Colm Burke (Fine Gael) | Oireachtas source

I thank the Minister for a comprehensive statement on the programme for 2015. There are many challenges but it is important to state that both the Department and the Health Service Executive are facing up to those challenges.

It is important to note that funding of over €13 billion is being put into this budget but that funding does not belong to the Government. It belongs to the taxpayer, and that money has to be collected from the taxpayer. Currently, the health budget is costing €260 million per week in real terms, which is a substantial sum of money. The question is about making sure we are getting value for money. The programme the Government had to do in the past three and a half years was to ensure that we worked on eliminating the inefficiencies in the system.

It is easy to be negative about the hospital services but we must examine the positives. My colleague on the opposite side of the House spoke about the negatives but one positive with regard to the first eight months of 2014 was that the total number of outpatient attendances was 2.14 million, which is an increase of 25% on the previous eight months of 2013. That works out at 63,636 outpatient attendances per week. That is the demand on the health service, and that is the demand that has been delivered on up to the end of August 2014.

My colleague on the opposite side spoke about the ambulance service. The national ambulance service recorded an increase in emergency calls of approximately 1,000 per month in the first eight months of 2014. Notwithstanding that, improvement in response times continued to be made, with ECHO calls reaching the target of 75.3% and DELTA response calls improving from 64% to 67%.

I acknowledge it has not reached all the targets but progress certainly has been made in this regard over the past eight or nine months, which I welcome. As for specialist palliative care, I note that 94% of specialist palliative care inpatient beds were provided within seven days of referral, which is also a positive development. The number of home help hours provided up to the end of August was 6.8 million, while home care packages have increased by 20% above the expected levels. Again, this is an area that is being dealt with but it is obvious that the Government must make sure it continues to ring-fence the funding and to increase it, because demands are increasing in this regard. The Minister has already outlined the status of the new hospital groups, as well as the Government's appointment of the six new hospital group chief executives. This is also reform the Government had promised, on which it is working and which is being delivered.

In respect of section 38 and section 39 organisations, I have raised concerns about this area going back to October 2013. More than 2,600 organisations receive funding from the Health Service Executive, HSE, in this manner and in both 2013 and 2014, more than €3.27 billion of the budget went to the aforementioned 2,600 organisations, which provide a good delivery of service in the areas in which they are working. However, there is also the issue of governance and accountability, which has been challenged and dealt with over the past 12 months. It has involved making sure that inefficiencies are dealt with and that moneys allocated are spent in a proper manner. Again, in recent weeks there have been instances in which problems have been identified and which are being dealt with.

I refer to one area about which I have concerns, have raised consistently and which will be a major challenge in 2015. The Minister referred to the memorandum issued by the HSE to hospitals about agency doctors and two-month contracts. I have concerns about that memorandum because of the number of hospitals that are completely reliant on agency doctors. If agency doctors are not available, difficulties will arise in providing replacements for them. I am aware of hospitals that are highly reliant on this structure of agency doctors, particularly in respect of non-consultant hospital doctors and while this should not have arisen, it has occurred. I am also concerned that the number of non-Irish doctors entering this country is not going to increase and, if anything, will decrease over the next 12 months. This will cause its own problems in the sense that the Government appears to have lost a battle in respect of retaining Irish doctors. Moreover, I am not satisfied that a sufficient amount of work is being carried out in respect of the MacCraith report. In fairness to the former Minister, he set up the mechanism to examine how the service could be improved with regard to the retention of junior doctors. I do not believe the HSE or the medical training bodies are acting fast enough. I also have concerns as to how the Medical Council is dealing with matters. I recently had a discussion with a senior consultant in a Dublin hospital, who had identified two good medical practitioners as candidates to come to work in Ireland. They have now run into problems with the Medical Council as regards their registration. I also have encountered cases of people who graduated in Ireland and worked in Irish hospitals for a number of years. They went to New Zealand and within two weeks of applying for registration in that country, secured it. When they tried to return to the Irish system, it took the Medical Council eight weeks to get them registered. This is unacceptable at a time when people are badly needed.

I also have concerns about an issue with which the Government must deal. It is unfortunate that the proposal put forward regarding the employment of medical consultants has been voted down by the Irish Medical Organisation, IMO. There are major challenges in this regard and what I am disappointed about is that I had tabled a question on this matter at the last health meeting. However, information was not provided to me on the numbers and locations of current vacancies.

Well over 250 consultant positions are vacant. It is unfortunate that although the HSE released this information to the media, I still have not received it even though the HSE promised it to me on 23 October. It is a major challenge as regards how we deal with the issue. One in four consultant positions are vacant in Waterford hospital and it shows the failure of long-term planning in the HSE over many years. It is a major challenge for 2015 and we must prioritise dealing with it over the next three to four years. The Minister has comprehensively set out the programme for 2015. It is extremely well planned and I hope we will continue to see the improvements we seek in the health service and deal with new challenges that will arise. We are working on it. I thank the Minister and his predecessor, Deputy Reilly, for the long-term planning he did while he was Minister.