Brian Stanley (Laois-Offaly, Sinn Fein)
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Question 43: To ask the Minister for Health and Children if he has a programme for the reopening of closed public hospital beds and wards; and if he will make a statement on the matter. [13464/11]

James Reilly (Dublin North, Fine Gael)
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In common with other public services, the health services are facing significant financial challenges. The key priority for me in dealing with the serious budget pressures on the health services is to minimise the effect on services for patients to the greatest degree possible.

The Government has a radical programme for reform of the health service. It is no accident that this reform programme is headed 'Fairness' in the programme for Government. I want to shift the debate away from beds to the actual number of patients treated. I want to focus on access to services based on need and on those services being provided in the best place, be that a big or small hospital, the community, a GP's surgery or in the patient's own home. I want to see a health system providing a service quickly, efficiently and safely.

Activity in acute hospitals has been increasing year on year. A modest increase is planned for 2011 despite the budget cuts. The most important thing is to drive out costs by relentlessly challenging practices which affect efficiency. We must increase the proportion of day case work, reduce the average length of stay and perform surgery on the patient's day of admission to the greatest extent possible. One hospital which I will not name has a day of admission surgery rate of 39% when the international standard is 75%. That has huge cost implications. In fact, physicians and surgeons in the hospital concerned have negotiated a change. I believe in fairness in that regard too; that if people do not understand and realise where they are going wrong we can hardly expect them to fix it. One of the problems that has affected the health service in recent years is that we find areas where excellent services are performed in a more clever, better way but that does not seem to get transposed across the system. That is something we intend to address. There is clear evidence of major variations in performance under various headings across the system. That means we are not getting the best value for patients and the taxpayer from the beds we have.

Additional information not given on the floor of the House.

I am determined to see these inefficiencies addressed. The special delivery unit, SDU, which I will set up will be a robust driver of improved performance which holds providers to account. It will also be a source of expert support for providers which helps them achieve better results quickly.

The purpose of the SDU is to unblock access to acute services and to do that by dramatically improving patient flows. That will free up capacity in the public health system to get more patients treated more quickly and-or to enable resources to be reallocated out of acute hospitals and into primary and community services.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister referred to shifting the focus away from beds and for improvements to be transposed across the system. I wonder how that applies to him? As spokesperson for Fine Gael on health issues in recent years, the Minister, Deputy Reilly, correctly laid the emphasis on the importance of restoring bed numbers. His answer now suggests that he has taken a completely different position, one that echoes his predecessor. Let there be no mistake about it; this is a very important matter. I welcome the fact that the Minister now accepts the Trolley Watch figures of the INMO. I commend him for it. Does he accept therefore the figures it has presented on the inappropriate placement of people over the first quarter of 2011, some 25,000 patients, in trolleys and chairs over the first three months of this year - yet another sad record in comparison with the previous five years? Does he also accept that the INMO has indicated that some 1,600 acute public hospital beds have been taken out of the system in recent years? The situation with which we are currently contending is that 1,600 beds have been removed. I have to ask-----

Michael Kitt (Galway East, Fianna Fail)
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I call on the Minister to reply. I am sorry, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I will conclude with this question, a Leas-Cheann Comhairle. The Minister indicated that he would establish a special delivery unit in his Department to help reduce hospital waiting lists. Has that been established and will the Minister clarify exactly his intention on bed numbers because the volte-face he has demonstrated today is incredible?

James Reilly (Dublin North, Fine Gael)
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I am not sure which of the myriad questions Deputy Ó Caoláin has asked, to answer. There is no about-turn or volte-face, as the Deputy suggested. There is a concern and realisation that what is important is service to patients and that patients get that service. There is also a realisation, with the excellent work being done by the clinical programme managers, that there are many ways to improve the service and increase the through-put through hospitals by having patients discharged sooner. That can be achieved without opening more beds. What I always said is that there should be no more money for the HSE until I found the black hole and that we do not need more beds until we get proper use out of the beds we have. Then we will see whether we need more beds. That remains the situation. It is the service to patients that is important, not the number of beds in a hospital, although, if properly and efficiently used that obviously has a determining effect.

Deputy Ó Caoláin asked about the special delivery unit. It is part of the 100 days programme to have it established. We still have several days to go and we will have something to say about that in the coming week. A serious effort will be made to look at the underlying problems in the health service that give rise to the situation in which we find ourselves. Even with our shrinking budget it should be possible to deliver the service and care that people so richly deserve and have paid for, but with due respect, with €1.5 billion gone from the budget in the past year and a half that will prove extremely difficult but not impossible.

We are utterly determined to make it happen but we are realists and pragmatists. We cannot do it overnight or within a week but in the next few months we will ensure that we never see the likes of what we saw last winter in our hospitals. That will not be made easier by the fact that the budgetary allowance for the fair deal nursing home support scheme has proven to be a totally inadequate and poorly constructed plan by the outgoing Government that has resulted in people being worried and concerned. I assure them that approvals will continue as funding becomes available. Funding will become available, perhaps not at the same rate as it was previously but it will continue.

In some of the examination to date I have discovered that people have been transferred straight from hospital to long-term care in many of the HSE-provided facilities and also in the beds that are contracted by the HSE without being afforded the opportunity to first avail of a home care package and then to be assessed. I put it to the House to consider whether it is wise to assess patients when they are acutely ill in hospital on their long-term ability to survive at home. Perhaps it would be more wise to have a system of convalescence, a place where people could go to continue their recovery and then be assessed as to their suitability for long-term care or whether they would be able to stay at home with support.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I have a brief question.

Michael Kitt (Galway East, Fianna Fail)
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The Deputy should be very brief as we are running out of time.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Undoubtedly, several patients would wish to remain at home but the Minister cannot make a blanket statement suggesting that one would not make that assessment when in acute hospital settings.

I do not have to go back over the record to cite what the Minister said week on week, month on month and year on year since taking up the role of spokesperson on health. Is he now of a mind not to re-open any of the 1,600 closed public hospital beds? Is his answer now that he has abandoned that position that he championed repeatedly in the House? If the Minister is intent on revisiting some of the 1,600 bed closures, does he not agree that a programme of re-opening to whatever degree is what would be required and that should now be planned for? Will the Minister be clear and specific to the House on his intention and that he has not abandoned the proposition which he knows is an integral part of addressing the crisis within the health system?

James Reilly (Dublin North, Fine Gael)
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Part of any plan for a winter crisis is the ability to open beds that have been closed, if that is necessary. Rather than focusing on beds we should focus on service, the treatment of patients and the service they require. I have not entirely abandoned the possibility of re-opening beds.

Based on existing data, at the weekend of 3 April, some 961 beds - 927 inpatient beds and 34 day beds - were closed. The highest figure to date for 2011 was 1,098 beds closed on 9 January and the lowest number was 868 on 23 January. The situation is in flux. I am concerned, as is the Deputy, that people who need long-term care can avail of it. However, I am equally concerned that people who should not be going into long-term care and who would prefer to stay at home get the appropriate supports and are not condemned to unnecessary institutional care.