Mary Harney (Dublin Mid West, Progressive Democrats)

Including the good or very good category, the satisfaction level is more than 90%. It is a positive reflection on the public health care system.

Deputy Higgins referred to accessibility. Until the early 1990s, there was no universality. The VHI was established 50 years ago because 20% of the population were not entitled to hospital services, but everyone has that entitlement today. I am a strong fan of maintaining this position. A hallmark of the new contract of employment for consultants will be access to diagnostics in public hospitals for every citizen on the basis of medical need rather than preference due to health insurance or the ability to pay.

Situations such as the Rosie case, which came to light last year, cannot be allowed. She was told by consultants that she could have her procedure immediately if she had insurance or else be put on a list. She waited six months. Access to publicly funding facilities should only be provided on the basis of medical need rather than a preference for one group over another. This is a fundamental principle in the ongoing negotiations between the Government, the management of the HSE and the consultant bodies. Were we to abandon some of our principles, we could have reached an agreement long ago.

Regarding the co-location of private hospitals, neither I nor the majority of taxpayers and patients care how services are funded. They want excellent services when required and as close as possible to where they live. GP services are a public private partnership of a kind in that the GP sees GMS and private patients without distinction. None of the people in a GP's waiting room knows who has a medical card. I support this system strongly because it works well. Moving more services from hospitals to the primary, community and continuing care sector is a strong feature of future policy.

Many public hospitals are hives of private enterprise. I do not understand why there was a hullabaloo when the previous Government sought to convert private beds funded by the taxpayer into public beds to which all patients have equal access. For many years, 20% of all public hospital beds have been ring-fenced for private patients while the taxpayer paid for the beds' running and capital costs, staff and diagnostics. Why should this be the case? We want to convert the beds for public use and have private beds co-located with public beds so that doctors are on site. Fine Gael has a problem in that regard. While it does not have an objection to private beds, it does not want them on site. Apparently, putting them five miles away is fine.

Concerning the measures taken by the HSE, every organisation, be it a sports club, political party or trade union, has an annual budget within which its management is expected to live. On a monthly basis, the board of the HSE monitors its budget and sends a report to the Government. It is a challenge for the HSE to live within its budget because there is always a large demand for services, but I do not understand the dire consequences predicted by some. Reference was made to the case of an anaesthetist going on holiday from Cavan General Hospital. There are eight consultant anaesthetists and ten registrars in Cavan General Hospital and Monaghan General Hospital. Compared to hospitals elsewhere, this is a considerable resource. I do not know why a team of 18 cannot organise its work in such a way as to prevent the predictions broadcast this morning.

Regarding the 30 nurses at Sligo General Hospital, it has a nurse to bed ratio of 1.8:1 whereas Waterford Regional Hospital has 1.3 nurses per bed. The latter can operate on half a nurse less per bed than the former. Is it acceptable that a hospital with 1.8 nurses per bed can predict such dire consequences when informed that the 30 nursing positions used to cover holiday periods will no longer be available?

Reference was made to consultants earlier in the debate. One locum consultant was appointed to facilitate a consultant to attend the Medical Council. I was not aware until I became Minister for Health and Children that if a consultant is appointed to a body, a locum is appointed to replace him or her in clinical practice. It is a recent development. Another consultant retired and while his replacement was taking up his position, there was a transition period during which a locum was in place. The two locums in question are, therefore, surplus to requirements. I do not understand why we hear the things we do when we seek to point that out.

I heard a doctor speak this morning about 62 beds and 150 procedures per month in Galway, which represents an incredible ratio of beds to procedures. I told the House last week that when Professor Keane was appointed to oversee the reform of cancer services in British Columbia, he had ten inpatient beds for radiotherapy for a population of 4.1 million. There are 179 inpatient beds in this city for a similar population. Professor Keane could do with ten beds in British Columbia what we have 179 beds to do despite the very dispersed population in that part of Canada. Professor Keane made the point that improving services is all about re-organising how things are done.

I made the point to the House last week that the most expensive bed is a hospital bed. Unless a patient needs to be in a hospital bed, alternative hostel-type accommodation must be used as it is everywhere in the world. If we could get all Irish hospitals to perform to the standard of the best hospital in the country, we would greatly reduce the burden we face. If we could get close to the performance in Canada, where twice as many day procedures are performed, it would have an incredible impact on our acute hospital system. If we could go further and introduce best practice in respect of in-hospital stays for basic procedures, we would greatly improve the performance of our hospitals. In Ireland, a simple procedure like an appendectomy can require from three to six and a half days hospitalisation. Many patients are in hospital over weekends when very little tends to happen. We must reform hospitals and acute hospitals in line with best practice in other European countries.

As part of the settlement with the nurses unions in May 2007, we agreed that 2.9 million hours per annum should be taken out of public nursing hours before June. Nurses would reduce their working week from 39 hours to 37.5 hours on a cost-neutral basis and without any diminution of services. If the failure to replace 200 to 300 staff each month to what I acknowledge will probably be the end of the year is to have the kind of consequences of which we are now hearing, I pose the question of whether we have the capacity to take 2.9 million hours out of the public health care system between now and June. I have yet to hear a nurse, doctor or other health care worker from the private health system complain about how awful the service is.

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