Dáil debates

Thursday, 18 April 2019

Saincheisteanna Tráthúla - Topical Issue Debate

Health Services Funding

4:45 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Minister of State, Deputy Catherine Byrne, is dealing with this question. We would have withdrawal symptoms if we did not have her here on a Thursday evening.

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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God help her, again.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I am Thursday's child.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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I welcome the Minister for Thursdays to the Chamber. I am grateful to the Ceann Comhairle for selecting this issue. I am joined by Deputy Eugene Murphy as my question also relates to Roscommon and County Galway. I understand that HSE management in CHO 2 in Galway, Mayo and Roscommon are planning a range of curtailments of services, including the cancellation of 20 agency staff contracts and the delaying of filling 50 positions which were committed to across a range of primary care services. That delay will last until the end of 2019 or 2020. There are extraordinary delays in a range of services across the region, including occupational therapy, dentistry and orthodontistry, dietetics and physiotherapy. The notion that positions that were promised and have been advertised will not be filled until 2020 is unacceptable and will only add to the delays and the pressure that people on those waiting lists are under.

I also understand that no maternity leave or sick leave replacements will be put in place for anyone who goes out between now and the end of the year. This is because HSE officials are curtailing and trying to manage a budget, which is one of the lowest in the CHO regions, because they are utterly frustrated in trying to engage with the Department regarding a base month on which their budget should be assessed. It seems the Department randomly assesses a month in the year as a base month to establish the budget. This model does not work and particularly does not serve the people of CHO 2, whom we represent, well at all.

I need an assurance from the Minister of State that the 20 agency staff will remain in place, that the 50 positions that have been approved to be filled and which are needed in communities in Mayo, Galway and Roscommon will be filled, and that people will get to work on addressing the waiting lists. If not, are we destined to pay for the failures regarding the national children's hospital through a lack of resources for CHO 2 to allow it to do its work at primary care level?

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister for Health, Deputy Harris, I thank the Deputy for raising this issue. I will read the response I have been given.

I would like to first clarify that it is not the case that budgets are being cut. This issue can be accurately described as individual hospital groups and CHOs across the HSE needing to live within their allocated budget. Where individual hospital groups or CHOs have not demonstrated their ability to do this the HSE have quite rightly introduced certain measures and controls across these locations.

By way of background, in recent months, officials from the Department of Health have been engaging intensively with the HSE in reaching agreement on a pay and numbers strategy for 2019. The key focus in developing the strategy is to ensure that affordable and appropriate recruitment decisions are made by the HSE and that they need to operate within its pay allocations.

By the end of 2018, agency staff overtime and pay costs had reached unaffordable levels. In light of this, the HSE decided to introduce interim control measures for a consolidation period of three months to the end of June, until it received clarity on plans and financial performance for quarter 1 of 2019 from hospital groups and CHOs. The intention is for these measures to be in place for a short period, and the overriding requirement for the HSE is to prioritise the delivery of safe services within the available resources.

With regard specifically to CHO 2, I understand that this location has an agreed affordable funding whole-time equivalents, WTE, limit, inclusive of an affordable level of agency staffing. The current WTE levels in CHO 2 are in excess of this arising from significant growth during 2018 and plans been put in place to bring back this growth to within affordable levels. This includes a plan for agency conversion which is a priority across the HSE. Agency conversion provides for the direct employment of staff resulting in a corresponding decrease in agency staffing while maintaining the level of service provided in 2018. These measures include temporary recruitment restrictions and the capping of agency and overtime expenditure. The HSE’s decision to introduce these measures is based on the high levels of recruitment in 2018 and the consequential impact in 2019. It is also based on the need for the HSE to live within the resources provided to them as set out in the national service plan for 2019.

As part of this process, the HSE directorate has made it clear that these recruitment restrictions will only be necessary for hospital groups or CHOs until such time as there is clarity on plans for 2019.

On receipt and acceptance of balanced plans, these additional controls can be reviewed and removed where appropriate. The earlier that costs begin to reduce towards affordable levels, the less impact it will have on staff and services over the remainder of the year.

Responding adequately within available funding to support the delivery of all key services whilst also responding to increasing levels of demand may result in waiting lists for particular services. However, as far as possible, the CHO has confirmed that it will continue to respond to the most pressing patient and service user needs using resources as efficiently as possible.

4:55 pm

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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I am afraid the response confirms all our fears. It is extraordinary. The HSE recruited for positions in 2018. The reason it recruited was because of extraordinary waiting lists but it did not plan for the resources of those extra positions during the 2019 budget. What kind of dummies are doing the accounts here? That is basic accounting. When one expands a service, one resources it to extend and provide the service. One does not provide the service for four months, provide no funding for it in the following years, and cut back the service that has been given to patients who are fed up of being on waiting lists and whose conditions are worsening because they are waiting lists.

I understand this is the only CHO region where this action is being taken. Are we now destined, in Mayo, Galway and Roscommon, to have longer waiting lists, further delays in treatment and unfilled positions because basic budget skills must not be available within the Department of Health and the HSE?

It is not good enough. The Minister of State is merely reading out a reply that has been provided for her. As a constituency Deputy, she will be aware the line, "as far as possible, the CHO has confirmed that it will continue to respond to the most pressing patient and service user needs", that does not mean anything. That means there will be no additional home help hours, there will be no extra occupational therapy, OT, services and no emergency orthodontic services, the lists will get longer and people's frustration will increase.

The Minister keeps trumpeting the fact that the Government is spending record levels of money on health and the highest in the OECD - spin, spin, spin. At the end of the day, people are suffering because somebody does not do their job right in accounts.

The Minister of State's response is confirmation of what I have been told. At this stage, many people are despairing, in particular, parents of children who are on those waiting lists.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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As the Minister for Health has previously stated, he recognises the need for individual hospital groups and CHOs to operate within their allocated budget considering the national service plan approved for 2019 and respects the prudent approach being adopted. He has also pointed out that the HSE's overriding requirement is to prioritise the delivery of safe services within the available resources.

As stated earlier, the HSE directorate has made it clear that these recruitment restrictions will only be necessary for hospital groups or CHOs until such time as there is clarity on plans for 2019. On receipt and acceptance of balanced plans, these additional controls can be reviewed and removed where appropriate.

The sooner that costs begin to reduce towards affordable levels, the less impact it will have on staff and services, as I already said.

While these temporary measures are in place, the Department of Health has made it clear to the HSE that it must proceed with filling approximately 2,000 additional approved and funded development posts to maintain and enhance key services across the acute, mental health and primary care areas.