A press conference is being organised by the Irish Nurses and Midwives Organisation to unveil the results of research carried out by Dr. Keith Hurst, an international expert on comparative medical staffing levels. The results of his research are stark and frightening. They suggest patient safety is being compromised and give the lie to the notion that front-line services are being protected. One finding is that comparative staffing levels are significantly lower than in the United Kingdom. For example, there are six fewer staff in 25-bed surgical wards here and 3.5 fewer staff in medical wards, 13.5 fewer staff in AAUs and 3.25 fewer staff in wards providing elderly care. I do not know if the Tánaiste is aware that last week a report was published by the relevant authority in the United Kingdom which indicated that in 25% of units in the United Kingdom, which are significantly better staffed than ours, nurse staffing ratios were below minimum safety standards, which resulted in hundreds of premature mortalities. The Tánaiste will be aware that the Government proposes to reduce staffing levels in the health service by 3,700 during the next 12 months and by 3,700 the following year. Taking all of this into account, what assurance can he give to the people that the Government is maintaining a safe health service for those forced to use it?

The Minister for Health will examine the results of the INMO study when published. Without the full details of how the work was undertaken and the findings, it is not possible to comment in detail on the study at this point. I am aware that other studies have cited figures which suggest Ireland has a more favourable nurse to patient ratio than in the United Kingdom. The Government has determined, in line with its commitment to reduce the size of the public service, that health sector employment numbers must be reduced substantially in 2013 and 2014. Spending on health services will also have to be tightly controlled. The cumulative impact of staff reductions this year and in previous years presents a significant challenge to the health system in delivering services. The priority is to reform the way health services are delivered to ensure a safe, more productive and cost effective health system. Effective service delivery requires processes to ensure there will be sufficient staff, with the right skills, diversity and flexibility at the right time to provide high quality care.

Skills mix is a central factor in staffing decisions. The Croke Park agreement has been crucial to the ability of the health service to manage in the difficult circumstances of recent years. The flexibility and adaptability shown by staff, including nursing staff, have meant that even with reduced numbers, service levels have largely been maintained, while performance in relation to emergency departments and hospital waiting lists has been markedly improved. In the grace period earlier this year the focus of the Minister for Health and health service management was on ensuring all critical and essential services were maintained. This was successfully achieved through measures that included the reorganisation of resources, more flexible working arrangements and the filling of a limited number of critical posts. The continuing reduction in staffing increases the need for reform, including greater flexibility in work practices and rostering and redeployment. The HSE is committed to fast-tracking innovative and more efficient ways of using reduced resources, including by providing for greater flexibiliy in work practices and rostering, especially of nursing and medical staff, and the changing of the skills mix. Further flexibility and efficiency measures are provided for in an updated health service action plan which has recently been completed.

The Tánaiste appears to dismiss out of hand the results of this research, even before he has studied it. He must be aware that his colleague, the Minister for Health, in justifying his decision to proceed with a HSE inquiry in the case of Ms Savita Halappanavar, has said he owes a duty of care to the women of Ireland. Is the Tánaiste aware that the recent report from the State Claims Agency indicates that there were 5,600 accidents or near accidents in the area of childbirth in hospitals last year? The total number of accidents and near accidents is 86,000 which cost the health service €81 million in claims last year. Is the Government going to take action on this research? Will it, at a minimum, organise risk assessments of all staffing levels, or is its concern for the safety of those using hospital services confined to bringing forward legislation to deal with the outcome of the X case?

That is a scandalous comment.

Having raised one issue and gotten an answer-----

I did not get an answer - that is the problem.

-----Deputy O'Dea now switches tack to two or three other issues. I will now take each of the points he made in sequence. The Government is not dismissing out of hand the study conducted for the INMO. I told the Deputy in my reply that the Minister for Health would examine the results of that study when it is available. Deputy O'Dea will agree that it is prudent, if not courteous to those who produced it, that we at least await its publication and examine, in detail, what it contains. I said to the Deputy, clearly, that the Minister for Health will do that.

In respect of the reductions in staff that have taken place in the health service, I again pay tribute to the staff who work in our health services, including nursing staff, who have been flexible and adaptable and who are providing the best possible level of care to patients.

The issue is that there are not enough of them.

They are burnt out.

They are taking on additional responsibilities and extra work as part of the undertakings to which they committed under the Croke Park agreement.

In respect of the issue that Deputy O'Dea now attempts to raise, it is unworthy of him to try to haul into this question the tragic case of Savita Halappanavar. The Deputy's party leader, only a week ago, acknowledged that this country is one of the safest in the world for childbirth.