Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister back to the House. He was here earlier dealing with the Commencement debates.

I welcome the service plan that has been set out clearly for 2014. We are talking about a substantial budget of €12.131 billion. The service plan clearly outlines how that budget is to be spent over the next 12 months. It is important that we get value for money but also that there is an efficient service which can deliver the level of care required. It is helpful that the plan also sets out clearly the intention for 2016 so that a lot more planning can go into the provision of health services, over not only the next 12 months but the next two years.

The reorganisation of the hospitals into hospital groups is a welcome long-overdue development. The previous Minister was to the fore in ensuring that this progressed and, likewise, the Minister is. In the reorganisation of the hospitals into hospital groups, there is one area on which we need to focus, namely, how we employ the medical staff. An issue on which I have focused since I became a Member in 2011 is that of medical staff being given six-month contracts where the standard response I get from the HSE is that different hospitals have different budgets and the HSE cannot give a junior doctor a contract for two or three years because he or she will move on to other hospitals. One aspect of the development of hospital groups is ensuring that we provide long-term contracts, by which I mean two to three years, for junior doctors so that the drain of young medical professionals out of this country is stopped. They need certainty, security and a clear career plan. The HSE has not given that issue the priority it deserves over the past few years. We now need to change that focus to ensure that we retain the maximum number of Irish graduates within the health system. That should be one of the priorities in the new hospital groups.

The Minister outlined the changes that will be made in 2015. BreastCheck will now be available to women up to the age of 69. There will be free GP care for over 70s and expansion of mental health teams. There is €30 million to fund access to new hepatitis C drugs. There is €25 million to deal with the issue of delayed discharges, the Minister has already given detailed explanation on that issue, additional day-surgery cases and €2 million for improved maternity services. I raised previously the important issue of maternity services. The Hanly report of 2003 set out quite clearly that there were slightly over 100 consultants in maternity services and the target was that by 2012 there should be 190. Currently, there are 130. Part of the plan for this year is that an extra ten consultants in that area will be employed.

As I am dealing with the issue of consultants, there is now a major problem. There are 2,500 whole-time equivalent consultants. I understand that up to 300 of those positions are currently vacant. These positions are filled either by agency consultants or locums. That issue needs to be tackled in 2015 because we need to ensure that there is continuity and clear organisational management within each section in hospitals as regards the provision of care, whether in surgery, orthopaedics, maternity and paediatrics, and that senior positions are not filled by consultants who may be moving on in two or three months' time. That is another area to which we need to give priority.

In the case of nursing staff, the figures for agency staff are quite frightening. I understand that the figure is €336 million, which is equivalent to 2,000 whole-time equivalent agency staff. There is a target that we reduce that by €140 million in 2015. It is essential that we reduce it and that we work hard to ensure that we get nurses in on a permanent basis and those in the medical area are given contracts the duration of which are similar to what they would be offered in the United Kingdom, Australia, New Zealand and Canada. The issue with agency staff is that it puts significant strain on the services right across the board, from management to nursing staff and those involved in administration, and occupies a considerable amount of time in administration. It is extremely important that we deal with that in 2015.

The report also refers to the EU cross-border directive. Ireland has a population of 4.6 million and it is not possible for us to provide every possible medical care that is required because within each area, consultants are sub-specialising. For instance, the area of paediatric urology, where one needs a paediatrician who specialises in that area, has been extremely difficult to fill, and yet there are a lot of patients who require a specialist in that area. We should look at this area of specialist care co-ordinating with services outside the country. The area of cross-border health care is one that will grow for which we need to be prepared, and on which we need to work.

There are a significant number of staff, 97,000 whole-time equivalents, working in the health care area. When one includes those involved in the home care area, the total number comes to 102,000. It is a significant number of staff employed. It is important that we give them the support they need to ensure that they are highly motivated and continue to get the supports within the service itself. One of the figures I looked at, returning to the agency staff issue, is that 8% of the total staff budget goes on agency and overtime. That is something we need to tackle, especially in 2015, ensuring that we get value for money.

Senator MacSharry spoke of the emergency department issue and I raised this earlier on the Order of Business. The prediction for 2015 is that 451,000 people, or 8,676 per week, will attend accident and emergency departments or will be accident and emergency admissions. If there is a 25% increase, it will bring the figure over 10,000 per week. As I stated on the Order of Business this morning, we need to get information out there to ensure that people use any available service they can before resorting to accident and emergency departments because we are suddenly asking accident and emergency staff to provide for a far greater number of people with little or no notice. It is extremely important that we get that message out there. The staff are dedicated and committed and provide a good service, and it is important that we give them recognition for that.

The service plan for 2015 has been carefully set out and well costed, and no doubt the standard of care that has been provided by the HSE in the hospitals will continue to be provided in 2015.