Lucinda Creighton (Dublin South East, Fine Gael)
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Question 7: To ask the Minister for Health and Children the reason, in view of the implementation of her ten point plan for accident and emergency services, her description of the accident and emergency services as a national emergency in March 2006, the establishment of a task force on accident and emergency services and the subsequent publication of the emergency department task force report, the number of people waiting on trolleys in accident and emergency departments nationally is in the region of 300 to 400 per day; and if she will make a statement on the matter. [2655/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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As I mentioned in an earlier reply, considerable improvements have been made in the delivery of services in emergency departments. Specific targeted actions are in train to deal with internal management in hospitals in order to improve patients' experiences. 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 56 of these places have been filled since 18 January. In addition, the HSE advises that it will open 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 last 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 the Dublin area in particular, a number of the other large urban areas and some specific acute hospitals, such as Cork city, Waterford, Wexford, Limerick, Galway, Mayo. A total of 120 of these are scheduled for implementation in the first quarter. The combination of these measures and those outlined in my earlier reply will lead to continued improvement in emergency departments.

James Reilly (Dublin North, Fine Gael)
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There were 400 people on trolleys two weeks ago. That is 20% more than in January 2007. A total of 57,000 bed days were lost last year between the Beaumont and Mater Hospitals, which is the equivalent of a 150-bed hospital being closed for a year.

Brendan Howlin (Wexford, Labour)
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The Deputy is giving information. The idea of Question Time is to elicit information from the Minister.

James Reilly (Dublin North, Fine Gael)
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Will the Minister acknowledge that we have a capacity problem and that demand is outstripping supply? We can reduce demand by putting in place things such as prevention, national body tests, diagnostics in the community and one-stop-shops in the community where people can be seen and treated by their general practitioner without having to go to hospital. We can increase capacity by getting better use of beds that are currently inappropriately occupied and by building more beds in the short term. That will have to be done. There is no point having long-term plans for 2020 with 4,000 fewer beds in the system. Whether it is cystic fibrosis, psychiatry, mental health, care of the elderly, accident and emergency figures, neurology, urology or neurosurgery, the dreadful situation is an indictment of our health service. Beverley Seville-Doyle went into hospital at 11 a.m. and was found dead in a toilet the next day.

Brendan Howlin (Wexford, Labour)
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Has the Deputy a question?

James Reilly (Dublin North, Fine Gael)
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I extend my sympathies to her family. It is all plans for tomorrow and cutbacks today. Irish men, women and children are dying. Will the Minister use modular hospitals, as they do throughout Europe, to build 1,500 community beds, rather than 200 or 300 such beds, over the next six months? I thank the Minister for alluding to such hospitals earlier in response to a question I asked. The Minister for Education and Science plans to use schools in such a manner. We need to get those who do not need to be in our hospitals out of our hospitals. Will the Minister at least free up the beds that are currently there?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Although we may be political opponents, I have a great deal of respect for Deputy Reilly, as he knows. As someone who has a lot of knowledge of this area, he knows it is not all gloom and doom and bad news in this respect. Things have vastly improved. In 1980, life expectancy in this country was two years below the EU15 average — it is now 18 months above that average. Sweden is the only country in Europe where men live longer than they do in Ireland. Just one third of the number of people who used to die from circulatory illnesses 30 years ago now die from such illnesses.

While we face challenges and pressures, we should put things in context. I invite Deputy Reilly, as a member of as the Joint Committee on Health and Children, to visit Stockholm, which has twice the population of Dublin but just half the number of acute beds. They do things differently there — they have better discharge policies and they do not keep people in hospital unnecessarily. If one is in a hospital in Dublin on Friday, there is a 99% chance that one will still be there on Monday morning. I hope the new contract will deal with some work practice issues, such as the availability of consultants. I accept that we need more consultants.

I know of a hospital in Dublin that could free up 64 beds if it were to organise its acute beds system differently. Consultants went in there. Experts who have brought about change in other countries made recommendations about the hospital in September. I have seen a letter sent to the hospital by the HSE asking why certain recommendations have not been followed, given that there are people on trolleys. When I looked yesterday at data from another Dublin hospital, I learned that a patient who was fit to be discharged in 2006 is still in the hospital because the person is unwilling to go to a nursing home or a long-term care facility, or to go home on a home care package. Some existing issues in that regard will be dealt with under the fair deal. It is not appropriate for somebody to choose to stay in an acute hospital when alternatives have been put in place. As Deputy Reilly is aware, it is dangerous for a patient to remain in such a hospital if he or she does not need to be there. People should be in such hospitals only if they have to be.

Just under 5% of people in Ireland over the age of 65 are in long-term care, which is in line with the international average. The problem is that one third of those people would not need to be in long-term care if we had better home support systems. Not only are more facilities being put in place, but new home support packages are also being provided. They take a while to put in place because it is expensive to recruit the appropriate staff etc. We have been building them up each year over recent years and they are making an impact. It is a question of doing a number of different things.

Brendan Howlin (Wexford, Labour)
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During normal questions, a Member has one minute to ask a supplementary question and the Minister has one minute to respond. We will not get many questions covered if we do not stick to those rules. Deputies are entitled to have their questions answered, as long as we get to them. I will contradict what I have just said by allowing Deputies Morgan and Jan O'Sullivan to ask a brief supplementary question each.

Arthur Morgan (Louth, Sinn Fein)
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While we might have a problem, a Leas Cheann-Comhairle, at least we are not facing a crisis, unlike the health service. How can the Minister credibly claim to be dealing with the accident and emergency crisis when she is continuing to cut back hospital services? Is she aware of a document that came into the public domain this week which advocates the closure of the accident and emergency department at Monaghan General Hospital? That would have a significant knock-on impact on Our Lady of Lourdes Hospital in Drogheda, which is already grossly overcrowded. How can the Minister claim to be dealing with the accident and emergency crisis when more and more services are being closed? When will she stop this approach? When will she take charge of this problem and sort it out? She is allowing HSE officials to tinker about with the health of people in this State as if they were dealing with cattle.

Jan O'Sullivan (Limerick East, Labour)
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I would like to ask the Minister about home care packages. Many Deputies attended a presentation made by the Irish Senior Citizens Parliament yesterday. When one meets senior citizens, one is told that their preferred option is to stay at home, with support. The Minister said that home care packages are expensive. They are primarily privately procured. We are privatising the care of elderly people in their own homes. Why can we not build up the home help service so it is like it used to be? The Minister talks about home help as if it were some kind of newfangled way of looking after people. Is she abandoning the development of the public home care system, involving public health nurses and home helps etc.? While I welcome the provision of an additional 360 home care packages this year, they do not represent much more than a drop in the ocean in terms of the number of elderly people in this country.

Rather than providing for such cutbacks in the HSE, would it not be more cost-effective to develop the public provision of care for people at home? It would mean that elderly people would not have to stay in acute hospitals and we would not have to pay the private sector its top-up profit, not to mention the cost of recruiting professionals and paying their salaries?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We are developing the home care sector. It is not something that has always been done, however. It used to be all or nothing — one went into a public long-term care facility, where 90% of the cost of one's care was subsidised, or one went into a private nursing home, perhaps with the help of a subvention, and had to pay at least 60% of the cost of one's care. It was totally inequitable. There was virtually nothing else at home. The home help service has been developed rapidly since it was initiated some years ago. I am in favour of whatever works for older people, regardless of who provides the care. I meet many families and hear their stories. I saw a letter yesterday or the day before in which a family in Dublin was full of praise for a private company that is supplying the care. There has to be some flexibility.

Jan O'Sullivan (Limerick East, Labour)
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It is more expensive.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is not actually. It costs a great deal of money to recruit people and meet their pension requirements, etc. I am familiar with the position in the north east, which is represented by Deputy Morgan. The document to which he referred is a draft — no final decision has been taken on it.

Arthur Morgan (Louth, Sinn Fein)
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It is an intention.

James Reilly (Dublin North, Fine Gael)
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It demonstrates a serious intent.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Can I outline the intention in the north east, which has a higher level of admission into the acute system than any other region? Half of the surgical patients in the region come to Dublin hospitals. One third of medical patients in the region come to Dublin hospitals. They have longer stays.

Arthur Morgan (Louth, Sinn Fein)
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It is proposed to bring an end to elective surgery at Louth County Hospital as well.

Mary Harney (Dublin Mid West, Progressive Democrats)
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There will be less inpatient activity in the north east. That is what is needed in the region and that is what will happen. It is forecast that inpatient numbers there will decrease by approximately 1,800. There will be more day case activity there. That is the way it should be——

Arthur Morgan (Louth, Sinn Fein)
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That cannot happen because we are grossly short of general practitioners.

Mary Harney (Dublin Mid West, Progressive Democrats)
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——and that is the way it is in every good health care system in the world. One should not have to staff hospitals on Saturdays and Sundays if surgical procedures can be done on a day basis from Monday to Friday. That is a fact all over the world.

Arthur Morgan (Louth, Sinn Fein)
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That was happening.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is happening here. We are not closing anything.

Arthur Morgan (Louth, Sinn Fein)
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You are.

Mary Harney (Dublin Mid West, Progressive Democrats)
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We are trying to make things better.

Arthur Morgan (Louth, Sinn Fein)
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Closures are being advocated.

Mary Harney (Dublin Mid West, Progressive Democrats)
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According to the HSE, 800 community supports will be provided in the north east next year.