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

On Deputy Kelleher’s points, I referred in my speech to other considerations. We have discussed the maternity end of this because Mount Carmel was the only private maternity hospital, whereas there are many other private hospitals dealing with the general medical care. It is important we deal in facts. In 2004, there were 16 private hospitals in the Republic of Ireland. Today, there are 21. There is plenty of capacity. The National Treatment Purchase Fund and the SDU, special delivery unit, used Mount Carmel to ensure outpatients did not wait untimely lengths for treatment and there were plans to use it again. There is no shortage, however, of capacity in the private sector to take up the slack. Apart from that, Mount Carmel provided medical paediatric and surgical services in a range of areas including orthopaedics, ophthalmology, gynaecology, endoscopy and ear, nose and throat. As I said, there are plenty of other providers to cover that capacity.

During 2013, the HSE secured additional treatment capacity in Mount Carmel, as well as in other public and private hospitals. However, the number of treatments outsourced to these facilities represents less than 1% of the total number of annual scheduled outpatient appointments and less than 0.5% of the total number of inpatient and day-case appointments undertaken nationally. Obviously, there is no shortage of capacity and there is no need for any concern in that regard. The HSE will continue to avail of the support and services offered by other public and private facilities where capacity is required and available. It is considered that other hospitals will be in a position to take the proportionate cases previously outsourced to Mount Carmel.

We will explore the use of the site as a step-down or short-term transitional facility for older persons. It will take some time to do that, however. The HSE is already examining it but at this stage it is not clear whether Mount Carmel can offer what is needed. To establish this would require a full assessment including appropriateness of accommodation, availability of staffing, ability to provide the required services to be determined, as well as outcomes, costs and timescales to commence the delivery of services. It is certainly part of our desired armamentarium that we want to have such facilities in highly populated areas where people can continue their recovery having had their acute medical condition addressed, rather than sitting in a hospital bed at great expense, as Senator Burke pointed out. It is important they would get the type of service they need because historically they did not. Once their medical treatment was over, that was it. They did not get the physiotherapy, occupational therapy or speech and language therapy they needed that could have resulted in many of them living an independent life at home. Sadly, if the opportunity passes, then they are destined for long-term care which all members will agree is not acceptable. As we all know, no matter how nice a place is, there is no place like home.

Discussions with NAMA were raised. The Department and the HSE would have had discussions with NAMA. However, it is a business decision by NAMA as to what it does with this facility. The hospital was losing money on a weekly basis. Contrary to what several members claimed that it was on target to make a profit at the end of this year, my understanding is that it was on target to lose over €1 million. This could not be sustained.

I do not believe the VHI should be determining the market. If a private hospital comes on-stream that has the appropriately qualified staff and facilities, there is no reason it should not be insured to treat insured patients. However, if it goes out of business, it has to be a matter for it. The VHI cannot be expected to support it, nor the Government. As I pointed out already, we had only 16 private hospitals in 2004 while today we have 21 plus Mount Carmel. It would not be fair to say that private medicine is disappearing off the face of the health landscape.

It was claimed that concerns have been expressed about the national paediatric hospital which we are not discussing today. However, I want to set down a marker in this regard. The Government has made its decision and it is not resiling from it. Those voices of concern want it built elsewhere. I am happy that the Government has made the right decision and that St. James’s is the right place for the hospital. It has more than enough space to accommodate the hospital planned, as well as the maternity hospital. Neither is there any planning danger with the expansion of this site and the additional grounds bought at another location.

Deputy Ó Caoláin referred to the recruitment embargo affecting midwifery services. We always said the embargo would be operated in a flexible fashion to get the right skills mix. Last year, we recruited over 700 nurses to the health service. Those with particular expertise in theatre, ICU and midwifery are much sought after. I believe the nurses in Mount Carmel with these skills will be quickly taken in by other hospitals. We also have 200 more general practitioners in the GMS than we had four years ago, as well as 200 more consultants. The health service is trying to get its skills mix right and focus on the right people delivering the right care in the right place at the right time to the right sort of patient. In other words, this is about treating the patient at the lowest level of complexity that is safe, timely, efficient and as near to home as possible.

We do have a problem in urban areas with delayed discharges and patients not being able to get the precise treatment they need to recuperate properly while other acutely ill patients are unable to access a bed because it is occupied inappropriately. This is to the detriment of the patient who is delayed. This is what we are addressing through the frail elderly programme put in place by the clinical probes.