Mary Harney (Dublin Mid West, Progressive Democrats)

With regard to the points made by Deputy McManus, I am not seeking to eliminate the element of discretion because the purpose in having a medical card based on hardship is to ensure there is such an element. However, my understanding is that there are huge disparities from one place to another. There are places where it seems a high proportion of the population have medical cards but this does not seem to relate to socio-economic circumstances. In a unified system one would have as good a chance of getting a medical card in Dublin as in County Donegal or elsewhere. That is the point I was seeking to make. I do not want to use the word "guidelines" in this regard because there is an element of inflexibility. Obviously, we want flexibility in this arrangement. That is why we have the capacity to do this.

I more or less answered the other points earlier. We want to make sure houses are as wheelchair friendly as possible. All new houses must be wheelchair friendly but one wonders if that is necessary. On the other hand, if we want to ensure people do not have to move from their home if a member becomes disabled, it makes sense but there are associated costs. We will pay initially in the cost of housing.

I welcome the fact that there is huge interest in this issue across parties. That is positive and has generally been the case. It is becoming a bigger issue for society because of the increasing numbers involved but with these increasing numbers we must not lose sight of the current situation.

Deputy McManus asked about the accident and emergency ten point plan that has been implemented. Many of the provisions relating to the acquisition of step-down facilities and high dependency beds were subject to tender. The tenders are being examined and I understand the beds will be in place this month.

A number of home care packages have been put in place while a number of others have been approved but not yet executed. The home care package is customised to meet the needs of the individual concerned. It is not subject to strict criteria but customised to meet the needs of a person who wishes to live in his or her home but cannot because the schemes in place do not facilitate this. I hope that the acquisition later this month of step-down facilities will facilitate up to 500 patients to move from the acute hospital system to a more appropriate setting, perhaps within six to eight weeks after the acute hospital experience. That is the idea.

The high dependency beds are meant for those who cannot be suitably cared for in the traditional long-stay institution and those who cannot return home as they need a high level of care. These beds have been tendered. I understand the tenders are being examined and I hope they will come on stream soon.

Three weeks ago when I met geriatricians, the number of long-stay patients or patients who could be medically discharged in the six Dublin hospitals was 350. These were patients who could have been cared for in more appropriate settings, whether in a rehab facility, a high dependency bed, a nursing home environment or a home care setting. That is a considerable number which does not vary much from week to week. This is a major issue which is exerting enormous pressure on the acute hospital system. Dr. Conor Burke, a respiratory physician attached to James Connolly Memorial Hospital and the Mater Hospital, recently stated in a newspaper article that if hospital beds were used differently, in other words, if people could leave the acute hospital system when they were medically fit to do so, there would not be a problem in the accident and emergency departments of the hospitals concerned. There were patients there who could have been discharged but there was no place to which they could have been discharged. This had led to a blockage in the accident and emergency departments of the hospitals concerned. The problem in accident and emergency departments is a symptom of the problem in the wider hospital setting.

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