Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

-----which I am certainly not trying to do. I will ensure the person in my Department who supposedly made the comment is fully protected should Deputy Keaveney wish to substantiate that allegation, which I believe to be entirely false. I am sure he will not substantiate it.

I appreciate the opportunity to address the House on this important issue. I wish to respond to some of what was said in the debate this evening and last night, which may be of interest to Members. Last night, Deputy Sean Fleming drew attention to the need for better links between hospital and community services. I agree with him that effective linkages in this area are essential if we are to get maximum benefit from available resources and provide the most appropriate care to patients. Improving this area is very much on the radar of both the Department and the HSE.

The Deputy also called for dialogue with private service providers who feel that they are being locked out of essential consultations on future plans. I fully subscribe to the principle of dialogue and consultation, and stakeholders already have access to officials in the Department of Health and its Ministers. For example, public consultations preceded the review of the fair deal scheme and took place during the preparation of the dementia strategy. A further meeting for private nursing home providers with my officials was agreed to as recently as this week. Indeed, I addressed their conference last week.

A number of Deputies argued that moving suitable patients currently in acute hospitals to less expensive nursing homes could free up significant funds. This is a nice idea but it is too simplistic and misunderstands how health spending works. It is true that a nursing home bed costs less than an acute bed, but it is invalid to argue that when we move a patient from that acute bed, we can then take that money and give it over to a nursing home or elsewhere because the vacated acute bed will be filled immediately by a new patient - perhaps one of the many on our waiting lists.

People who make the argument that it is cheaper to have patients in a nursing home than in a hospital do not quite understand how it works. Their economics and logic work if, after the patient is discharged to the nursing home, the hospital bed is closed behind him or her. That is something I am not willing to do at a time when patients are on trolleys and so many people are on waiting lists. I want to keep all those beds open for those who need them. So there is no false economy here. The savings that people suppose exist unfortunately do not.

Deputy O'Donovan was concerned that outsourced home-care services cost the HSE far more than is paid to the workers providing the service. These services are procured by the HSE by competitive tender and include an assessment of the tenderer's capacity to provide a quality service. The objective in the future will be to identify providers in each region who can provide home supports on the most economically advantageous basis and the HSE will be responsible for that.

Deputy Ó Caoláin claimed that the review of the fair deal scheme had been completed and is being withheld. This is not the case. The review has not been completed. External consultants have reported on specific aspects of the scheme but this is and always was only an input to the overall review. When the review is completed the input from Deloitte & Touche, the consultants in question, will be published along with it. I expect the review to be completed in the first couple of months of next year.

Deputy Ó Caoláin also expressed concerns that older people formerly enjoyed universal eligibility for public facilities and that this is now removed. That is not the case. In fact, universal eligibility for public facilities remains but it is now augmented by universal eligibility for any private facility that can meet their demands. Patient choice is central to this.

Deputy Mitchell O'Connor asked why it costs more to have somebody in a public nursing home than in a private one. I am not sure why that is. In part it may be down to staffing levels being higher in HSE nursing homes or it may be down to pay scales. However, I suspect the real reason is the dependency ratio. People who are in public nursing homes and HSE nursing homes often have greater and more complex needs. That is often missed by those who suggest that the private sector can do things cheaper. They do not always compare like with like.

The Minister of State, Deputy Kathleen Lynch, and I are very aware of the very long waiting list for the fair deal scheme. We are not satisfied with it. We are working very hard in the context of the service plan to do everything we can to reduce the waiting list in coming weeks.

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