James Reilly (Dublin North, Fine Gael)

I am not sure which of the myriad questions Deputy Ó Caoláin has asked, to answer. There is no about-turn or volte-face, as the Deputy suggested. There is a concern and realisation that what is important is service to patients and that patients get that service. There is also a realisation, with the excellent work being done by the clinical programme managers, that there are many ways to improve the service and increase the through-put through hospitals by having patients discharged sooner. That can be achieved without opening more beds. What I always said is that there should be no more money for the HSE until I found the black hole and that we do not need more beds until we get proper use out of the beds we have. Then we will see whether we need more beds. That remains the situation. It is the service to patients that is important, not the number of beds in a hospital, although, if properly and efficiently used that obviously has a determining effect.

Deputy Ó Caoláin asked about the special delivery unit. It is part of the 100 days programme to have it established. We still have several days to go and we will have something to say about that in the coming week. A serious effort will be made to look at the underlying problems in the health service that give rise to the situation in which we find ourselves. Even with our shrinking budget it should be possible to deliver the service and care that people so richly deserve and have paid for, but with due respect, with €1.5 billion gone from the budget in the past year and a half that will prove extremely difficult but not impossible.

We are utterly determined to make it happen but we are realists and pragmatists. We cannot do it overnight or within a week but in the next few months we will ensure that we never see the likes of what we saw last winter in our hospitals. That will not be made easier by the fact that the budgetary allowance for the fair deal nursing home support scheme has proven to be a totally inadequate and poorly constructed plan by the outgoing Government that has resulted in people being worried and concerned. I assure them that approvals will continue as funding becomes available. Funding will become available, perhaps not at the same rate as it was previously but it will continue.

In some of the examination to date I have discovered that people have been transferred straight from hospital to long-term care in many of the HSE-provided facilities and also in the beds that are contracted by the HSE without being afforded the opportunity to first avail of a home care package and then to be assessed. I put it to the House to consider whether it is wise to assess patients when they are acutely ill in hospital on their long-term ability to survive at home. Perhaps it would be more wise to have a system of convalescence, a place where people could go to continue their recovery and then be assessed as to their suitability for long-term care or whether they would be able to stay at home with support.

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