James Reilly (Dublin North, Fine Gael) | Oireachtas source

Many of the questions asked by members of the committee relate to officials who are in attendance. I will touch on the questions that are appropriate to me and pass the other questions on.

Deputy Kelleher asked about the temporary suspension of the fair deal scheme. Mr. Tony O'Brien went into that in some detail, in fairness. I would like to comment on it in the overall context of the Deputy's concern that the trend is going in the wrong direction and his comments about the pressure on our emergency departments from December to April. The special delivery unit, which has received tremendous co-operation from the clinical programmes, has been successful. I am pleased that Dr. Áine Carroll, who is leading those programmes, is here today. There have been tremendous savings in bed days. Over 120,000 bed days have been saved since we started. Substantial moneys have been saved. I reiterate that the money we save in the primary care reimbursement service, elsewhere in the hospital system or in any other part of the health service, goes back to making sure more patients are seen more quickly.

I would like to touch on what was said about increased pressure in December. The special delivery unit, the clinical programmes and the front-line staff have managed to create a new flexibility within the health service that allows us to deal with the surges and the waxing and waning of demand that we know is there. When we are under pressure in our emergency departments, of course elective surgery slows down to allow for the admissions that need to come in. These are the most acutely ill people in our society and they need urgent care. As the director general designate, Mr. Tony O'Brien, has said, it was reaching the stage where we felt patient safety was being compromised. As I said at the outset, outcomes for patients and patient safety are our absolute priority. We are very keen to stay within our budget, but we will always put patient safety first.

I will address some particular aspects of this issue. The suspension of the normal chronological order allowed for people who were in the delayed discharge category to be moved to long-term care from the hospitals. It is not just a question of the patient in the community waiting on a bed and the patient in the hospital waiting on a bed. There is a third patient involved here, namely, the critically ill patient, often an older person, who is lying on a trolley in the emergency department. We know that the outcomes for patients who are left in that scenario are far worse than the outcomes for patients on hospital beds in wards, even if there are more people in those wards than would normally be the case. That is why this flexibility was used to suspend some elective surgery. It allowed for acute admissions to take place and it enabled a greater emphasis to be put on outpatients. We will catch up on our elective surgery as the year progresses. The demand is easing. It can be seen that trolley counts are much lower than they were earlier in the year. We always get a rebound in January, February and March after the hyperactivity associated with the end of the year. We plan for that. I am quite happy that we have the wherewithal and the resources within the intervention fund to deal with those targets and waiting times in a focused fashion. The numbers of people who are waiting for forms of surgery and procedures that would make huge difference to their quality of life are not targets. I think I have covered what the Deputy said about the trend going in the wrong direction. It is coming back now and we are heading in the other direction.

Deputy Kelleher also spoke about how to fund universal health insurance. Dr. Fergal Lynch will speak about that in more detail. The Deputy argued that we are basing our approach to universal health insurance on private health insurance. That is not the case. It is made clear in the programme for Government that the VHI will be kept as a public option. There is no doubt that more people have opted out of private health insurance. Part of that might relate to increased premiums. Much of is relates to the fact that 450,000 people are unemployed and the country is in the state it is in. I do not intend to trade political brickbats with the Deputy about why that is the case. We know the reasons. The high level of unemployment is one of the reasons for the increase in the number of people on medical cards. The Minister of State, Deputy White, will deal with the issues raised around medical card eligibility. The bottom line and the inescapable fact is that there are more people with medical cards now than at any time in the history of the State. There will always be hard cases.