James Reilly (Dublin North, Fine Gael)

The Minister seeks to enshrine in law what has been the approach de facto, namely, disengaging and devolving responsibility from her to others who have not been found to be up to the mark, such as the HSE. There are now nine reviews. The Taoiseach, on 6 November, and the Minister, on 7 November, promised the report of Dr. Ann O'Doherty by the end of November. Tomorrow is the end of the Dáil session and there is no sign of it. The HIQA report was promised for 18 November and there is no sign of it. Is the Minister becoming the Minister for reviews in the same way as her predecessor became the Minister for committees and task forces, with 117 reports under his belt but no action taken after four years in the job? The Minister is three years in the job and there is an unhappy resemblance forming.

The major problem with beds is the lack of proper use, such as the unit lying idle in Mullingar or the 57,000 bed days lost between Beaumont Hospital and the Mater hospital last year. That is the equivalent of five 30-bed wards closed for an entire year because there are no facilities available in the community or for rehabilitation. It may cost €1,300 to keep a person in a bed in a public hospital such as Beaumont Hospital but when treatment is finished it would be much cheaper to keep the person in a nursing home at €1,000. Equally, there is a perverse incentive in that it could cost up to €7,000 per day if a person is being intensively investigated while acutely ill. That must be addressed.

The ambulance service cannot get people into hospitals because the ambulances are queued up outside and trolleys are locked in the accident and emergency unit. What about our primary health care plan and our rehabilitation and nursing home places? These are areas where we could free up beds quickly but we need staff and funding to do so. The Minister and particularly Professor Drumm have said they wish to see primary care developed, an idea to which I fully subscribe. As with the cancer strategy, the Hanly report and bringing people from psychiatric hospitals and long-term institutions into the community, the harsh reality is that the service must be maintained for those who need it now while we develop new services. It is not either-or, it is both. People are sick and in pain now and need treatment now, not three years hence.

I have no faith in the co-location plan. The devil will be in the detail. We have been through all this, being told that certain things would not happen, such as cutbacks not hurting patients. If the Minister wanted co-operation from this side of the House on the substantive issue of this Bill, she would have stuck to the substantial issue, namely, to underpin the vires of those 19 bodies and institutions on which the Attorney General advised the Minister.

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