Joan Collins (Dublin South Central, Independent)
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18. To ask the Minister for Health if his Department estimated that the health budget would need to be increased by 25% in 2017 to compensate fully for the austerity cuts made from 2009 to 2014 and to take account of demographic change; and if he will make a statement on the matter. [12341/17]

Joan Collins (Dublin South Central, Independent)
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There have been two periods of cuts in health spending by the State from which the service has yet to recover. In the 1980s, the Fianna Fáil Haughey Government cut public hospital beds by 3,000, and this is still a key factor in the accident and emergency room trolley crisis. From 2009 to 2014, there were five years of cuts in the health budget and staffing numbers. This is against a background of a growing and ageing population with greater needs. According to the Department of Health, the budget in 2017 would have needed an extra 25% to compensate fully for the austerity cuts and demographic change, amounting to an extra €3 billion this year alone without any increase in eligibility criteria. Will the Minister make a statement on what will be done in this regard?

Simon Harris (Wicklow, Fine Gael)
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I always appreciate Deputies seeking additional resources for my Department and the health service. This Government is committed to prioritising the needs of those requiring health services in determining the annual budget and it will continue to prioritise those needs. This is evidenced by the provision of an additional €977 million in this year's allocation to the Health Service Executive, HSE, in comparison with the original allocation for 2016. The provision for 2017 represents a 3.5% increase on the final projected 2016 outturn and a 9.4% increase over the 2015 outturn position. That the funding provided for health is the highest ever clearly demonstrates the Government’s commitment to investing the gains from a recovering economy in a better health service.

The additional funding secured will continue to ease the pressure on the health service to provide the optimum level of safe services for patients within the budgetary limits. There will always be a need for effective management of overall resources, particularly as health care demands continue to rise due to our growing and ageing population, the increasing incidence of chronic conditions and advances in medical technologies, drugs and treatments.

The Deputy may be better informed than I am but having checked with my officials, I am not quite sure to what she is referring with a 25% budget increase. A 25% increase in the health budget would require additional funding of €3.5 billion in a single year, as the Deputy correctly notes. Such an increase in a single year would likely lead to a breach of EU fiscal rules and would also raise questions about the capacity of the health services to plan and recruit staff in the time available so as to manage this level of increased resources effectively. We are now back in an era of reinvestment in health and the Deputy is correct that there were a number of extraordinarily difficult years for the health service. The issue cannot just be about the level of investment and we must consider what we are doing. It must be about moving services to primary care, doing more in the community, the new GP contract we are currently negotiating with GP organisations, and bed capacity. The bed capacity review is under way and that will lead to a clear figure for the capital review. Crucially, this is about recruitment and retention of staff, as we currently do not have enough nurses in the health service.

Joan Collins (Dublin South Central, Independent)
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The 25% figure came from a reply to a question put to the Department. Budget cuts were achieved through a variety of means over the austerity years. Staff numbers in the HSE were reduced from 111,000 to 99,000 from 2008 to 2015 and we are still reeling from that. Having listened to public health nurses last week on potential industrial action, I know they are absolutely crippled with work and cannot keep going. There were also cuts to pay. In the same period, home help hours for the elderly, disabled and sick went from 12.2 million to 8.3 million. Along with this, the cost of health care was shifted from the public purse to individuals, with increased charges introduced for accident and emergency visits and hospital stays and prescription charges introduced for medical card holders. A higher threshold was introduced for drugs for those who did not hold that card. All of this means that in 2013, citizens paid €450 million more for health in 2008. I am not asking the Minister to say he will produce €3 billion in a year but how will we bring ourselves back to the level we saw in 2008 and eliminate those out-of-pocket payments?

Simon Harris (Wicklow, Fine Gael)
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The Deputy is asking a reasonable question. We need to continue to invest and reinvest in the health service. We have made progress in that regard and I outlined that with the €977 million increase this year in comparison with the original projected budget from a year before. I am glad the Deputy raised the now deferred industrial action by the Irish Nurses and Midwives Organisation.

The Deputy is right. Our nurses believe there is a recruitment and retention challenge. So do I. That is why we had a very good engagement with the INMO and SIPTU at the WRC.

We have put in place a set of very good and innovative proposals that will help fill the 1,200 new nursing posts we want to deliver this year, including more than 120 advanced nurse practitioners, more midwives and staff to cover maternity leave - and today is International Women's Day - in what is a nearly all-female workforce. We have put in place a pre-retirement scheme to allow nurses aged 55 to 65 to choose to work part time rather than retiring. We have doubled the amount for the "bring them home" campaign. It was €1,500 for a nurse who returned from the UK. It will now be €3,000, €1,500 in the first 12 months followed by another €1,500, and we have extended it beyond the UK. We have much work to do after a lost decade for our public services. These are some of the areas in which we are trying to get progress.

Joan Collins (Dublin South Central, Independent)
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I raised points around the cuts that have taken place during recent years. The Minister's Department states it needs €3 billion per year to bring us back to the previous level. The Minister knows we are in crisis regarding staff and staff retention. Before Christmas, the Minister tried a recruitment drive. It did not get the numbers he was hoping for. We have a crisis regarding people accessing surgery and lists being cut. I could name several issues, such as problems with access to the St. John of God Menni services. Basic surgeries and appointments are being cut, outpatient appointments are being put off and lists are being changed. The list goes on and on and people have completely lost faith in our service. I know people from Tallaght hospital, Cappagh National Orthopaedic Hospital and St. James's Hospital who have been waiting months for basic requirements. If we do not reinvest money in our health services where it is needed, this will continue and there will be no fruits from the cuts nurses endured during the past five years.

Simon Harris (Wicklow, Fine Gael)
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The era of cuts to the health service and public service pay is over.

Joan Collins (Dublin South Central, Independent)
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We are in a worse situation.

Simon Harris (Wicklow, Fine Gael)
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Will it take us time to get to where we need to be? Absolutely, but the era of Ministers for Health being obliged to stand in this position and cut health services due to the financial situation is over. We are increasing the health budget and staffing levels and are putting money into waiting list initiatives. In the House later tonight we will pass legislation to provide domiciliary care allowance medical cards for approximately 10,000 children with disabilities. We are recruiting again. During the three days at Christmas which the Deputy spoke about, we hired 115 new nurses. This year, we have a target of 1,200. Because of the talks we had with the INMO, we have a much better set of proposals to try to attract those nurses.

We are reducing prescription charges for people over the age of 70 with a medical card and their dependants, which means 390,000 people will see a real difference when they go to the pharmacy each month. We must do more about it. As we all know, it is not just an issue of funding. If it were an issue of funding, some of the issues the Deputy is raising would not have existed during the Celtic tiger era. It must be about how we deliver the service, the work of the Oireachtas Committee on the Future of Healthcare and moving to primary care. I do not deny that there is a major challenge and a huge amount of work but these are the steps we want to take.