend within the Louth area. That is now being rectified through the various hospitals. The Minister is committed to supporting those in Louth and Meath to make the changes as quickly as possible. There is nothing in what I said to suggest that nurses would not be recruited. There is a definite response to the effect that additional staff will be employed but that it will take time.

Unfortunately, I do not have the specific answers to the Deputy's questions. However, I have taken down in detail what she has said and I will speak to the Minister for Health about it and ask him to reply to her in person.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Deputy Byrne is a woman of her word and I am sure she will revert to Deputy Munster. I apologise to Deputy Munster for cutting her short but I need to stick to the time table. She raised an issue which is of concern throughout the country.