Mary Harney (Dublin Mid West, Progressive Democrats)

There are 2,500 private beds in our public hospitals at present. That some 46% of the elective work at Tallaght Hospital last year involved private patients does not cast any reflection on its catchment area or on its accident and emergency activities. The beds in question were entirely funded and are 40% subsidised by the taxpayer. The wages of the nursing and other staff are paid by the taxpayer.

I want to reduce the amount of private activity in public hospitals so patients are seen on the basis of medical need. Ireland has more beds pro rata than Finland or Sweden and the same number as Britain, even though 18% of the population of Britain is over the age of 65 and just 11% of the population of Ireland is over the age of 65. It almost does not matter how many beds one has if they are not being used efficiently. The results of the process mapping exercise at Cork University Hospital, which were published last week, highlighted that 2,280 bed days were lost at that hospital because people who were fit to be medically discharged were not discharged for all kinds of reasons. Very few people are discharged from our hospitals, particularly those in Dublin, on Saturdays or Sundays. If one is not seen by a consultant until late in the evening, one will not be able to go home until the following day.

We need to change many aspects of how we use our beds. While there are fewer beds in Finland than in Ireland, there is more hospital activity in that country than there is here. When one talks about beds one has to consider how they are used. The number of procedures carried out on a day case basis doubled from 250,000 in 1997 to 500,000 in 2004. That means there should not be as much need for inpatient beds. Deputy Gormley asked me to outline the extent to which it is acceptable that there are patients on trolleys. People will always be treated on trolleys — that is a fact throughout the world. Many treatments are performed while patients are on trolleys. We are trying to ensure that people who are waiting to be admitted to acute beds in hospitals do not have to wait for more than six hours. That is the aim and the ambition. In autumn 2005, there was a reduction of 20% in the number of people waiting on trolleys.

The care of the elderly is one of the issues that arises in this regard. Approximately 4.5% of those over the age of 65 are in long-term care, which is in line with the international average. Some people who are in care could be at home if a set of measures had been in place in the past to support such people. We do not have such supports, however, and it will take some time for us to catch up. We are putting them in place at present because we understand that over the next few years we will have to expand the services we provide to older people in the community. We need to provide home help and home support and to recruit additional chiropodists, physiotherapists and other professionals who can help people to stay in the community. I have given the HSE additional resources to procure beds for older people in the acute system. There were approximately 440 such people in the Dublin area a few weeks ago. Older people who have been medically discharged are being moved from the acute system to alternative settings. That will continue for the rest of this year. It will have a major impact on accident and emergency services as the year progresses.

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