Leo Varadkar (Dublin West, Fine Gael)
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I thank the Ceann Comhairle's office for allowing me to raise this important issue which relates to Connolly Hospital, Blanchardstown, in my constituency of Dublin West. As the Minister will, no doubt, be aware the hospital currently has a deficit of €4.5 million out of its annual budget of €91 million. As a result, the hospital has been prevailed upon by the HSE to close a number of hospital beds. Ten beds are closed already, another 14 closed last week, bringing to a total of 24, the number of beds closed in Connolly Hospital. This is in addition to the 30 beds that have closed at the Mater Hospital and 64 in Beaumont Hospital, resulting in a total of more than 110 beds closed in the north Dublin region. Hospitals in the north Dublin region are facing additional pressure because of the removal of surgical services from Navan Hospital. It is clear we are heading into a bad winter in the accident and emergency units of our hospitals.

I have worked in Connolly Hospital, Blanchardstown, in the accident and emergency unit and in the medicine for the elderly department. I have also worked in the accident and emergency unit in Beaumont Hospital. I worked in a system that was already overcrowded and full of trolleys when there were 100 more beds in the system than there will be this winter. We are heading for a monumental disaster, a breakdown in medical care and a serious loss of life in the north Dublin hospitals, as a result of the current situation. We all accept that health spending will be reduced over the coming years and this year, but there has been a failure of the Government and HSE management to get the deficit under control much earlier.

I suggest that three things be done. First, a similar approach should be taken to that which was taken to the banking sector. There should be a bailout of these hospitals for the remainder of this year. Second, the management of the HSE and the hospitals, who have contributed to this crisis by not dealing with the emerging deficit much earlier, should be replaced. Finally, a new funding system should be introduced next year based on the Fine Gael model of universal health insurance, where money follows the patient and hospitals are paid for the work they do, the number of patients they treat and the number of inpatients they have. Under this system, hospitals will never again try to making savings to meet their budgets by closing down hospital wards and cutting back on services. The whole situation is reminiscent of that famous "Yes Minister" episode where we are told by the civil servants that the most efficient hospital is one with no patients. Clearly, the current Government takes the same view that we achieve budget targets by closing down services. That is not the way it should be and I look forward to the Minister's response.

John Moloney (Laois-Offaly, Fianna Fail)
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I will be taking this Adjournment matter on behalf of the Minister for Health and Children.

It is important to note that the number of inpatient beds open at any one time is only one indicator of the volume of service that hospitals can actually provide. Services should be provided on an outpatient or day case basis whenever possible, with patients only being admitted to acute inpatient care when it is essential to do so. In turn, this will involve reducing inappropriate hospital admissions, more same day of surgery admissions, more day-care cases and earlier discharges and reductions in waiting times for elective surgery.

The planned changes announced by the three hospitals are designed to allow them to deliver their service plan targets while remaining within budget. The HSE has assured the Department of Health and Children that none of the national speciality beds in these hospitals - neurosurgery, transplantation and cancer services in Beaumont, and heart and lung and national spinal injuries services in the Mater - have been affected by these bed reductions.

The reduction of beds must also be seen in the context of the reduction of delayed discharges. Since 2006, the winter initiative has focused on addressing the fundamental issues such as its code of practice for integrated discharge planning. This is being driven across the country by joint implementation groups, which have been formed across each geographic region and include hospital and community personnel. In 2009, the delayed discharge peak for the Beaumont and Mater Hospitals was 176 and 121 respectively. The total number of delayed discharges has now decreased in both hospitals to 70 and 69 respectively.

The nursing homes support scheme, known as "A Fair Deal", which has helped reduce delays in discharging patients from hospital, alleviates pressures on beds. An additional €97 million was provided for this scheme in the budget for 2010. Since the introduction of the scheme, it is estimated that the number of patients discharged from the Dublin academic teaching hospitals to nursing home care has more than trebled to 23 per week, equating to about 1,200 annually.

An initiative was put in place for seven hospitals, including the Mater and Beaumont, which were considered to have particular problems in emergency department waiting times. Each hospital has agreed specific work plans to drive performance improvements with targets in place, with progress being monitored on a weekly basis. Furthermore, a number of developments are also taking place in the three hospitals that reduce the need for inpatient beds. The Mater Smithfield rapid injury clinic, which opened in April 2010, acts as a satellite service to the Mater Hospital's emergency department. It has the capacity to reduce significantly patient waiting times as it can cater for at least 30% of the hospital's main emergency department cases. The clinic has treated over 4,000 patients since its opening in April 2010.

Building works currently underway for the Mater Hospital and scheduled for completion in early 2012 will provide a new accident and emergency department, a new outpatients department, 12 new theatres and intensive care unit and high dependency unit departments containing 36 beds, a new radiology department and 120 replacement beds in single rooms. During the summer, the HSE commissioned 32 additional step-down beds in the orthopaedic hospital at Clontarf for Beaumont Hospital. In addition, Beaumont Hospital is planning to commission 100 long-term care beds at St. Joseph's Hospital in Raheny.

Connolly Hospital is currently developing a medical assessment unit to increase patient access to senior clinical decision makers. This is due to come on stream in the new year. A new CT scanner was also installed in 2009 to provide increased diagnostic capabilities.

Reforming the way these services are provided, reducing costs, and maintaining a clear focus on patient safety will allow us to treat people in more effective ways and protect access to appropriate services. The implementation of this type of patient centred reforms by the Mater, Beaumont and Connolly Hospitals have the Minister's full support.