Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I will start with Deputy Kelleher's remarks. The situation in emergency departments is variable. We have roughly 50 emergency departments across the State. In some, it is rare for patients to be on trolleys - St. Vincent's hospital is one example of that - while in others it is intermittent, but in certain hospitals it is almost always the case that there are large numbers of patients on trolleys. It is not simply down to bed capacity; a lot of it is down to patient flow and bed management.

Neither the Department of Health nor the HSE dismisses the concerns of staff in these emergency departments. In fact, they are our staff and we take what they have to say seriously. However, I do think we need to challenge the idea that it is always down to staff resources or bed capacity, because it is evidently not. In one hospital, another 20 beds were opened quite recently and it solved the problem for a few weeks, but then all of a sudden the beds were all full again.

I look at the numbers every day and it is a much more complex phenomenon than people make out. It is remarkable that some hospitals seem to be capable of managing their emergency departments without having patients on trolleys, while others seem to be incapable of it no matter what supports they are given.

As regards the alleged manipulation of waiting lists, it is certainly the case that waiting lists are validated. The HSE does make sure that people are not on two waiting lists for the same procedure, for example, and that people are still in the country. Such things are done to ensure they are validated, and that is entirely appropriate in my view. I have not seen the memo but I do understand that it may have been at regional level or at the level of a local manager. In some ways that is reassuring, because it shows that certainly at national level in my Department and in the HSE there is no policy of manipulating waiting lists. If we could see the memo it would allow us to take action against any manager at regional level who was clearly breaching policy. The policy is that urgent cases are treated first and everyone else in chronological order. I want to make that clear.

Leaving that aside, the Deputy touched on a much more important issue - the fact that people are waiting far too long for procedures and appointments. It is distressing that in a lot of areas - orthopaedics, for example - people are waiting for unacceptably long periods of up to two years. That is something I hope to drill down into and understand better in the next few weeks. While we may have great difficulty meeting the eight-month and 12-month targets, I really hope that next year we can do something to deal with those people who are waiting unbelievable lengths of time for treatment. I think we all agree that that is unacceptable.

On the Fair Deal scheme, there may well be delays in the assessment. The Deputy is fundamentally correct in saying that the real problem with the Fair Deal scheme is that it is budget-capped, which is in the legislation. It is not like medicines that have to be reimbursed or medical cards that happen to be issued if the person is entitled to them. The entitlement to the Fair Deal scheme is budget-capped, and when the budget runs out that is part of the big problem.

Prescription charges were introduced by the Deputy's party when it was in Government. There is no commitment in the programme for Government to abolish prescription charges. I would love to be able to do it, if we could - they bring in hundreds of millions of euro every year - but it is not within the current finances to be able to do that. I certainly have not increased them, however, and do not intend to do so.

The number of delayed discharges at the moment is 700, heading for 800, which is bad. It is bad for the health service because it means that beds that should be used by other patients are not available. It is also bad for the individuals whose discharge is delayed because they are more at risk of falls, infection and medication errors. We have set aside a dedicated fund of €25 million for the early part of next year to try to get a handle on delayed discharges. There are lots of things that could be done, including step-down beds while people are waiting for the Fair Deal scheme, and enhanced home care packages to get them home with a higher level of home care than we have been used to providing. In addition, community intervention teams can get people home and have nurses visit to provide intravenous infusions, while early supported discharge can be used in the case of stroke patients. Many things could be done but we do not yet know how best to employ that €25 million or over what period of time. That is something that the HSE and I will be working on closely in the next couple of weeks.

I will leave mental health questions to the Minister of State, Deputy Kathleen Lynch, a bit later.

When it comes to the national maternity strategy, as a first step the Department is currently finalising a policy paper on maternity services. I have not yet seen the draft of that, however. After that is finalised a working group will be established to review the policy paper and develop a comprehensive national maternity strategy. The working group will be convened before the end of this year. I hope to have some international involvement in that too. With cancer services, for example, we have often brought in international views, and I would like that to be done in this case also.

It is envisaged that the development of the strategy will be subject to wider consultation with stakeholder interests and that the strategy will be completed during 2015.

I imagine all 19 units will be visited and I cannot see why they would not be. I expect that to happen and I share the view of others that maternity care is too obstetric-oriented, much more so than it needs to be. I have an open mind on midwife-led units. In Britain, a woman makes a choice early on, in the case of a low-risk pregnancy, to go left into the midwife-led unit or right into the obstetric unit. They tend to be beside each other in case something goes wrong. In any pregnancy, the one thing we do not want to happen is for the woman to bleed heavily after pregnancy and be at home with one midwife. No matter how good, one person cannot deal with a patient who is bleeding and one patient who has just been born. That is my opinion, and international models will be studied before we come to a proper strategy in 2015.
I will leave the questions on the HIQA report to Dr Tony O'Connell. My understanding of the case in Cavan is that the court quashed the recommendations, not just the findings, and that leaves us with a dilemma. Dr. Tony O'Connell knows more about that than I do. I do not want to talk about the midwife in question because an investigation is starting quite soon, if it is not already under way. Court actions have been taken and, while we have parliamentary privilege, we should not abuse it. I do not wish to speak too much about things that are sub judice. The investigation is occurring as a result of complaints made by other clinicians, not an unqualified individual with a vendetta against home births. The complaint is from other midwives who have concerns.