Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I have no doubt that she has, and I have some myself. One simple thing we could do is carry out an audit or a comparison with other countries that do not have the same problem. There must be one. Ireland is among the highest spenders and we know what we have to compare with. Can this be done? I am aware that the number of people on trolleys has been reduced and I am aware that the flu is a serious issue and it comes at this time and so on. Despite what people may think when they look at me, I remained standing in our household when everyone else got the flu. I do not go along with the general appraisal of the situation that Deputy Kelleher did that I should have gone down in the early stages. I am really concerned that it should be simple to find out where people have come from when they are sitting on trolleys, if we do not have the accommodation ready, if we should have the accommodation ready, if they should be treated somewhere else or if have they been treated or was there any attempt to treat them somewhere else such as primary care centres. There is not much sense in having primary care centres if they cannot do the job one would expect to be done in a primary care centre. There are a lot of them all over the country now, including a good few in my own constituency, and it does not seem to affect the numbers of people who are turning up in accident and emergency departments. I believe it should. If we cannot identify this information then all we are doing is duplicating services, in a very expensive way.

A simple audit needs to be done and I would love to find out why it cannot be done. RTÉ conducted an investigation some time ago on some of the things that were happening in the hospitals and it was able to find out information we did not know about or if we did, we did nothing about it. That is not being critical but it is something we have to answer. We must answer to the public and we must tell them outside what we are at. If it is not satisfactory, then the public has a way of very quickly dealing with us. I would like an answer to why there are deficiencies and whether they are permanent or are temporary. Are they theatre deficiencies or are they accident and emergency deficiencies? Is one overlapping into the other and if so, to what extent? Is extra capacity needed? The local hospital in Naas opened up 11 extra beds, a move which was very welcome and came at a good time. I thought we would have needed 20 beds at that time to eliminate peak time shortages. This is why I am concerned in this area. The Minister has pointed to the extra beds that are required between now and 2030 but I believe we need them before then. From my own observations, which I admit are not scientific, I believe we need the beds before 2030. Modern building methods will now very quickly bolt on extra accommodation to an existing hospital to high standards and the same as the rest of the building. This can be done very quickly, efficiently and cost effectively.

On the issue of spending, does an examination ever take place as to the cost-effectiveness of the service we provide at all levels in community care or in the hospitals and so on? There must be some way of identifying these. Deficiencies have been identified over the years and I am not suggesting these were simple; Ireland has come through a serious time in the context of the availability of finances.

However, we cannot go on with that forever. We have to move on, pick up the cudgels once again and simply ask ourselves why we seem to be chasing the game all the time. If we are always chasing the game, it is bad for the personnel in the hospitals and for all health personnel. We are always the subject of criticism. By "we", I mean all of those involved in the provision of services. Some time ago, a role in a local GP service was advertised. There was a great deal of furore about it beforehand, to the effect that the service was closing down. All the people who seemed to know everything announced publically that the service was closing down. What was the result of that? There was only one applicant for the position. Nobody wants to join a service that is closing down. I have never known that to happen anywhere. We must examine the impact of what we do and say about the services, and the effect it has on the confidence of those involved in them, particularly where emergency services are concerned.

My final point concerns step-down beds. A classic case of this issue is St. Brigid's Home, Crooksling, where we already have step-down beds. Somebody, who I will not name, wrote a letter to tell me that home was definitely closing down. I have news. That will be difficult, because I do not agree with closing it down. The reason is simply that the facilities there are state-of-the-art and are much sought after in this country at present. They are readily available beds of a high standard, with a high quality of nursing care, the use of modern technology to the greatest extent possible and a dedicated staff. What do we do with this asset? We try to make the bed situation worse by closing it down. The theory is that another facility will be opened somewhere else. I contend that we can open one somewhere else as well, because we need that too.

I cannot understand why people do things like that. The message I want to deliver is that nursing homes that are effective and well-run should not merely be kept but that we should continue to improve them. When somebody from the Health Information and Quality Authority, HIQA, tells me that I do not understand, that the building is falling down, my answer is that it is not. I know as much about buildings as HIQA does. Sometimes I get frustrated. Frustration leads to annoyance, and annoyance leads to reaction. At that point, something needs to be done.