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 Header Item Mental Health Services Funding (Continued)
 Header Item Health Services Staff Recruitment
 Header Item Services for People with Disabilities

Thursday, 2 June 2016

Dáil Éireann Debate
Vol. 911 No. 3

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(Speaker Continuing)

[Deputy Helen McEntee: Information on Helen McEntee Zoom on Helen McEntee] As such, I intend to have each Department and Minister identify a specific element of their remit through which they can contribute to mental health services because the issue is not confined to the Department of Health or, for that matter, the Departments of Children and Youth Affairs and Education and Skills. The overall budget for mental health services is larger than it may appear and will continue to increase year on year. I hope it will also receive a greater focus than was the case in the past.

Health Services Staff Recruitment

 4. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the status of recruitment processes for all grades, groups and categories in the Health Service Executive; if there have been budgetary impediments to the recruitment processes in specific areas; if there has been a problem with recruitment because of budgets; where has this occurred, by area, hospital and location; how he will meet staffing needs; and if he will make a statement on the matter.  [14021/16]

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris An easing of restrictions on the employment of additional staff was announced by the previous Government in budget 2015. Under this new approach, public sector organisations can obtain delegated sanction to recruit within the parameters of their pay budget once they obtain approval for their pay and numbers strategy from their parent Department and the Department of Public Expenditure and Reform. This change allows for greater autonomy to be delegated to Departments and agencies to manage their staffing levels within allocated pay frameworks. It also provides for further recruitment flexibility, for example, where it is determined that offering permanent contracts can achieve more economical service delivery than agency usage. This practice is evident across the health service.

The Health Service Executive is working with the Department of Health on the finalisation of its 2016 pay and numbers strategy. This has involved the development of detailed workforce plans at hospital and community service level. Rather than HSE head office telling health service entities what their recruitment requirements are, the strategy involves a bottom-up approach to recruitment requirements. Meanwhile, the HSE has emphasised to service providers that they must operate within their pay budgets. This does not impact on a hospital’s ability to recruit where there is funding available to facilitate recruitment, for example, in the case of funded replacement posts or where additional funding has been allocated for new positions under the HSE service plan. Mental health is one very important area in that regard, but recruitment can also take place in the areas of critical care and emergency services. I was pleased to be able to provide assurances for the Irish Nurses and Midwives Organisation in that regard this week.

The HSE has continuously increased staffing levels since the beginning of 2015. By the end of April this year, overall health service employee numbers had increased by more than 6,000 whole-time equivalents since the start of last year, with an extra 1,600 whole-time equivalent staff in the first four months of 2016 alone. The vast majority of these employees are in front-line positions. Numbers in the medical and dental category increased by almost 600 whole-time equivalents or 6.5% since the start of 2015, while nursing figures rose by more than 1,700 or 5% during the same timeframe. Let me be clear that the number of staff working on the front line of the health service increased this year and last year and will increase every year under the Government.

Deputy Louise O'Reilly: Information on Louise O'Reilly Zoom on Louise O'Reilly Let me be equally clear - activity levels in the health service are increasing but staffing levels are not matching them. The Minister can deny that there is a pause in recruitment, but I have in writing from the office of the assistant national director for oral health a statement that there is a pause in temporary recruitment pending the outcome of cost containment discussions. No one will contradict me when I state there is not a hospital or health facility in the State that is staffed to adequate levels. Is the Minister aware that between January and April 2016 the HSE spent €68 million on 2,379 whole-time equivalent agency staff? I sincerely hope I do not have to convince him that agency workers are less cost-effective than directly employed labour. If it is established that agency workers are less cost-effective and money is the main issue, why is more direct labour not being employed? Doing so would be a much better utilisation of budgets. I have a statement that there is effectively a pause in recruitment.

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris No, the health service must be cognisant of its budget. I am sure many areas of the public service need more front-line staff. I am aware that the public service went through an extraordinarily difficult time and that an increase in the numbers of front-line staff is needed. We increased staff numbers in 2015 and will increase them again this year and in subsequent years. However, if the Garda Commissioner wants 1,000 more gardaí tomorrow morning, she has to be cognisant of the budget available to her. Equally, hospitals must be cognisant of the budgets available to them. However, exemptions apply to emergency departments and critical posts and more autonomy is available at local level. This relates only to the pay budget and is not to offset overspending in any other area.

The Deputy makes an important point on agency staff. These posts can continue to be converted into permanent posts. Agency staff conversions continue in the health service and it is possible to recruit staff. As the Deputy is aware, it is not always possible to recruit staff in certain parts of the health service and certain locations. I am not suggesting there is an adequate number of employees on the front line of the health service. Approximately 12,000 health service posts were lost in the deep recession, of which approximately 6,000 have been reintroduced. I acknowledge, however, that we have much more to do.

Deputy Louise O'Reilly: Information on Louise O'Reilly Zoom on Louise O'Reilly Given that activity is increasing, even returning to the staff levels that applied before they were decimated will not cut it. The Minister referred to the Garda Commissioner. As he will be aware, we have had carnage and a great deal of blood spilled in the north inner city. Is this what we are waiting for before the budget will be increased? The Garda Commissioner sought an increase in the Garda budget and €5 million was provided. It is not acceptable to claim that staff levels are increasing when clearly they are not keeping up with demand. Activity levels are increasing month on month and year on year, but staffing levels are not matching the increases. I do not know if the Minister speaks to front-line staff, but I have spoken to nurses, porters and home helps and they are at crisis point. They have heard from the Minister and other Cabinet members that some recovery is under way, but they do not see one when they look around.

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris Of course, I speak to front-line staff. No one here has exclusivity on speaking to them and I will continue to speak regularly with them, as will, I am sure, Deputies from all sides. While staff accept that the economy is recovering because more money is being invested in the health service, they would be the first to tell me and I would be the first to agree that we must do much more to improve the health service. The only reason the previous Government was able to increase the health budget was that we had money available to do so. We could not increase it when the troika was in town. I find myself in my new position as Minister for Health at a time of reinvestment in the health service and there is much in which to reinvest. The health budget increased and will increase again. While we will continue to invest in the health service, we cannot fool people or pretend something is the case when clearly it is not. There are recruitment issues. There are vacant nursing posts which are funded and could be filled and we need to persuade more nurses to return from the United Kingdom. This can be done by a variety of means. I speak to nurses on the front line and representatives of nursing organisations. We also need to attract consultants from abroad and, as the Deputy correctly pointed out, we must continue to convert agency posts to front-line permanent posts. While a significant job of work remains to be done, let us not promote the myth that staff numbers are being reduced when the figures clearly show they are increasing.

Services for People with Disabilities

 5. Deputy Margaret Murphy O'Mahony Information on Margaret Murphy O'Mahony Zoom on Margaret Murphy O'Mahony asked the Minister for Health Information on Simon Harris Zoom on Simon Harris his plans to increase the numbers of personal assistant hours for persons with disabilities; and if he will make a statement on the matter. [14120/16]

Minister of State at the Department of Health (Deputy Finian McGrath): Information on Finian McGrath Zoom on Finian McGrath I thank the Deputy for her question and wish her well in her new position as Fianna Fáil Party spokesperson on disabilities.

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in A Programme for a Partnership Government which is guided by two principles, namely, equality of opportunity and improving the quality of life for people with disabilities.

With regard to assisted living services, the Health Service Executive's priority in the 2016 national service plan is to protect the level of services provided in 2015 and to provide 1.3 million hours of personal assistant services for 2,000 people with a physical and-or sensory disability and 2.6 million hours of home support for 7,300 people with a range of disabilities. The provision of personal assistant services has an annual cost of €30 million, with an annual cost of €52 million for home support services.

Personal assistant hours are reviewed on an ongoing basis to ensure the service is at all times responsive to clients needs and the hours available are allocated appropriately and in a timely manner. In 2015 the Health Service Executive exceeded the expected activity level for personal assistant hours by approximately 100,000. This reflects the responsive nature of the service provided and takes account of the fluctuation in assessed need over time. The need for increased personal assistant services is acknowledged and the HSE continues to explore various ways of responding effectively to this need from available resources.

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