Paudge Connolly (Cavan-Monaghan, Independent)
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I thank the Ceann Comhairle for the opportunity to speak on the cause of bed shortages in Cavan and Monaghan and the problems caused by the vancomycin resistant enterococcus, VRE, virus in Cavan, where no new patients are being admitted to the critical care unit. These difficulties are replicated nationally and are a major problem in the health service. A number of patients occupy beds without receiving active treatment. There are three categories of such patients — tertiary patients awaiting a nursing home bed whose subvention claim has not been processed, patients awaiting transfer to another hospital for an investigation, such as a CAT scan, and those who are clinically discharged but have nowhere to go because relatives cannot accommodate them. It is not acceptable that patients are occupying hospital beds without receiving treatment. We must examine this. Some 20 people were on trolleys in Cavan-Monaghan General Hospital recently while more than 20 people were occupying beds and not receiving any treatment. A hospital bed costs €651 per day, while for the same amount a patient can stay in a nursing home for a week. It is not logical.

Budget holders of the hospital management and community sections are part of the problem. The hospital budget manager does not care whether patients are receiving treatment once the beds are full. In fact, the less treatment patients are receiving, the more likely he is to keep them because he has no incentive to bring in patients who require treatment. The community manager does not wish to accept another patient full-time because it is a drain on his assets. Two hospital departments are playing with the taxpayers' money. They see it as a budgetary gain, but patients suffer. We must examine how this is allowed to continue.

The same problem exists with regard to clinics. Patients discharged from a hospital who need a taxi to a clinic are encouraged to seek the money from the hospital budget. That department will claim that no money is available for taxis.

I suggest, as I have suggested to the manager of hospital services and others, that we consider vacant floor space in the psychiatric establishment at Cavan-Monaghan General Hospital. A considerable amount of floor space is used at St. Davnet's Hospital to deliver services for Monaghan General Hospital, a practice that is very successful. Adjacent floor space could easily be transformed into hospital step-down facilities for patients receiving no form of treatment. There is already a nursing home on the campus. The additional floor space would not require the same level of high specification, such as oxygen points or nursing care, as the main hospital and this measure would relieve pressure from the general hospitals.

It is ridiculous to keep somebody in a hospital bed at a cost of €651 per day when the same amount would pay for a week's stay in a nursing home. Keeping patients in a hotel with full board would not cost that amount. Playing with budgets is the source of this problem and somebody must crack the whip. The taxpayer, so badly exposed in this situation, must be protected. If the HSE is serious about its task, these minor issues must be addressed. Everyone suggests we need more beds, which is true, but we must examine how we use the beds available to us. We do not make the best use of the available beds even though this problem can be solved.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I am taking this matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. The HSE has advised the Department that over the past 12 months the average number of patients clinically discharged from Cavan-Monaghan General Hospital but awaiting accommodation elsewhere has been in the region of seven to nine at any time. The HSE is examining ways of reducing the number further in order to free up these beds for other patients requiring admission.

The HSE has established hospital bed use review groups in Cavan-Monaghan hospital, Drogheda-Dundalk hospitals and in Our Lady's Hospital, Navan. The purpose of these groups is to review the bed use at each hospital site, to alleviate the overcrowding situation where possible by the introduction of any initiatives deemed appropriate, to develop and implement effective admission, transfer and discharge policies and procedures, to work in partnership to manage bed use in each hospital group in a more effective manner and to liaise with colleagues in the primary, community and continuing care directorate regarding arrangements for clinically discharged patients. There is a representative from the primary, community and continuing care directorate on each of these groups.

Deputy Connolly raises the possible temporary use of St. Davnet's Hospital as a step-down facility for patients who have been discharged following their acute phase of care. The HSE has indicated that there is currently no suitable space available for that purpose. In order to facilitate the ongoing refurbishment of wards at Monaghan General Hospital, the remaining vacant wards at St. Davnet's are being used as a temporary outpatients unit for Monaghan General Hospital.

The development of home care packages and further home support structures give wider options in looking at delayed discharges in the acute hospital system. The HSE advises the Department that additional funding has been allocated to enable more home support packages to be put in place. A joint continuing care and secondary care management team has been established with representatives of senior personnel from Cavan-Monaghan hospital and the primary and continuing care services. The team, which closely monitors all hospital discharges, has met on several occasions and continues to do so with a view to identifying innovative and appropriate responses to patients.

Paudge Connolly (Cavan-Monaghan, Independent)
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Very briefly——

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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There is no facility for supplementary questions.