Health Services.

I thank Senator McFadden for allowing me to raise this issue now.

I thank the Minister of State for attending to respond on the impact the moratorium on public service recruitment is having on district hospitals and nursing units, particularly in Buncrana and Carndonagh. The absence of staff on maternity leave and so forth is putting many local facilities under pressure. I offer as an example Cardonagh Community Hospital in my locality which was the subject of a recent HSE report which offers a flavour of the work it does.

Carndonagh Community Hospital is operated by the HSE. The main hospital was built in 1956 and a badly needed new dementia care unit which has been a great addition to the hospital was added in 2007. The centre provides a broad spectrum of care services to meet the needs of the people of Inishowen and complements the work being done in the Buncrana nursing unit. Its services include short-term assessment, respite, convalescence, palliative care, continuing care and dementia-specific care. A range of services are being provided at the centre which includes a 39 bed residential unit and a 16 bed unit for dementia patients. Accommodation consists of multiple occupancy wards and five single rooms. Two palliative care suites are also available which allow family members to stay with their relatives at the end of life. I commend the voluntary sector for the work it has done, as well as the staff, from the matron Maura Gillen down, to ensure people can remain in the area and be supported by their families and friends to the end of their lives.

The recent assessment shows that the hospital provides occupational therapy, physiotherapy and podiatry services, offers a day care centre, X-ray service and other clinics. A general practitioner and the NOW DOC service also operates from it. On the day of inspection the hospital was catering for 55 patients on-site, of whom 48 were at maximum dependency level, five at high dependency level and two at medium dependency level. The hospital has a vital role to play. It is not just a place where people go to live but is a community hospital, in the real sense, catering for high dependency patients.

The Health Information and Quality Authority, HIQA, report was released in July 2009. Inspectors were satisfied that the health care and medical needs of the residents were well catered for and that good systems were in place to assess their needs. The centre was found to be well organised and managed and the person in charge had a good knowledge not only of the residents in her care but also of the new legislative requirements and her role in that context. Residents and relatives commented positively on the quality of care provided and most were happy with their quality of life, the staff at the centre, the food provided and the daily routine. However, people would welcome more activity, particularly at the weekend, to keep residents as occupied and challenged as possible. When one is dealing with older facilities, there will always be a negative commentary, as in the case of this report.

Four residents and 11 relatives completed pre-inspection questionnaires and a further nine residents and three relatives were interviewed during the inspection. Everybody felt well cared for and gave a positive account of life in the centre. The vast majority had a sense that the staff were more than nurses to the patients; they were friends who sat with them in the middle of the night and comforted them when they did not feel well.

I have tried to give a brief overview. My impression is the one that comes through in the report. The services offered by community hospitals and nursing units within communities, particularly in rural areas, are vital. However, they are under pressure as a result of the moratorium on recruitment. To a certain extent, they are also under pressure with regard to the decisions people can make about where they want to be cared for. If they choose to stay in community hospitals when perhaps they should move to nursing facilities, it could put pressure unnecessarily on community hospitals.

I look forward to the Department's response. There is controversy in County Donegal about the potential closure of the facility in Lifford. We want our community hospitals and facilities to remain open, but if they are allowed to become run down as a result of the moratorium, nobody will be able to replace the homely care being provided at these facilities in rural areas. Coming from a rural constituency, I expect the Minister of State will not think differently on the matter.

I am taking this Adjournment on behalf of my colleague, the Minister of State, Deputy Áine Brady.

We endorse Senator Keaveney's remarks on supporting people, particularly older people, to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care and we as a Government continue to develop and improve health services in all regions of the country and to ensure quality and patient safety.

The Health Service Executive has sole operational responsibility for the delivery of health and social services, including those at facilities in Carndonagh and Buncrana. Senator Keaveney will appreciate that all developments must be addressed in light of current economic and budgetary pressures and have regard to the current moratorium on the recruitment of nursing and non-nursing staff. The HSE has been asked to make a rigorous examination of how existing funding might be re-configured or re-allocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources currently available.

The integrated services directorate is the executive's directorate responsible for the delivery of health care services. I understand that, in line with what is happening around the country, the HSE in Donegal is currently reviewing its use of resources and facilities for residential care in the county.

The factors relevant to this process in Donegal include compliance with the 2009 regulations under the Health Act 2007 and with the national quality standards for residential care settings for older people, staffing and resource issues, overall residential care needs within the area, the options available in public and private nursing homes and the HSE's capital programme to replace and/or upgrade existing facilities. On completion of the review the HSE will then be in a position to outline any proposed changes arising for HSE facilities in Donegal.

Employment control frameworks have been used for a number of years in the health sector to give effect to Government policies on the number employed in the health sector. The employment control framework for 2010-12 gives effect to our decision on employment policy in the public sector. It provides that there will be a net reduction in employment to 2012. This includes a target reduction in numbers in 2010 to achieve the overall reduction of 6,000 from March 2009 to the end 2012, and consequential pay-roll savings. Based on reductions already achieved in 2009, the net target reduction for the health sector to the end of 2012 is 4,560 whole-time equivalent positions, or 1,520 per annum.

Similar to 2009, there are a number of grades exempted from the moratorium on recruitment in order to maintain key front-line services and to support the development of policies in disability, mental health, cancer, older people and child care. In addition to these exempted grades, the 2010 framework also gives the HSE delegated sanction, subject to meeting the target reduction referred to of 1,520, to fill critical posts, in grades other than management and administrative grades, by way of exceptions to the moratorium. Such exceptions may be made where the HSE has satisfied itself that there are compelling reasons for doing so in order to maintain essential front-line services.

This arrangement supersedes the requirement to obtain the approval of the Department of Health and Children and the Department of Finance for the filling of any vacancy arising in a post in a non-exempted grade. It is, therefore, a matter for the HSE itself to determine the relative priority to be accorded to the filling of such vacancies without reference to either Department. This is provided that it delivers the required overall reduction in numbers and the associated pay-roll savings, and meets the policy requirements in service development posts and exempted grades, as I have outlined. The Department of Health and Children's view is that exceptions should be kept to the absolute minimum in order to achieve the target growth in exempted grades and support the transformation agenda.

At a national level, Senator Keaveney will be aware that significant changes took place within the nursing home sector in 2009 resulting in a single system of registration and inspection for all providers, public, private and voluntary, and a single system of financial support. The net effect of these changes is an assurance to every person in need of care that the same quality standards and the same level of financial State support will apply regardless of which nursing home they choose.

In light of these important changes and in light of service pressures arising from demographic trends, the Department is continuing to work closely with the HSE to examine long-term capacity, quality, staffing and funding requirements.