John Minihan (Progressive Democrats)

I listened to the Minister, Deputy Harney, and her upbeat comments on the reform agenda being driven through the health service. It is refreshing that despite the onslaught of criticism and ongoing gamesmanship, we have a Minister who is so committed to driving that agenda in the interest of patients. The key issue is the interests of patients. On the one hand there are the Government, political parties, policy makers and officials, while on the other there are the consultants, doctors, nurses and the many health care professionals associated with the health service, down to the administrators in hospitals. All have different and competing interests. In the middle are the people it is all about, the patients.

Nobody can deny that reform is necessary. We can argue and debate about how that reform should take place and what it should comprise but we must all agree that it must be patient driven and in the interest of the patient. Health is an emotive subject. It is traumatic for any family or patient who must experience our health service. However, we should not lose sight of the fact that an independent survey found that 90% of patients who had experienced the health system were more than satisfied with the care they received. A total of 10% were dissatisfied. There will always be dissatisfaction.

The key issue is speedy access to the service. Patients want to be seen, treated and discharged faster. The reform agenda is about ensuring that people are seen faster, their treatment is speedily provided to the best standard and with the best care, and that they are discharged. It is about ensuring we no longer have continuous delays in the occupancy of acute beds and that people are discharged to step-down facilities. I dislike the term "step-down" but it appears to be the buzz phrase in use. People should be moved out of acute beds and into facilities where they can receive the necessary care to recuperate.

The reform agenda will only be fully embraced when the competing parties set aside self interest, empire building and promotion of their speciality or interest and work together. That applies not only to medical professionals but also to political parties, officials, bureaucrats and the like. We all must put self interest aside and try to work towards improving facilities for patients. As we move nearer to an election, the self interest becomes more vocal. There is the self interest of constituencies, with people wanting hospitals at every crossroads and more cancer facilities. However, we must ask if that is in the interest of all patients. I believe we have set out a reform agenda that is focused on delivering services for patients and we must continue in that direction.

The horror stories are, of course, traumatic and capture public attention. However, we probably have not done a good job, or the media are not interested, in presenting the success stories. There have been success stories. It is no harm, for example, to briefly consider accident and emergency services. There are still horror stories but waiting times in accident and emergency departments have dramatically improved in all 35 hospitals with those departments.

New accident and emergency facilities are being provided. A new management focus, driven by the HSE, is in place to improve the health services. Hospitals and accident and emergency facilities are being monitored. The hygiene audits have improved cleanliness in hospitals. Waiting times for operations and major surgery have decreased from years to months. At times it is difficult to listen to the criticisms of the health services when there have been positive improvements. I accept there is room for more. The National Treatment Purchase Fund, which was received pessimistically when first mooted, has brought about tremendous results. I have criticisms of certain aspects of it, such as orthopaedic services where there are difficulties with figures for referrals and outputs. This is not due to availability but because of professional self-interests not pushing the treatment fund to work properly. It is only when self-interest is put aside can progress be made.

The Government's announcement on the package of services for older people, including the fair deal package which will commence in 2008, is welcome. Society and the sense of family have changed dramatically. The traditional arrangement of three generations living together has changed, resulting in a greater requirement for care of the elderly. Care for the elderly must be provided in a safe and secure environment. Some reports on nursing homes have highlighted unacceptable conditions. Standards and inspectorates are being put in place and a proper approach to this new demand on our health care system must be put in place.

A political debate has emerged over the co-location of private facilities in hospitals to create an extra 1,000 hospital beds. Political opponents argue the State is building 1,000 beds in private hospitals. The reality is that the 80%-20% mix in acute hospitals is out of kilter. If private patients are occupying public beds above the required mix, the public patient is being deprived of a bed. While we allow the private sector to use our facilities, it will have to locate its beds and have to build its facilities in the hospital. It will receive the benefits of the hospitals' facilities but it must create its own beds. It is not about building 1,000 beds on public sites. It is a case of freeing up 1,000 public beds that are occupied by the private sector.

This matter can be debated all day but the key point is that when these facilities are rolled out, 1,000 public health patients will benefit. I welcome an initiative that can create 1,000 beds at less cost to the State and to the benefit of the public patient. That is not the privatisation of the health services. It is the freeing up of public spaces. I am dismayed by the political and ideological arguments surrounding this matter. It is a question of looking at the glass either half-full or half-empty.