Dara Calleary (Mayo, Fianna Fail)

I am taking this Adjournment on behalf of my colleague, the Minister of State, Deputy Áine Brady.

We endorse Senator Keaveney's remarks on supporting people, particularly older people, to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care and we as a Government continue to develop and improve health services in all regions of the country and to ensure quality and patient safety.

The Health Service Executive has sole operational responsibility for the delivery of health and social services, including those at facilities in Carndonagh and Buncrana. Senator Keaveney will appreciate that all developments must be addressed in light of current economic and budgetary pressures and have regard to the current moratorium on the recruitment of nursing and non-nursing staff. The HSE has been asked to make a rigorous examination of how existing funding might be re-configured or re-allocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources currently available.

The integrated services directorate is the executive's directorate responsible for the delivery of health care services. I understand that, in line with what is happening around the country, the HSE in Donegal is currently reviewing its use of resources and facilities for residential care in the county.

The factors relevant to this process in Donegal include compliance with the 2009 regulations under the Health Act 2007 and with the national quality standards for residential care settings for older people, staffing and resource issues, overall residential care needs within the area, the options available in public and private nursing homes and the HSE's capital programme to replace and/or upgrade existing facilities. On completion of the review the HSE will then be in a position to outline any proposed changes arising for HSE facilities in Donegal.

Employment control frameworks have been used for a number of years in the health sector to give effect to Government policies on the number employed in the health sector. The employment control framework for 2010-12 gives effect to our decision on employment policy in the public sector. It provides that there will be a net reduction in employment to 2012. This includes a target reduction in numbers in 2010 to achieve the overall reduction of 6,000 from March 2009 to the end 2012, and consequential pay-roll savings. Based on reductions already achieved in 2009, the net target reduction for the health sector to the end of 2012 is 4,560 whole-time equivalent positions, or 1,520 per annum.

Similar to 2009, there are a number of grades exempted from the moratorium on recruitment in order to maintain key front-line services and to support the development of policies in disability, mental health, cancer, older people and child care. In addition to these exempted grades, the 2010 framework also gives the HSE delegated sanction, subject to meeting the target reduction referred to of 1,520, to fill critical posts, in grades other than management and administrative grades, by way of exceptions to the moratorium. Such exceptions may be made where the HSE has satisfied itself that there are compelling reasons for doing so in order to maintain essential front-line services.

This arrangement supersedes the requirement to obtain the approval of the Department of Health and Children and the Department of Finance for the filling of any vacancy arising in a post in a non-exempted grade. It is, therefore, a matter for the HSE itself to determine the relative priority to be accorded to the filling of such vacancies without reference to either Department. This is provided that it delivers the required overall reduction in numbers and the associated pay-roll savings, and meets the policy requirements in service development posts and exempted grades, as I have outlined. The Department of Health and Children's view is that exceptions should be kept to the absolute minimum in order to achieve the target growth in exempted grades and support the transformation agenda.

At a national level, Senator Keaveney will be aware that significant changes took place within the nursing home sector in 2009 resulting in a single system of registration and inspection for all providers, public, private and voluntary, and a single system of financial support. The net effect of these changes is an assurance to every person in need of care that the same quality standards and the same level of financial State support will apply regardless of which nursing home they choose.

In light of these important changes and in light of service pressures arising from demographic trends, the Department is continuing to work closely with the HSE to examine long-term capacity, quality, staffing and funding requirements.