Máire Hoctor (Tipperary North, Fianna Fail)

I am pleased to have the opportunity to address the House in this debate. In particular I want to build on what the Minister of State, Deputy Devins, has just said in terms of the Government's total commitment to improving the health services and working from the progress we are already making.

Since 2004, the Government, particularly the Minister, Deputy Harney, have organised the largest ever expansion in services for older people, covering every area from new home care supports, more home help, long term care, palliative care and measures to counter elder abuse. This is about more services and more innovative services, closer to older people's homes, designed around their needs and resulting in much better support than ever before. Our plans and our commitment as a Government is to do more, year in, year out, to make steady, constant progress in supporting older people in every way possible.

I wish to focus some remarks on the financial aspects of the debate, because it shows just how much we are backing up the reform process with high levels of investment. This year, there is an increase of €1.1 billion in overall health funding. This is being done when most economic experts are predicting a difficult period internationally which will affect our economy too.

In 2008 the Government is providing a total of over €16 billion for expenditure on the health group of Votes. This is made up of the €14.931 billion for the HSE, €695 million for the Office of the Minister for Children and €530 million for the Department of Health and Children. This represents an increase in health funding of 9%. Once again, it places Ireland very high in international terms in relation to growth in public health spending. This funding will enable, for example, the continued prioritisation of services for older people and people with disabilities, and the cancer control strategy.

To put matters into sharp focus I draw attention to the following facts. The revenue funding to the former health boards in 2004 was €9.8 billion. The funding being provided to the HSE for service delivery this year in 2008 is €14.3 billion, an increase of €4.5 billion or over 10% a year for the four years since the HSE's establishment. In international terms according to the OECD, health spending in Ireland grew in real terms by an average of 9.1% per year between 1999 and 2004 while the OECD average was 5.2%. Total health spending accounted for 7.1% of GDP and about 8.5% of GNP. The relevant GNP measure is very close to the OECD average of 8.9% and this is without any adjustment for our generally younger age profile.

In terms of health spending per capita, Ireland spent US$2,596, adjusted for purchasing power parity, in 2004. This is over the OECD average of US$2,550. Alongside Norway, in 2004, Ireland had the highest level of public capital investment in health as a proportion of national income. At 0.6% of GNP, this is twice or more times the level of most OECD countries. The national development plan will continue a very high level of public investment generally and health capital development in particular. To illustrate the Government's commitment to high levels of public health spending, in Ireland nearly 80% of health spending is funded by government revenues, above the OECD average of 73%. This compares to a figure for Ireland of 71.5% in the mid-1990s. This is the record of Government since 1997, consistent under three Ministers for Health and Children.

Improving the delivery of accident and emergency services continues to be a top priority for the Government and the Health Service Executive. Considerable improvements have been made during the past two years in the delivery of services in emergency departments. The number of patients awaiting admission to a hospital bed from accident and emergency departments reduced by 50% between December 2005 and December 2007, from an average of 155 to 78 per day. While there was an increase in the numbers in recent weeks due, for example, to increased levels of the winter vomiting bug and increased levels of influenza and chronic obstructive pulmonary disease, the HSE is working intensively with the hospital system to bring about further sustainable improvements. The HSE and hospitals have our full support in urgently improving known processes that will speed up care and reduce waiting times for patients. This is as vital as the new investment we have already made in hospital and long-term care capacity.

One of the key issues being addressed is the system of discharge planning. A major focus is being placed on ensuring the following: that all patients have an expected date of discharge within 24 hours of admission, that the expected date of discharge is actively managed on a daily basis against the treatment plan and any changes are communicated to the patient, that patients can be discharged in a more proactive manner at weekends, that there is an increased emphasis on nurse facilitated discharges and that ward rounds are scheduled in a way that facilitates a more timely review of treatment plans. The HSE is also working closely with a number of hospitals which are reporting significant numbers of patients awaiting admission. This includes a specific focus on the establishment of clinical decision units and short stay units to accelerate the throughput of patients who present at emergency departments. Additional measures are also being put in place to deal with the issue of delayed discharges.

I also hope in light of the successful conclusion of talks on the new contracts for consultants that progress will be made in advancing the recruitment of additional consultants under the "100 plus" initiative previously announced by the HSE. The initiative is designed to reward hospitals which are operating in line with established performance targets. The additional consultants are to be employed in specialties which can alleviate the problems which manifest in emergency departments.

The HSE is also arranging for 200 additional beds to be contracted in private nursing homes with a particular focus on major Dublin hospitals. The HSE advises that 98 of these places have been filled since the middle of January, with 85 filled in Dublin. In addition, the HSE advises that it will be opening an additional 100 long stay beds from March onwards in a new community nursing unit at St. Mary's Hospital in the Phoenix Park. These will be used mainly for older people who have completed their acute phase of treatment. These developments follow on from the opening in December of 94 additional long stay beds at Cherry Orchard Hospital.

The HSE is proceeding with the implementation of an additional 360 home care packages in 2008 at a cost of €10 million. It is intended to prioritise these additional home care packages to support in particular the Dublin area and also a number of the other large urban areas and specific acute hospitals in Cork city, Waterford, Wexford, Limerick, Galway and Mayo. Some 120 of these are scheduled for implementation in the first quarter. We can be confident that the combination of these measures will lead to continued improvement in emergency departments.

With regard to acute hospital beds, the health strategy of 2001, Quality and Fairness — A Health System for You, identified a requirement for additional capacity throughout the health system and a need to reconfigure services to achieve maximum efficiency and effectiveness. This covers acute services, primary care and continuing or long-term care, all of which is being progressed.

For acute hospitals the strategy estimated that 3,000 beds were needed in the acute hospital system by 2011. It is well recognised that acute hospital care is just one component of the health care delivery system. Hospital services cannot be evaluated in isolation from primary care, community and specialist services. The need for hospital services is influenced by the availability and accessibility of those other services. In 2001, the average number of inpatient beds and day places available for use in the 53 acute hospitals, now under the National Hospitals Office, was 12,145. The provisional number of acute hospital beds recorded by the HSE for 2006 was 13,771 — some 12,574 inpatient beds and 1,197 day places — based on a total bed complement.

Significant progress has been made in providing the additional 3,000 beds. On average, over 1,600 inpatient beds and day places have come on stream since 2002. Far from falling behind, this represents one the fastest rates of expansion of acute hospital capacity in our country's history. In the modern era there has never been such a rate of new acute beds coming on stream. The Government is committed in its programme to providing an additional 1,500 beds. Approximately 1,000 of these will be provided through the co-location initiative and the balance through the Health Service Executive capital plan. Both of these tracks are progressing well.

With regard to the provision of 1,000 beds under the co-location initiative, this will be achieved by freeing up existing public beds through the development of private hospitals on the sites of public hospitals and the transfer across of private activity. Significant progress has been made so far. Project agreements for the six hospitals where successful bidders have been approved are due to be signed in the very near future. Two further hospitals which are participating in the co-location initiative are at an earlier stage of the procurement process. The co-located private hospitals will most likely open within three years of receiving planning permission. This means that available public bed capacity in public hospitals will be expanded simultaneously. Overall, it will mean new public beds being made available fast.

With these developments, the Minister asked the Department and the Health Service Executive to review public capacity requirements in the acute hospital sector up to 2020 in the light of developments since the health strategy and the progress of this initiative. The Health Service Executive recently published a review of acute bed capacity which proposes an integrated approach to health service delivery that seeks to achieve the right balance between inpatient, day case and community based care. The review found that with future challenges, such as our ageing population and the increase in chronic diseases, we will need to plan for a 60% increase in demand for health care by 2020. It suggests that if current practices and processes continue, the demand for public hospital beds will escalate to nearly 20,000 by 2020. To meet this need we would have to provide the equivalent of 12 new 600-bed hospitals over the next 13 years. It concludes that such reliance on acute hospitals for service delivery is neither sustainable nor in the best interests of patients.

The review examined alternative approaches to meeting this demand. It recommends an integrated approach to health service delivery involving substantial change in the way care is provided. Among the measures proposed are significant increases in day beds in hospitals, more long-term care beds, more rehabilitation beds and more services in community-based, non-acute hospital settings. The report acknowledges that additional beds are planned under the co-location initiative and under the HSE capital plan, and that this will meet the current needs. The review also advises that services in acute hospitals should not be altered until viable and appropriate community-based alternatives are in place. We believe the review forms a basis for discussion with key stakeholders on how best to plan for the provision of public health care delivery to 2020.

The Government is also committed to the continued development of primary care services and community services for older people. We will be developing and enhancing the range of services available in the community and providing for additional beds in the community for older people.

What I have outlined gives a clear demonstration of the significant progress that has been made by the Government in its commitment to delivering an additional 3,000 acute hospital beds over a ten-year period, a target which, I am confident, will be met.

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