Barry Cowen (Laois-Offaly, Fianna Fail)
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440. To ask the Minister for Health to advise how the number of hours worked by agency nurses and level of spending on agency nursing in the Midland Regional Hospital, Tullamore, compares to employed staff who worked the same hours at the hospital in 2013. [10665/14]

Barry Cowen (Laois-Offaly, Fianna Fail)
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441. To ask the Minister for Health his plans to reduce agency spend at the Midland Regional Hospital, Tullamore; and how he will implement them. [10666/14]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 440 and 441 together.

While the focus under the Public Service Agreement and the Haddington Road Agreement (HRA) is on increased productivity and reform, additional nursing support is being made available throughout the system.

In its Service Plan for 2014 the HSE undertakes to minimise the instances of overtime and agency. It is envisaged that the additional hours element of the HRA, the Graduate Nurse Programme and the Support Staff Intern Scheme, coupled with redeployment will deliver major savings in the overall pay bill while maintaining quality and service levels.

The increase in nursing hours available under the HRA equates to nearly 1,400 additional nurses. Nearly 500 nurses and midwives have commenced employment in recent months on the graduate scheme, with over 200 others currently going through the recruitment process.

In relation to specific queries regarding the Midland Regional Hospital, I have arranged for the question to be forwarded to the HSE who will respond directly to the Deputy in this regard.

Barry Cowen (Laois-Offaly, Fianna Fail)
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442. To ask the Minister for Health if there are plans to replace nurses who have resigned or retired from the Midland Regional Hospital, Tullamore as there has been a reduction of 63 nurses since 2009 but activity has increased by between 25% and 30%. [10667/14]

Barry Cowen (Laois-Offaly, Fianna Fail)
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444. To ask the Minister for Health the way he intends to maintain patient safety and deliver quality care at the Midland Regional Hospital, Tullamore where the skill mix and nursing numbers are inadequate owing to the continuing recruitment embargo which means experienced staff with a wide range of skill sets are not replaced by similar new staff. [10669/14]

Barry Cowen (Laois-Offaly, Fianna Fail)
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445. To ask the Minister for Health if management at the Midland Regional Hospital, Tullamore is fulfilling its duty to provide a safe place of work when nursing staff are unable to take meal breaks as per health and safety legislation and the Organisation of Working Time Act. [10670/14]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 442, 444 and 445 together.

Notwithstanding the need to reduce public service numbers the HSE has the capacity to recruit where it is necessary to do so in order to ensure patient safety and quality care and to support service delivery.

While the focus under the Public Service Agreement and the Haddington Road Agreement (HRA) is on increased productivity and reform additional nursing support is being made available throughout the system. The increase in nursing hours available under the HRA equates to nearly 1,400 additional nurses. Nearly 500 nurses and midwives have commenced employment in recent months on the graduate scheme, with over 200 others currently going through the recruitment process.

It is important also to note the link between nursing qualifications and safety and to recognise that nurse education levels are also linked to patient outcomes. The recent Lancet study showed that a 10% increase in the proportion of nurses holding a nursing degree is associated with a 7% decrease in the risk of death. Ireland has invested significantly in nurse education since the Commission on Nursing in 1998. Approximately €55 million is spent annually on nurses education and around 1,570 nurses enter the undergraduate programme each year.

All staff working in the Midland Regional Hospital Tullamore are entitled to breaks in accordance with the provisions of the Working Time Act and the Working Time Directive. As the provision of breaks is a service matter I have asked the HSE to revert directly to the Deputy in relation to his query regarding the Midland Regional Hospital, Tullamore.