James Reilly (Dublin North, Fine Gael)
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Question 1: To ask the Minister for Health and Children the reason there is a 30% increase in delayed discharges from acute hospitals between 2007 and 2008 which lost the hospital system 216,885 bed days; the further reason the health service is not using beds available in the community; and if she will make a statement on the matter. [6947/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am determined to ensure that all possible measures are taken to facilitate the discharge of patients in a timely manner. At present, there are approximately 750 patients whose discharge is delayed. That represents more than 6% of the total inpatient capacity. There are many reasons for discharges being delayed, including the need for long-stay capacity, community-based supports and, in some instances, a reluctance by families to allow their relative to be discharged until a publicly funded bed becomes available.

The Health Service Executive is addressing the issue of delayed discharges through a combination of increased investment in alternatives to acute hospital stay and improvements in the discharge planning process at hospital level. An additional 273 long-stay beds were made available in 2008, and a further 414 new beds are scheduled in 2009. The HSE has also recently funded 245 additional contract beds to alleviate delayed discharge pressures. Investment in community-based, long-term care supports will be maintained in 2009. This year the HSE will provide 4,700 home care packages, benefiting more than 11,500 people. A total of 6,000 patients were cared for by the community intervention teams that were recently established.

The HSE's funding for long-term residential care services for older people in 2009 is €909 million and it must operate within this resource. This funding currently supports the provision of public and contract beds and the payment of nursing home subventions. It will also be required to support the introduction of the new nursing homes support scheme, a fair deal, later this year. Under the fair deal, long-term care will be more affordable for all who need it.

Hospitals are working to ensure that care is provided in a timely, appropriate and efficient manner. All patients are to be given an expected date of discharge within 24 hours of admission and patients will be discharged at weekends where appropriate. The new consultant contract is key to that. More generally, the HSE's national service plan for 2009 commits to a number of key steps which are designed to improve the efficiency of the hospital system including a reduction in the level of inappropriate admissions, reducing average length of stay, increasing elective surgical admissions on the day of surgery and shifting activity from inpatient to day procedures. The delivery of those measures and targets, combined with the initiatives which I have described, should ensure more efficient use of available capacity.

James Reilly (Dublin North, Fine Gael)
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An average of 293 patients were on trolleys to date in February 2009. That is an Irish Nurses Organisation figure. The average number in February 2008 was 244. In February 2007 it was 297, and it was 332 in February 2006. In March 2006 the Minister declared the situation in accident and emergency services to be a national emergency. Last year the Minister closed 500 beds and this year she intends to close another 600 beds. The Minister has rationalised eleven accident and emergency departments, cut front line and agency staff and critical overtime. In addition, more than 100 long-stay and respite beds are being closed at locations that include the Orchard Nursing Home, Bray, Bethany House, Carlow, St. Patrick's Hospital, Waterford and Heatherside Hospital in Buttevant, County Cork. I was in Waterford last week.

Brendan Howlin (Wexford, Labour)
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The Deputy should please ask a question.

James Reilly (Dublin North, Fine Gael)
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I want to talk about that for a moment. St. Brigid's ward is perfectly good. People are delighted with it. Families are supportive of it. Patients want to stay in it. Staff are delighted to be working there, yet the Minister wants to close it down. In addition, the HSE is closing a ward in Waterford, which will put more pressure on accident and emergency services there.

Brendan Howlin (Wexford, Labour)
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Will the Deputy ask a question, please?

James Reilly (Dublin North, Fine Gael)
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When I asked a question of the HSE it provided responses from 36 hospitals giving a total of 216,885 bed days lost. Will the Minister inform the House of the number of bed days lost from all 51 public hospitals?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy seems to have it every which way. St. Patrick's Hospital, which I have visited, and also Bethany House in Carlow, are very inadequate facilities in modern circumstances. One centre is a former work house and both centres are being closed down for health and safety reasons.

James Reilly (Dublin North, Fine Gael)
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Nonsense.

Jan O'Sullivan (Limerick East, Labour)
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Bethany House is a relatively new building.

James Reilly (Dublin North, Fine Gael)
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That is not true. I was there.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Reilly——

James Reilly (Dublin North, Fine Gael)
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A total of €500,000 has been spent on it by friends of the hospital. Staff and patients and their families take a great interest in the hospital.

Brendan Howlin (Wexford, Labour)
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Deputy Reilly should allow the Minister to answer the question.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I know Deputy Reilly is an expert on many subjects but I do not believe he is a health and safety expert. I know the expertise that was sought. I had a meeting with the HSE this very week on those matters. I have now signed into law standards of care for residential settings, which will be enforced from the summer of this year by HIQA and we must prepare for that environment. In the circumstances that exist in St. Patrick's in Waterford, it is not safe for patients to be on the first floor or for wards to have as many as 28 beds. There is no reduction in capacity in either of those facilities and alternative facilities are being provided. Patients in St. Patrick's will be moved downstairs as beds become available and families will be consulted. I accept there are issues relating to staff but I am concerned in this instance with patients.

Deputy Reilly's accident and emergency figures are wrong. The figures for accident and emergency services have continually improved in the past four years. Deputy Reilly can use averages at 8 a.m. before staff come in. He knows well the difference between the situation then and when the appropriate medical expertise is available. Deputy Reilly cannot have it every which way. We cannot have a situation where every piece of health reform introduced is opposed week in and week out. I refer to the cancer strategy and the reconfiguration of hospital services around patient safety. He cannot continue to do that.

The bed utilisation study will show that if bed utilisation was appropriate in terms of when people went home and who went into hospital in the first place many more bed days would be saved than the late discharges. I accept late discharges are an issue. I believe they are a particular issue as people wait in public hospitals for public beds and that is why the introduction of the fair deal legislation which passed Second Stage yesterday will make an enormous difference in providing affordable long-term care for older people and their families.

James Reilly (Dublin North, Fine Gael)
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I put it to the Minister that the ward in St. Patrick's has had €500,000 spent on it, that the health and safety report, which I have seen with my own eyes, has been addressed, bar one remaining issue, namely, fire screens in the attic that will cost €50,000, which the friends and families of St. Patrick's are prepared to pay.

As to the Minister's contention that the figures are wrong, I put it to her that I have more faith in the emergency medicine group's figures and the INO's figures, which I compared year on year, than I will ever have in the HSE or her.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I know the Deputy does not have much faith in me. He accused me of criminal negligence in the House last week. He should reflect on some of the things he says. Deputy Reilly cannot have it every which way. He has opposed every single reform for political reasons, and he made complaints about the many initiatives that were taken to improve the performance of the hospital system, especially as far as accident and emergency and the utilisation of hospital capacity is concerned.

Jan O'Sullivan (Limerick East, Labour)
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Question 2: To ask the Minister for Health and Children if she intends to proceed with the plan for co-located hospitals on the grounds of public hospitals; if she has satisfied herself that the proposals are viable in view of the economic climate; the position in regard to each proposed project, including whether or not contracts have been signed, the planned commencement date of each and the projected completion date; when she expects that the first beds will become available; and if she will make a statement on the matter. [6787/09]

James Reilly (Dublin North, Fine Gael)
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Question 4: To ask the Minister for Health and Children the progress of her hospital co-location plan; her views on the viability of the plan in view of the fact that the funding environment has changed in the past six months; when she expects the first bed to come on stream; and if she will make a statement on the matter. [6949/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 2 and 4 together.

The co-location initiative is a complex process but it is an efficient means of delivering extra bed capacity. Significant progress has been made in advancing the individual projects involved. The board of the HSE has approved preferred bidder status for the development of co-located hospitals at Beaumont Hospital, Cork University Hospital, the Mid-Western Regional Hospital, Limerick, St. James's Hospital, Waterford Regional Hospital and Sligo General Hospital. Project agreements for the projects in Beaumont, Cork, Limerick and St James's have been signed.

Planning permission was granted by An Bord Pleanála for the Beaumont project late last year. Planning permission for the Cork and Limerick projects has been granted by the local authorities concerned and appealed in each case to An Bord Pleanála. The preparatory work required to make the planning application for the St James's project is under way.

The necessary preparatory work for the project agreements in respect of Waterford Regional Hospital and Sligo General Hospital is proceeding. A tender in respect of Connolly Hospital has been received and is under consideration. Work is being undertaken to finalise the invitation to tender for Tallaght Hospital.

It is a matter for each successful bidder to arrange its finance under the terms of the relevant project agreement. It is the case that the funding environment has changed significantly in recent months, and that has affected both the public and private sectors. The co-location initiative, like other major projects, has to deal with the new situation. The successful bidders are working on the details of contractual terms with banks and other arrangers of finance. The HSE is continuing to work with the successful bidders to provide whatever assistance it can to help them advance the projects.

Jan O'Sullivan (Limerick East, Labour)
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The Minister announced this proposal in 2004 and she said it would be a quick way to provide beds in acute hospitals. Does she accept she has failed miserably in this regard? Five years later, no block has been laid, no bed has been provided and no patient has been catered for and none will be for probably two years. The Minister did not reply to the question about when the first beds will become available. This is not fast provision of beds. Will she comment on that?

Does she accept the finding of the expert report relating to Beacon Hospital that health insurance will increase by approximately 25% as a result of this scheme? Has she amended the conditions for the funding of co-located hospitals? Various media have reported on pressure on the Department to make it easier for investors to obtain funding from banks and to provide fewer safeguards for the public purse in this regard. Does she plan to make changes? Will the hospital projects proceed?

Mary Harney (Dublin Mid West, Progressive Democrats)
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When the Deputy reads reports, she should read them thoroughly because the first page of the famous Goodbody report states, "The co-location initiative is highly beneficial for the public health system and the Exchequer. It delivers great value for money". Goodbody is working on behalf of the promoter of one of the sites and not the State. We take the advice of the National Development Finance Agency, NDFA, which is the Government's economic adviser. The proposal met the public sector benchmark and the agency said it would provide terrific value for money.

Private health insurance costs have increased since I became Minister because I have steadily increased the cost of private beds in the public health system. I have doubled the cost of such beds, which are subsidised by the State to the tune of €300 million annually.

Jan O'Sullivan (Limerick East, Labour)
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I do not dispute that.

Mary Harney (Dublin Mid West, Progressive Democrats)
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If the Deputy accepts the policy of charging the market price for these beds, it will have a knock on effect on the cost of insurance. Every year insurers have complained but that is a complaint worth hearing because this cost is not acceptable. The policy behind this is right. If we were establishing a greenfield health system in Ireland from scratch and recruiting consultants, we would never arrive at a position where beds were ring-fenced. In addition, a consultant is paid a private fee for insured patients in public hospitals and that has led to a scenario where public patients are put on waiting lists and private patients have ready access to publicly funded and staffed hospital facilities.

The first objective of co-location is to convert 1,000 such beds, which cost €350,000 each a year, for public use at a cost of less than one third of that amount. That would deliver terrific value for money because the staff are paid anyway. The second objective is to secure private investment in delivery capacity, which I have sought elsewhere in the health system, because we face major pressures. The announcement was made in July 2005 and not five years ago. We have a disparate capital infrastructure because the health services are the most decentralised of all State services given that they must be provided locally and, therefore, there are significant demands on infrastructure, much of which is old. New equipment is always coming on the market to deliver improved care and there are always pressures.

There will no change to the terms of the co-location scheme. The only advice the Government has taken is from our own adviser, the NTDA, which continues to provide us with expert advice.

James Reilly (Dublin North, Fine Gael)
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The Minister did not answer my previous question but, hopefully, she will answer this. The reason I have opposed many of her reforms is she tends to undertake them back to front, as is the case with this scheme. Having removed 500 beds from the system last year and with plans to remove 600 this year, the Minister is still talking about these much vaunted hospitals. She is not shy about opening facilities and turning sods. Has she received an invitation to turn the sod on any of these hospitals yet? When will the first bed be available for a patient? At the end of the day, this is about trust and credibility. The Minister will not deliver on her promises in this regard in the same way she did not deliver on cervical vaccination. When will the beds be available? When does she hope to turn the sod on one of these projects?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have never turned a sod on a private sector development nor do I intend to do so, and I rarely turn sods on public sector developments. I have been involved in openings but the majority were public sector openings. The Deputy is involved in private health care and I was lobbied by him previously for tax breaks on private health care. I do not understand why he believes private health care in nursing homes and general practice is fine but when it comes to hospitals, it is a mystery.

James Reilly (Dublin North, Fine Gael)
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Answer the question.

Mary Harney (Dublin Mid West, Progressive Democrats)
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We have to go through appropriate procurement and tendering procedures, value for money audits and the planning process because it is a private sector initiative. A former Member, for ideological reasons, appealed most of the planning permissions for these projects to An Bord Pleanála and that delayed them by up to 12 months. Planning for the Beaumont Hospital project was granted only at the end of last year.

James Reilly (Dublin North, Fine Gael)
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I do not want the history to this. When will the beds be available?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I presume the Deputy would like to know the facts.

James Reilly (Dublin North, Fine Gael)
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I know the facts. When will the beds be available?

Brendan Howlin (Wexford, Labour)
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The Minister without interruption.

Alan Shatter (Dublin South, Fine Gael)
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There is a connection between 500 beds being removed from the system and her scheme.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Planning permission has not been granted for a number of these projects and clearly I am not in a position to say when the beds will be available. I hope we will see the beginning of this investment as soon as possible.

James Reilly (Dublin North, Fine Gael)
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That is not an answer.

Jan O'Sullivan (Limerick East, Labour)
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In the current economic climate, can the taxpayer afford to forego approximately €800 million in tax over seven years for these projects? Does the Minister believe there will be private funding for them?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Every day the House discusses the financial difficulties confronting this country and many others relating to public and private projects. I do not want to be dishonest and, therefore, securing money for an investment currently is a challenge in Ireland, as it is elsewhere.

I refer to the study the Deputy mentioned. The tax generated on an annual basis will be more than €200 million and 4,500 jobs created during construction.

Jan O'Sullivan (Limerick East, Labour)
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What about tax foregone?

Mary Harney (Dublin Mid West, Progressive Democrats)
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It will cost the Exchequer approximately €100 million a year to secure 1,000 beds. If the Deputy can outline a better way to secure 1,000 beds in our public hospital system using modern infrastructure with the facility available to all patients, provide public patients with services at a hugely discounted price and one accident and emergency department, I am open to her suggestion.

Jan O'Sullivan (Limerick East, Labour)
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What about getting the 700 patients out of acute beds who are ready to be discharged?

James Reilly (Dublin North, Fine Gael)
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The Minister should eliminate delayed discharges by opening facilities in the community to allow those patients to be discharged because the guts of 1,000 beds would be available in the morning.

She did not answer the question. She stated planning permission has been granted and contacts signed for a number of these projects. When will the first beds be available? If she cannot say, she should tell the House she is not in a position to do so because all the talk about delivering value for money and so on is precisely that. It will not happen.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is seeking 4,000 additional hospital beds and I have yet to see how they will be funded. Fine Gael also wants cuts amounting to €2 billion. I would love somebody in the party to show me how all that will happen.

James Reilly (Dublin North, Fine Gael)
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Answer the question.

Mary Harney (Dublin Mid West, Progressive Democrats)
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A contract has been signed for one and there are project agreements for many others, which is a different matter. Regarding the hospital where a contract has been signed, clearly I am not in a position to say when the final pieces will be completed. There are legal and financing issues involved. I am not in a position to tell the Deputy when that will happen.