asked the Minister for Health if he will give urgent clarification to health boards regarding the meaning of his recent directive on the filling of staff vacancies, in so far as it applies to (a) key surgical and medical posts; (b) temporary vacancies caused by maternity leave; (c) temporary vacancies caused by career breaks; and (d) mental handicap institutions, where shortages of staffing in the case of non-ambulant patients can cause a serious risk to the lives of those patients; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Medical Staff Vacancies.
6.
My Department issued a circular on 23 April 1987 to each health board, public voluntary hospital and home for the mentally handicapped which gave clear instructions to these agencies as to the basis for implementation of the Government's decision on non-filling of vacancies in the health services.
The types of posts referred to by the Deputy, those in the surgical and medical areas, those occasioned by maternity leave or those in mental handicap homes, are subject to similar criteria in relation to filling of vacancies. Such vacancies may be filled on a temporary or locum basis, without specific approval, provided the agencies are satisfied that they are on target to meet their staffing reduction targets and that they do not exceed their 1987 financial allocation. Filling of such vacancies on a permanent basis requires my approval and is dependent on strict criteria being met.
Temporary vacancies arising from career breaks may only be filled if the particular agency is on target to meet its 1987 staff reduction requirement and its 1987 financial allocation is not exceeded. The agencies have also been advised that persons due to return from career breaks in 1987 may be offered an extension on their career break or be allowed to return provided suitable vacancies are available.
Is that statement consistent with the statement made by the Minister for Finance in the course of his budget speech and which must have left all Deputies in this House under the impression that no vacancies in health boards could be filled except by the express approval of both the Minister for Health and the Minister for Finance? Has that situation now changed? I want to ask the Minister, too, if he is aware of the chaos being caused in every health board area, both in urban and rural communities, by virtue of the fact that not a day goes by without large reductions in staffs of the health boards. Is the Minister going to continue with the policy he has been implementing for the past two months or does he now realise that that policy is totally incorrect and, if so, is he prepared to change it?
In the Dáil on budget day my colleague the Minister for Finance announced that the public service embargo would apply right across the public service and that vacancies would not be filled without the prior consent of both the appropriate Minister and the Minister for Finance. Because of the sensitive nature of the health services it was agreed with the Minister for Finance that vacancies in essential areas could be filled temporarily while awaiting the sanction of the Minister for Health and the consent of the Minister for Finance.
I want to ask the Minister if he, as a medical practitioner, can conceive of a situation where vacancies, for example, surgical vacancies, would arise and where there would be available locums on a temporary basis to fill those positions for months on end pending sanction by him and the Minister for Finance? Would the Minister not agree that such a personnel procedure is a recipe for chaos and will lead to total confusion within the voluntary hospitals, the health board hospitals and even in the agencies for the mentally and physically handicapped? Is it true that a nurse who has got, say, a two year career break will only be allowed back into the hospital provided there is a vacancy in the hospital? Would the Minister not agree that that procedure is a total travesty of the policy of career breaks. That procedure which is now apparently being applied will mean that career breaks in the public service will terminate forthwith because nobody will go on a career break if they have no prospect of being reabsorbed——
Will the Deputy please conclude his question?
——after the period of a career break.
There is nothing new in a public service embargo. In 1981 the Coalition implemented a public service embargo in which only one in three vacancies was to be filled. That embargo was not successful in reducing the numbers working in the public service which was the object of the embargo. Because of the arrangement between myself and the Minister for Finance I am satisfied that there will be no serious problem in the filling of essential vacancies in any of the health agencies.
I am looking into the question of temporary career breaks to see what can be done to alleviate the problems that are created both for people who are on career breaks and for those who may want to take career breaks in the future.
The Minister says he is happy with the arrangements in the health services but he must be totally alone in being so satisfied. Will the Minister now confirm that the total number of reductions to be implemented in the health services area in 1987 is now in the region of 3,750 persons and is he yet in a position to tell the House the actual reductions in the numbers of staff?
That seems to be a separate question.
As regards my being happy with the health services, I am satisfied that an expenditure of over £1,300 million and 60,000 persons working in the health services are sufficient to ensure an adequate and comprehensive health service for the people of this country. With regard to the reduction in the number of people working in the health service I accept that 2,000 vacancies will not be filled and that other jobs may be lost as a result of the inability of the health agencies to fund these jobs. I am not in a position at this stage to say what that number of jobs will be.
Deputy Desmond will have to be very brief because I want to call other Deputies.
Because 2,000 vacancies will not be filled this year and because a minimum of 2,000 non-permanent staff will be laid off, would the Minister not agree that the figure to date of 3,750, as given by Deputy Spring, is a reasonable figure in terms of calculating losses? It is twice the number projected in the budget. Would the Minister not agree that hospitals, for example, Temple Street where 90 staff have been laid off this week, St. Vincent's where 70 staff have been laid off this week——
I am seeking to convey to Deputy Desmond that I want to assist two other Deputies in putting supplementaries before we proceed to questions nominated for priority. I intend to call Deputy Mary Flaherty and Deputy Proinsias De Rossa.
I am satisfied the numbers of people working in the health service are sufficient to ensure an adequate and comprehensive health service. The number of people working in the health service increased by 16,000, from 47,000 15 years ago to 63,000 last year. In accordance with the public service embargo I am satisfied the vacancies that will be left unfilled will not impinge seriously on the level of treatment available.
You thought differently in January.
The health boards are obviously taking a far deeper cut in terms of staffing than any other section of the public service. Will the Minister not agree that the staffing levels of the health services are affected by the cut backs over and above the embargo? Will he comment in relation to St. Vincent's hospital and say how a particular situation will be dealt with in the context of the Minister's guidelines? I am sure the Minister is aware that a senior heart specialist is to retire from St. Vincent's this month and that he is one of two serving the whole hospital. Will that surgeon be replaced? Will some other staff member lose a job in order that the heart specialist can be replaced?
I am sorry we are now entering into priority Question Time. I sought to facilitate Deputies. We can have a brief question from Deputy De Rossa.
What steps is the Minister taking to rectify a position whereby the dental service for adult mentally handicapped people in St. James's hospital has been closed down? Is he aware that the intensive care beds in the Children's Hospital in Crumlin have been reduced from eight to six, resulting in lengthening queues for heart operations for children?
In relation to St. Vincent's hospital and the dental services, I will communicate directly with the Deputies as I have not all the relevant information here. On the question of cut backs to the health boards, the basic problem is that the health boards are effecting savings that should have been effected over the past two years because of an over-run of £55 million allowed by the previous Government.
They were carried through by your own members in the health boards. What the Minister has said is a total untruth.
We increased the allocation to each health board this year over and above what they received in 1986.
We will move to Priority Questions.
(Interruptions.)
The Chair ruled out of order my Private Notice Question——
Will the Deputy wait until the Order of Business. I hesitate to permit interruptions during the course of Priority Questions where time is very limited.
Is it a record that only six questions have been replied to in an hour's Question Time, as a result of the stonewalling and waffling by the Minister?
The Chair did his best to accelerate matters. Will the Minister reply to Question No. 38.
It is outrageous carry-on.