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

I will ask the director general to speak about the information sharing between the HSE and the State Claims Agency which is important. I will ask the chief medical officer to discuss the plans for open disclosure and the decision made between mandatory and protected disclosure. He will also expand on the issue of figures for perinatal mortality rates, which unfortunately give false reassurance.

Based on figures from the Irish Nurses and Midwives Organisation, there were 42 patients on trolleys yesterday morning or 35 based on the SDU figures. As the nurses' union's own website confirms, their figures include people who are not on trolleys - people in beds, in day wards or surgical wards - patients who may not be in the right ward but are certainly not on a trolley. Nonetheless, 35 based on our figures is still unacceptable. By 8 p.m. last night, that figure was down to 16, of whom only eight had been on a trolley for more than nine hours, so it does change during the day, and that is the nature of an emergency department.

Beds have been opened in Moorehall nursing home and patients from the Louth hospitals have been moved there. Navan and Dundalk have been used also to relieve Drogheda. There are the additional fair deal places, but even where there is funding for fair deal, the shortage of nursing homes in the Louth-Meath area is a problem. We need more nursing homes built, but that will not be done quickly. They are also getting additional home care packages which allows more patients to go home. In June or July 2015, a new modular ward will provide an additional 20 beds for Our Lady of Lourdes Hospital, Drogheda. In a logical world, if there are 35 patients on trolleys in the morning and 16 by the evening, an extra 20 beds should mean it will be down to 15 in the morning and none in the evening. That is not going to happen and it is a concern that one can add more and more bed capacity to a hospital and it does not bring down the numbers on trolleys - there are so many other dynamics. Admission rates vary and in some hospitals one is twice as likely to be admitted as in others, even though they are similar hospitals. The duration of a hospital stay can vary between hospitals. Often, when there are no people waiting on trolleys, there is less pressure to get tests done quickly or to discharge patients quickly. People may be brought in unnecessarily on some occasions. I have been there - I have been a doctor in the hospital where we were encouraged to admit everyone and also in the hospital where we were discouraged from admitting unnecessarily. There are many factors and I do not agree with Deputy Fitzpatrick's suggestion that we just need more beds.

If it was just down to that, the problem would have been solved a long time ago. We have started a programme in Tallaght called the Irish hospital redesign programme which applies management techniques such as lean six sigma to hospitals. The programme is starting to work in Tallaght and if it proves successful, Drogheda might be one of the sites to which we will extend it next. It is all about patient pathways and making better use of what we already have before we add an extra 1,000 beds because if the beds are not used correctly they will never be enough.

I have to prioritise the public health (alcohol) Bill 2015 but we intend to prepare a new action plan on obesity by the end of the year. Two weeks ago we had a good discussion on this issue in Farmleigh with Professor Donal O'Shea and staff from McKinsey who carried out international research, among others. The message I took from the discussion is that no single action will work. The list is topped by issues like portion size reformulation but taxes are far down it. We will require a cross-sectoral action plan which includes policies on physical education and snacks in schools. Health policy will clearly be a major element, however. Children who are signed up for GP care for under six year olds will receive two obesity checks per year. It will be important that we put in place referral systems so that something can be done if obesity is identified. We will need to introduce legislation on calory posting, marketing and product placement. The jury is still out on the sugar tax, however. Mexico has introduced such a tax and several other countries are completing research into whether it works. If it works, we should introduce it but if it does not there are more efficient ways to raise revenue.

Deputy Conway asked about the meeting I attended last night. As this was a private meeting and I assured people of confidentiality, I will not recount anything that they might have said. I commend those who attended on their courage and strength and thank them for sharing their experiences with me, the Chief Medical Officer, the new CEO of the hospital group and my departmental officials so that we might learn from them. It was a valuable exercise for that reason. Some of the issues raised were specific to Portlaoise and they are being addressed. However, other issues were more systemic. If we were to go back 20 years to meet 100 patients who had bad experiences in Waterford or Blanchardstown hospital, the discussion might have been very similar because people have bad experiences in all hospitals, including tertiary referral and national specialist centres. Much of the discussion concerned the quality of care received but equally there was concern about the way people were treated afterwards, both in terms of how professionals communicated with them initially and how their complaints were dealt with by management subsequently. This is why I think an independent patient advocacy service would make a huge difference. Somebody would be available to listen to patients, take their side and guide them through a difficult process laden with unnecessary officialdom, medical jargon and defensiveness. That could drive a change of culture in our health service to make it more focused on patient experience. This is something I want to achieve in the next couple of months.

Deputy Conway also asked about the five additional academic posts in University Hospital Waterford. The Department is keen to support linkages between the hospital groups and their academic partners and careful consideration is being given to any service implications that might arise from these posts in the context of the strategic plan currently being prepared by the south and south west hospital group. The cost of the five posts is €1.4 million per year. That amount of money would allow us to staff the new Waterford hospice for the best part of a year.