David Cullinane (Sinn Fein)
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I welcome the Minister to the House, as he is a frequent visitor when taking Adjournment motions relating to Waterford Regional Hospital. I have tabled this matter on the back of a parliamentary question asked by my colleague, Deputy Caoimhghín Ó Caoláin, a couple of weeks ago regarding staffing levels at Waterford Regional Hospital from 2007 to 2014. The HSE provided those figures in tabular form, and over the seven years, only in 2008 was there an increase in overall staff levels.

There were 1,903 people working at Waterford Regional Hospital in 2007 and there are now 1,597 people working there, which is a drop of 306 people. The Minister is aware that Waterford city, in particular, has been very badly hit by high levels of unemployment, and even this week there was the announcement of another company closing, with 27 jobs gone. The city is really in trouble because of dangerously high levels of unemployment. The State is adding to that problem, and with 300 fewer people working at the hospital, it is like losing a small or even a big factory. There is a concern about the jobs lost, although I accept that the Minister will argue that we had to make savings and cut our cloth to measure because of the economic crisis.

We can look at the overall figures, although the headings were far too vague in general for us to draw conclusions. The nursing figures jump out, as the hospital had 753 whole-time equivalent nurses in 2007 but that figure has reduced to 623, equating to a loss of 130 nurses working at Waterford Regional Hospital. From speaking with people working in the hospital, I know two surgical theatres have been closed, along with a ward and a number of beds have been lost. One of the main reasons for the closures or decreased capacity is a lack of staff and particularly nurses to take that capacity. Overcrowding in the accident and emergency ward has a knock-on effect on the ability of the hospital to carry out elective surgeries, and we have seen them cancelled far too often. I have also asked my colleague, Deputy Ó Caoláin, to table parliamentary questions with regard to waiting times for treatment. Some pressure points in the hospital still have not been resolved in departments like ophthalmology, orthopaedics and the ear, nose and throat specialty. I am very concerned about the overall reduction in numbers in the hospital and specifically the nursing staff.

We have to protect and defend services in our local area. I am sure when the Minister was in opposition, he did the same thing. Our instincts are to protect services as best we can in our localities for the people we represent. Figures like this are alarming and cause concern, and so is the closure of surgical theatres and wards. If we speak to people working in the hospital who tell us it is very difficult to continue providing the level of service required because of repeated cutbacks, we are also concerned about that. The hospital budget allocation for the hospital was cut again this year, as it was for all hospitals. We are eating into the bone and although we simply cannot cut any more, there will be other cuts this year because of the HSE service plan.

I will briefly move away from the numbers of people working in the Waterford hospital. A couple of weeks ago we discussed the implementation of the Higgins report, and we were promised five academic posts. We were promised that Waterford Regional Hospital would become a university hospital but when will that happen? Will there be a name change? How will that process be realised and when will the five academic consultant posts become a reality? When will a 24/7 cardiology service be delivered for the people of Waterford? I have raised this issue and will continue to do so until I get satisfactory answers. When I see cuts to services in the hospital in my locality, I will continue to raise Adjournment matters like this. It is wrong to cut hospital provisions and front-line care when there is so much waste of public money in this State in a variety of areas.

James Reilly (Dublin North, Fine Gael)
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I thank the Senator for raising this issue, which is of concern to the people of Waterford. Any loss of a job is upsetting for the Government. We want to create jobs and we have been very successful in doing so in areas such as Waterford. It might not have been as quickly as people would like, but none the less, more than 70,000 jobs have been created overall in recent years. That is in comparison to a time when we were losing 1,500 jobs a week. We have had a huge turnaround in that regard.

Senator Cullinane said the State was adding to unemployment, but if we do not have an efficient public service then people will have to pay more taxes unnecessarily and that is a disincentive to people to become employed or for them to employ others. The reduction in the size of the public service has been an essential component of the approach to addressing the State's fiscal difficulties. That has been combined with a firm focus on improving public service efficiency and effectiveness. The Croke Park agreement and now the Haddington Road agreement have enabled health services to be sustained and indeed improved despite a staffing reduction of 11,000 whole-time equivalents, or 10%, since 2007.

I acknowledge the major contribution staff have made to meeting the unprecedented challenges of recent years and putting the State's finances on a sustainable footing for the future. The Haddington Road agreement provides for some five million additional working hours annually and for the appointment of 1,000 nurses and midwives as well as 1,000 intern support staff under targeted employment initiatives. These measures will enable the health service to substantially reduce levels of agency employment and overtime and continue to reduce overall numbers while maintaining services and service levels to the greatest possible extent.

While both the Croke Park and Haddington Road agreements have resulted in a decrease in staff numbers, the roll-out of the Haddington Road agreement has also extended the working day by an average of two hours per staff member. That represents greater flexibility and enhances service provision. The HSE continues to support efficiencies in how services are managed and delivered.

As Senator Cullinane pointed out, the staffing level in Waterford Regional Hospital has been reduced. However, recruitment initiatives are ongoing across a number of health care grades to address staffing deficits and to reduce overtime costs and reliance on agency staff. Recruitment is in progress for nurses, NCHDs, hospital consultants and health and social care professionals, and there is an intern scheme for health support staff.

The Senator will be aware that public hospitals are being reorganised into more accountable hospital groups. Waterford Regional Hospital is now in the south/south west group along with Cork University Hospital and Cork University Maternity Hospital, Kerry General Hospital, Mercy University Hospital, South Tipperary General Hospital, South Infirmary-Victoria University Hospital, Bantry General Hospital, Mallow General Hospital and the Lourdes Orthopaedic Hospital, Kilcreene. The group structure being put in place will allow for more efficient deployment of human resources, facilitating effective and flexible use of staff, thus allowing a better response to service needs. I officially met and spent time with Professor Geraldine McCarthy, the chair of the group. She is anxious to move things on, as am I. Hospital groups will be required, within one year, to develop a strategic plan which will outline their plans for future services within the group area. These strategic plans will determine the way services are provided within each group, and their successful implementation will be required before groups can advance to become hospital trusts when the necessary legislation is put in place.

Waterford Regional Hospital can now look forward to a new and expanding role within the south/south west hospital group as well as developing a new relationship with its primary academic partner, UCC. In particular, the research opportunities presenting through close collaboration with UCC will make for an attractive working environment and will assist Waterford Regional Hospital in being able to compete for and recruit the best clinical talent available. By being in such a group with an academic partner the hospital will be able to buddy up with industry in areas such as IT, medical devices and pharmaceutical companies to produce jobs through research and innovation. That is another goal of creating the hospital groups as well as improving outcomes for patients, which must be our central concern.

David Cullinane (Sinn Fein)
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I very much hope that the hospital groups will work for all hospitals in the region. I look forward to working with the new CEO and chairperson of the group in the south west and the south east. I welcome the announcement of recruitment in a number of areas, including for nurses, NCHDs, hospital consultants and health and social care professionals, and intern places for health support staff. I do not expect the Minister to have the figures, but perhaps he could ask the HSE to forward details to me on the number of vacancies in each area, as that would be helpful. New or additional posts in the hospital would be most welcome.

James Reilly (Dublin North, Fine Gael)
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I thank the Senator. Sometimes it is easy to look at the headline figures on how many doctors or nurses there are and how many millions or billions of euro are spent, but that is no longer our focus, nor can it be. We must change the model of care. It must now be about outcomes for patients – how many are seen, how many are treated and how quickly, and how many had to be seen a second time because they were not treated properly the first time.

I wish to put some facts on the record. Notwithstanding all the brouhaha about emergency departments in the first six weeks of this year – there is no doubt there has been pressure – the numbers are still 3% lower than this time last year. From 2011 to 2013 there was a 34% drop in the number of people in emergency departments who had to endure long waits on trolleys. Last year, 99% of people received inpatient treatment within eight months. That compares to a time before we were in government, when nobody knew how long they would have to wait. Very often it was a case of years. For the first time ever we did count the outpatient waiting list. More than 103,000 would have been waiting for longer than a year by the end of the year, but only 4,500 are still waiting. That is still 4,500 too many. It is a hardship for people to have to wait that long. We are addressing the issue as well. We are making real changes and at the same time we are continuing the reforms.

I must point out that there are more GPs now in the GMS than three years ago. There are also more consultants. Last year, notwithstanding the moratorium, we recruited more than 700 nurses. We are changing the model of care. We want to move away from a situation in which consultants are seeing patients that GPs or advanced nurse practitioners could be looking after, GPs are looking after patients that nurses could be looking after or nurses are looking after patients that health care assistants could be looking after. We are also focusing on the role of allied health care professionals, speech and language therapists, occupational therapists and physiotherapists, who can do much work if they are allowed. The role of the community pharmacist is also being considered. All of the current models must change. The model of care must change from episodic treatment to more prevention and secondary prevention through chronic illness care and preventing people from getting the complications that result in their being in hospital, which causes them much pain and distress and costs the taxpayer so much money. I will endeavour to get the Senator the information he sought. I thank him for raising the issue. The future for Waterford Regional Hospital will be extremely bright.