Michael Finucane (Fine Gael)

If I had my way, I would ban the use of scripts in the House. Many years ago I was on the joint committee dealing with State sponsored bodies, as was an eminent Limerickman, former Deputy Desmond O'Malley. At the time, we were reviewing the operation and performance of the voluntary health insurance board. We were disappointed that people did not have freedom of choice in the Mid-Western Health Board Area because there was no private facility in the area. We felt this was unfair and that there should be a private hospital facility in the area so that people would not have to travel long distances.

Now the area has a very good facility in Barrington's hospital, although this is just a short-term surgical day care type facility. It is run well and does much work for the national treatment purchase fund. As well as that, there are also proposals for a private facility development on the campus of Adare Manor and for a private health facility at Blackberry Park outside Limerick. On top of these we now have a proposal from the Department of Health and Children for a facility on the campus of the regional hospital. Having suffered the embarrassment of a dearth of private beds in the past, if these proposals go ahead, we will have an embarrassing richness of private beds.

My only regret about this motion is that I do not think the Department is looking at the issue properly. When people go to hospital they are often there for three or four days longer than they should be. It would be more effective to have a step-down facility in the campus of the regional hospital to accommodate people for a while to free up beds in the hospital proper. The same could be done in many hospitals around the country. This was brought home to me forcefully last January by the situation in Cork University Hospital where there was congestion in the accident and emergency unit. The cardiac surgeon came into the hospital several days to do scheduled operations, but all the intensive care beds were occupied by accident and emergency patients. It is not rocket science to know what should happen in such situations. There should be a convalescent facility on the campus to ensure people vacate these beds and they are available.

Most of the private hospitals operating around the country have been incentivised by generous largesse from the Government, introduced originally after a private conversation between the former Minister for Finance, Mr. McCreevy, and a prominent person involved in private hospitals. The seed sown by this idea has been taken up and is now very much profit driven. Capital costs can be paid off within seven years as a result of tax-based concessions and this costs the Exchequer significant amounts of money. We need to consider whether all the private hospitals we have currently operate to full capacity and whether we need the type of private hospitals projected. We also need to find out whether we will get an imbalance within the system to the detriment of public beds in favour of private beds. This could happen.

Despite the fact we know our elderly population is growing, we have already seen that it is physically impossible for many of them to get places in homes for the elderly — St. Ita's and St. Camillus's in my region — because of the shortage of beds. These public beds are not increasing in number because the same incentive operates in the case of private nursing homes and people are encouraged to use those facilities. No recognition is made of the cost of a nursing home for a person with a pension. The onus is supposed to fall on the elderly person, but in many cases it falls on their families to make up the difference. Often people who recognise the excellence of the facilities in St. Ita's and St. Camillus's request places there, but they cannot get in. I am sure the same is true throughout the rest of the country. It is becoming impossible for people to get into the public nursing homes and hospitals. We have a contraction in the number of public beds despite the demographic trends of our exploding population.

For example, a private hospital in Galway that made a facility available to the National Treatment Purchase Fund was extremely disappointed. I understand that just 7% of clients have come through the NTPF mechanism, even though it has been made available, if possible, to approximately 50% of patients.

I wonder what will be the reaction to the creation of a private hospital within the campus. We heard a great deal of talk about such matters in recent times. The Taoiseach had to apologise for his statement that Willie Walsh was trying to "steal" the assets of Aer Lingus. Such criticisms have been made in many cases. In this case, are we trying to strip the assets of a public facility in the form of our hospital network? I am concerned about the direction in which we are going. I would not be as discouraged by this approach if I thought fewer private hospitals were being made available by private companies. As I pointed out at the outset, we could end up having an embarrassment of private beds in Limerick Regional Hospital.

I believe we are going down a dangerous road. I was contacted at a clinic last Monday by a person who told me about an elderly gentleman in his 80s who is being discharged after four weeks in hospital. I was informed that he cannot afford to go to a private nursing home, but he has to be discharged nonetheless. I was told that it would be good if the man in question, who has suffered a minor stroke, could be kept in the facility for another few weeks. He will not be considered by the hospitals for the elderly even if he can sustain it financially and medically. Financially, his income would have to be taken into consideration, and on the medical side, he would have to be in category 1 or category 2 to be considered.

One has to have a serious stroke or be deemed incapable before one can be considered for our public hospitals. One does not have to be a rocket scientist or have a great deal of imagination to know why beds are being taken up within our hospitals system and why there are not enough step-down facilities. We would have addressed the shortage of beds in our hospitals if we had realised this.

There has been a great deal of talk about primary care, but it needs to be borne out by action. On the Order of Business this morning, I raised the case of an 85 year old man with a serious medical condition who lives at home. It is wrong that he is not considered for an hour of home help because he has two pensions. I ask the Minister of State, Deputy Tim O'Malley, who is familiar with the mid-west region, to examine the pilot nursing home care package project.

I will conclude by highlighting the case of a person who is eligible for home help, is means tested by the local community welfare officer and is validated on the medical and financial sides. If that person wants to get extra help through a nursing home care package, he or she will be financially means tested all over again by different people within the health system. That does not accelerate the long process that is involved. There was never a greater amount of duplication or more of a need for simplification. It is a pity that it cannot be examined. We should not be hypocritical by saying we are spending €150 million per annum on primary care at a time when an 85 year old man cannot be considered for an hour of home help because he receives a second pension from the county council. That is wrong.

I do not know the means testing criteria which are used. I would like to see some flexibility and common sense in the system, which has become layered with bureaucracy and administration. There are not enough people at the coal face.