Róisín Shortall (Dublin North West, Labour)

A considerable number of patients in acute hospitals need more appropriate care and it makes sense to provide care and step-down facilities as locally as possible to ensure older people, in particular, who spend short spells in acute hospital have access to the rehabilitation required for them to make a full recovery and live independently in their own homes, which is what the vast majority of them want.

A number of issues have to be taken into consideration. The model of care provision needs to be reconsidered while the cost of care in private settings and, last but not least, the quality standards required by HIQA must be taken into account. These will all be factors in the review of the services provided in step-down facilities over the coming months.

A substantial amount is owed to the HSE by acute hospitals because consultants who are exceptionally well paid have not filled out the necessary forms. It is unacceptable that they are required to fill out those forms in order that hospitals can access the payment from the insurance companies. These two requirements need to be decoupled and consideration is being given to that. It is also not acceptable that consultants have failed to do their duty and comply with the requirement to fill out the forms. This means substantial debts are owing and the HSE is faced with difficult decisions. The executive needs to be much more proactive in this regard, as I stated in reply to Deputy Keaveney. It is not acceptable that the HSE should leave an outstanding debt while imposing cuts on the most vulnerable. It needs to tackle this issue as a matter of urgency. I agree with the issues raised by the Deputy.

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