Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 5: To ask the Minister for Health if he will commence a programme of reopening public hospital beds in view of the research by the Irish Nurses and Midwives Organisation showing that more than 1,900 public hospital beds are currently closed [26440/11]

James Reilly (Dublin North, Fine Gael)
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There are some 13,000 acute hospital beds, including some 1,800 day beds, in the Irish public acute hospital system. The exact number available for use at any one time varies according to a number of factors, including planned levels of activity, refurbishment and infection control.

Beds are also closed to control expenditure because, like all other public agencies, hospitals have to operate within budget.

As I have already outlined for the House and as I will outline again, we started this year with a hospital overrun of €70 million. In the first three months of this year, under the previous Government, we had a wild overrun of activity, whether by design or through negligence. Because of the economic situation we must, effectively, take €1 billion out of the budget. We must also maintain a service that is safe for patients and implement the reform programme.

The criteria for counting bed closures and methods vary between hospitals. Instead of having a debate about the exact number of beds that are judged to be open or closed at any one time, we must concentrate on getting the best possible services for patients from the budgets available to us.

This means we need to focus on how beds are used, on the throughput of patients, on reducing length of stay to international norms and on having as many procedures as possible carried out as day cases rather than inpatient work.

The work of the special delivery unit, together with implementation of the clinical care programmes in the HSE, will help to improve the efficiency of our hospitals, allowing us to treat as many patients as possible within budget.

I believe that pursuing efficiencies through these means will be a far more productive approach than debating the number of beds open or closed at any one time.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Shortly after he came to office, the Minister indicated, in his address to the INMO conference, that he accepted the INMO trolley-watch figures. Does he also accept the INMO figures for closed hospital beds? It is strange that he does not want to talk about bed closures because he talked about them ad nauseam when he was on the Opposition benches. At the last count the INMO figure was 1,847.

The Minister is repeating the mantra of his predecessor about the fluctuation of beds at any one time. We heard all this before. The Minister himself, when in opposition, described it as a dodge. It was a dodge then and it is dodge now.

Of course we must have greater efficiency. The Minister must also accept, as he repeatedly stated when in opposition, that too many beds have been taken out of the public hospital system and that those closures must stop. Indeed, a significant number must now be reversed.

What about the closures of the very beds that he himself says are the most needed for efficiency? What about beds for day cases and short stays? Does the Minister agree that more beds closed means more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations? Does the Minister agree with that statement and will he commence a public bed re-opening programme as an essential part of addressing the current crisis in accident and emergency departments and acute hospitals across the State?

James Reilly (Dublin North, Fine Gael)
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I will start with the Deputy's last point, lest I forget it. I do not agree that more beds closed means more patients on trolleys and more people waiting. I do agree with something I said myself when in opposition: "Not another bob more into health until the black hole is found and fixed."

We are in the process of doing that and of changing how hospitals operate and how and where operations are carried out. We are placing more emphasis on day surgery. People are being admitted into hospital the night before procedures when they do not need to be. They could be admitted on the day. Five beds have been freed up in the Mid-Western Regional Hospital, Dooradoyle, as a consequence of this happening.

Deputy Ó Caoláin asked if I agreed with the INMO trolley-watch figures and I said I did. I did not say I agreed with the bed closure figures. No joint study on bed closures between the INMO and my Department has taken place. While I do not utterly reject the INMO numbers I cannot accept them because I have not had advice from my own Department.

There are great inefficiencies in our system and much work is being done inappropriately. The basic principle of what we are trying to achieve is that the patient will be treated at the lowest level of complexity that is safe, timely and efficient and as near to home as possible. That remains the principle. We do not want patients going to see GPs when nurses could see them or going to see consultants when GPs could see them. We do not want operations being carried out in large hospitals, which should be reserved for more serious complex cases, when those procedures could be carried out safely nearer to the patient's home in smaller hospitals around the country.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister is good at citing what he said previously.

James Reilly (Dublin North, Fine Gael)
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The Deputy is pretty good at it himself.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What the Minister has just indicated he does not agree with is what he said himself on a previous occasion. I quote from a statement of May 2010:

More beds closed means more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations.

Who said that? The Minister said it when 33 beds were closed on a five-day ward in Beaumont Hospital in Dublin.

The Minister has played a game of double standards. He championed various positions as Opposition health spokesperson but since taking office he has regurgitated what the previous Minister said. He now employs exactly the same language in parliamentary questions. He promised to take up the issues of responsibility and accountability. The parliamentary replies he gives me and other Deputies when we raise matters with him are verbatim what the previous Minister, former Deputy Harney, used to give.

Will the Minister not recognise, as he has said previously, that we need to see the restoration of some of the beds that have been closed and which are contributing to a calamitous situation in hospitals and accident and emergency departments across the State?

James Reilly (Dublin North, Fine Gael)
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The nature of the Deputy's question has changed somewhat.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Not at all. The only thing that has changed is the Minister's response.

James Reilly (Dublin North, Fine Gael)
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I would always be prepared to review the situation in an individual hospital. In the past a blunt instrument was used, with 10% of capacity being taken out across all hospitals with no regard to where they were within their own capacity, so that some hospitals suffered more than others. An analysis of that is taking place at present to see where there is a capacity issue, as opposed to a perceived capacity issue. I am not yet in a position to report on that.

Six months after the formation of the Government, there is a real prospect of getting real-time information from our emergency departments and on inpatient waiting and financial situations. We will know within two weeks what the financial situation of a hospital is, what its spend is and if it is going off budget and out of control.

We are also seeking, through the clinical programmes, to improve the delivery of service within hospitals, making it more appropriate and making sure patients are treated at the appropriate level and in the appropriate setting.

I do not accept the Deputy's contention that the Government is the same as the previous one or that I am the same as the previous Minister. I have a very different approach. Within months the Deputy will see greater improvement than is currently the case.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is not in evidence as we speak.