Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am actively looking at it. I recently met a delegation on the issue. The Chairman is very passionate about it and he has brought it to my attention. I need to look at it in the context of the fact we do not fund postgraduate training for other elements of the health service, so there is an equity piece here. I am looking at it and I do hear feedback, not just from the Chairman, and passionately from him, that it is a model that works. I am looking at it in the context of budgetary matters.

In the context of the private health insurance issue, the Chairman is correct that the income reduction level is a factor in the growing deficit. I am pleased to say there is not a service reduction. The Oireachtas, for better or worse, passed legislation that is very clear on how this operates. Private health insurance companies have a different view and that is causing a real challenge here. It is something we are going to have to look at from a variety of perspectives.

On the public and private piece, it is interesting that the Taoiseach's maiden speech in this House was on decoupling public and private medicine. That is not to suggest that people with private health insurance do not have a right to have private health insurance or that doctors do not have a right to practice private medicine. However, it is hard - the Sláintecare committee arrived at this point - at a time when emergency departments, EDs, are crowded and public service waiting lists are lengthy, to work out how someone with private health insurance can use a public hospital bed ahead of someone who might have a greater clinical need but cannot afford private health insurance. It is easy to say that as a political point of view and it is one I share passionately. I spoke about it at the Health Management Institute, HMI, conference this week. If one were to say in the morning that one was going to decouple public and private health care, one would blow a hole in the health budget of about €700 million, so this is something we need to look at. Sláintecare calls for an impact study to be done, which I think is a really welcome body of work, and I have announced this week that it is my intention to proceed with that. We have to ask ourselves, when we have public beds in public hospitals, why public patients cannot access them while private practice in the public hospital can continue unabated. That is a real challenge.

I fully take the point on the question about some hospitals performing well and others not. I am not in any way endeavouring to dispute the fact that in certain parts of this country there are certain challenges that may or not exist in other parts. The point about reconfiguration is correct. I support the reconfiguration measures that took place, but they took place on the promise of more beds at some point in the future, and in some places those beds have yet to materialise. I get that. We are in discussions about the 96-bed block that is needed for the University Hospital Limerick. I do not want my crucial point to be lost and I do not think it is lost, namely, that if one just looks at hospitals as stand-alone hospitals, it is evident that all hospitals are seeing increases. All hospitals are facing a situation with more patients being older and therefore staying longer, and all hospitals are seeing more chronic care. Despite this, Beaumont Hospital, Connolly Hospital, St. Vincent's University Hospital, Cavan hospital, Mayo hospital - without any extra beds and with more patients - have seen fewer people on trolleys. I am not making it overly simplistic. They are the INMO figures from January to July this year. As a people and political system, we need to ask why that is. I know why it is. It is because of good patient flow and really hard work throughout the hospitals. That is not to suggest that other people are not working really hard, but it is about people saying not just that they need more resources, which they do, but that there are also things they can do better within the hospitals for patients.

The figures are stark. A total of 4,282 people were on trolleys in Beaumont from January to July 2016, but this year that was halved to 2,193. It is still far too many people on trolleys but it is clear that something was done in that hospital and this is the learning I am trying to embody in the system. We have to scrutinise that. One could say it is a big Dublin hospital but look at Cavan. There used to be an emergency department in Monaghan but there has not been for a number of years, yet Cavan General Hospital for the same period this year saw 207 people on trolleys compared with 621 last year. I am purposely cherry-picking the good ones. There are many on this list that have gone the opposite way, so while I do not suggest in any way that the trolley situation is getting better, I am suggesting that some hospitals are using good practice and we should learn from each other. Any system that does not learn from another is not good. When we talk about hospitals and trolleys, we need to point out that some hospitals are making significant progress.