Vol. 618 No. 2
48 Dr. Twomey asked the Tánaiste and Minister for Health and Children if the recommendations contained in the report of the national task force on medical staffing, the Hanly report, remains Government policy; the steps she has taken to date on foot of this report; and if she will make a statement on the matter. [15607/06]
The national task force on medical staffing was set up to devise a strategy for reducing the average working hours of non-consultant hospital doctors to achieve the requirements of the European working time directive, address the consequent medical staffing needs of Irish hospitals, analyse the practical implications of moving to a consultant-provided hospital system, and consider the requirements for medical education and training arising from any changes to the current model of delivering services.
The report of the national task force — the Hanly report — made a series of important recommendations. These covered issues such as the changes needed in non-consultant hospital doctor, NCHD, work patterns, the need for a significantly revised contract for medical consultants, the need for a significant increase in the number of consultants, reform of medical education and training, and the reorganisation of acute hospital services.
My Department is working closely with the Health Service Executive to build on, and progress, these recommendations. Negotiations on NCHD work patterns and a new contract for consultants have begun. The Government also announced details of a €200 million initiative for a major reform of medical education and training, including an increase in the number of medical training places. These measures, combined with ongoing investment in acute hospital facilities, extra consultant posts and the organisation of services around hospital networks, are designed to provide patients with faster access to high quality consultant provided services.
The issues that led to the establishment of the national task force remain to be resolved, including the full implementation of the EU working time directive and the introduction of a consultant-provided service. Addressing these issues requires negotiation and agreement with the medical representative bodies. This process is under way.
This report was published in June 2003, almost three years ago. The former Minister, Deputy Martin, wrote the foreword which stated: "the Task Force has also concluded that a consultant-provided service is the only viable means of providing safe high quality patient care while reducing the working hours of NCHDs". If we are to replace junior doctors with consultants, we will need a new consultants' contract which deals with the extended working day and issues around who will be on duty at night and at weekends. There was nothing in the Tánaiste's reply which gave us any indication where this consultants' contract is going. Getting rid of category two consultants is only a red herring; it will not make a fundamental difference. Locating new private hospitals in the grounds of public hospitals will not change this fundamental problem. Who will be on duty at night and at weekends when the EU working time directive is implemented? That is what the Hanly report is all about.
There should have been a new consultants' contract by now which would provide for an extended working day and cover issues around on-call and working at night and at weekends. The Tánaiste has given no indication that we have moved on this issue in the past three years. We are in exactly the same position in which we were when all these discussions started. That is not good enough. Nothing which has been said on this issue will make the crisis in the health service better. We need to see a change to the consultants' contract, a reduction in the number of non-consultant hospital doctors and more consultants doing the job about which we are talking. While the Hanly report has very much been taken up with the closure of smaller hospitals, this fundamental issue covers every hospital in the country, the largest and the smallest.
We would have agreement if we threw in the towel and gave everybody what they wanted, which seems to be Deputy Twomey's attitude, that is, every time we go into negotiations, we should agree and then they will be over. At present non-consultant hospital doctors get approximately €200 million per year in overtime for the long hours they work. One cannot reduce working hours and pay people the same amount. I do not believe anybody would find that acceptable.
An analysis was done in nine different sites where there was agreement with the doctors to do some pilot work around the new working time directive, including rostering, etc. Unfortunately, I understand the Irish Medical Organisation has instructed them not to participate in that process, which is regrettable. In the context of that analysis, it is worth noting that 21.9% of the junior doctor's time was spent reviewing a patient already seen by a colleague while almost 10% of his or her time was spent talking to another clinician.
We must move to a situation where we have fewer non-consultant hospital doctors. At present there are approximately 4,000 non-consultant hospital doctors but we want to move that figure down towards 2,000. We need to double the number of consultants because it is only when consultants — the key decision makers — deliver the service as opposed to leading it that we will get the best outcome for patients and greater efficiency and effectiveness.
The talks are before the Labour Relations Commission. I appeal to the doctors involved to agree to the implementation in the nine sites. We are already in breach of the 58-hour provision in the EU working time directive, which should have been introduced on 1 August 2004. Since we are in the process of implementation, apparently we can be facilitated. However, in the interest of the reform of the health care system, we need to reach agreement. There are proposals from the Government side, including the HSE, on rostering and sharing. It is not a question of people working a 39-hour week from 9 a.m. to 5 a.m. and that everything else will be dealt with on an overtime basis. That is not the manner in which we will get the type of health service we need.
I am not asking the Tánaiste to throw in the towel in any negotiations. I am asking her to tell the House whether she has no hope of renegotiating, or has failed to renegotiate the, consultants' contract or whether there is some light at the end of the tunnel. Given that nothing has happened in the past three years, are we talking about another nine years before we move forward and see these changes? These changes are fundamental and will affect every aspect of hospital services, yet we have not moved one inch in the past three years since this report was published. Rather than criticise me and act like an innocent bystander in all this, the Tánaiste should tell the House if we are getting anywhere on these issues. If we are not, she should tell the House.
The process is under way in the LRC. I accept what the Deputy said, that we need changed work practices whereby doctors work as part of teams and clinical directors. We have already seen some initiatives, especially in Blanchardstown hospital where seven new consultants have been appointed. They will work on a team and on a 24-hour per day basis. These are the types of initiatives which will deliver the best health care for patients. We are in discussions for a contract for consultants too and it may well be that all of them will be concluded together. I know the chairman is hoping to have those talks resumed quickly. We need to move quickly to get a more flexible and appropriate contract of employment for consultants and non-consultant hospital doctors. It is my intention and that of the HSE and the Department of Health and Children to have that soon.
49 Ms McManus asked the Tánaiste and Minister for Health and Children her views on the strong criticisms made at the recent IMO annual meeting of her proposal for private hospitals on public hospital grounds and the fact these proposals do not represent an evidence-based approach to health policy; if she will review her insistence on pushing through proposals that are likely to have a serious and adverse impact on the health services; and if she will make a statement on the matter. [15686/06]
It is to be expected that diverse views are expressed at a gathering of the Irish Medical Organisation. For example, Professor John Higgins, consultant in obstetrics and gynaecology at Cork University Hospital, stated the following at the organisation's conference: "If dynamic, flexible arrangements are put in place then I think the co-location model recently suggested by the Tánaiste should be an absolute winner [for us all]". Similar views were expressed in the media last week by Dr. Rob Landers, consultant pathologist at Waterford Regional Hospital and chairman of its medical board.
The policy direction I have given to the Health Service Executive is to achieve 1,000 new public beds. If we build a new public bed in the traditional way, the Exchequer bears 100% of the capital cost. If we do it in the new way, that is, by moving the private beds into new co-located facilities and freeing up new public beds, the capital cost to the State is less than 50%. In addition, the running cost of the private beds would no longer be subsidised or managed by the State. The HSE is now taking the necessary steps to implement this policy to achieve a significant increase in the number public beds.
Like very many other countries, we have a mixed system of financing and provision of hospital services and there is no reason we should not continue to build on this. We already have excellent private hospital management dating back to the 18th century when St. Patrick's Hospital in Dublin was founded by Jonathan Swift. The Highfield group has been offering services in the Dublin area for 150 years. There are many other hospital providers which have, more recently, established strong reputations for quality and service among the public.
There is no evidence from Ireland that for-profit hospitals have a lower patient safety record than all others. It is highly relevant that the same body of consultants largely treats patients in both public and private settings. I do not believe those consultants would accept, still less promote, a proposition that their patient care and patient safety be lower in one location than in another. Patient safety is vital in all hospitals, both public and private. I will promote accreditation and clinical auditing for all settings, irrespective of their financing structures. I urge support from medical organisations and practitioners for all measure to assure quality care for all patients in all locations.
The board of governors of St. Patrick's Hospital will be surprised that it is a for-profit organisation. Is the Minister not taking on board the fact that, overall, there was widespread criticism of her proposal, not just from the IMO but also from others? Does she not need to listen to this? Will she indicate what research she has carried out to justify what appears to everybody else to be a top-of-the-head kind of proposal?
Does the Minister not accept that international evidence indicates that for-profit hospitals are more costly and do not have outcomes as good as those in public hospitals? Will she indicate how she can justify the diversion of so much public money into private hands? The hospitals in question are not private, they are publicly funded for-profit hospitals. Does the Minister not accept that by saying the State will have no management role in these hospitals, although it is funding them to a great degree, she is exposing a weakness in her argument? Whatever happens in those hospitals will be determined largely by the desire to make profit rather than anything else.
Does the Minister not feel at this stage that it is important to circulate among the public evidence to back her claims and to agree to take on board and consider carefully the criticisms that have been made, not only those of the medical profession but also those of economists, who reckon the proposal will cause more problems in the health service than exist at present?
There are 2,500 private beds in the public hospitals. The policy pursued by the Deputy's party, when it was in Government, was that 20% of beds in all new hospitals would be private. The taxpayer pays the full cost of these and, furthermore, staffs them and subsidises them to the tune of 40%. The only staff members getting any income from the insurers are the consultants. I recently compared this to pilots getting all business-class air fares.
I want to convert 1,000 of the 2,500 beds into public beds for all patients, not just private patients. The manner in which I suggest doing so is such that these beds would be provided to the taxpayer at less than half the cost, including the capital allowances, of building the beds in the traditional way. Furthermore, these beds are already staffed by nurses who are being paid through the public system, and therefore all that is required is the relocation of the private beds to a different facility that would be totally financed by private investors. Hospitals would have these facilities co-located so the consultant staff could be on-site. We all know that consultants can use their time more effectively if they are on-site as opposed to operating at a number of different sites under a system of bi-location. This is why this policy is being pursued. Before I announced the policy, Prospectus, which has great expertise in this area, did some consultancy work for me.
In the OECD approximately 27% of health care is provided privately and 72% or 73% is provided publicly. In the United States, where the reverse is the case, some 60% of health care is private and 40% is public. I noted recently that the Prime Minister of British Columbia, Gordon Campbell, asked why Canada was so afraid to consider a mixed health care delivery model like those in many European states and others which would deliver results for its patients at a lower cost to taxpayers. That is what I am trying to do.
I am trying to provide 1,000 beds at less than half the cost of doing so in the traditional way, thus avoiding the need for the huge subsidy of 40%. Much private work is carried out in our public hospitals and the rate is increasing very rapidly because of the great numbers with private health care insurance. The taxpayer should not fund the capital provision of the private beds, nor should he or she subsidise them to the tune of 40%.
I take it the Minister is to stop private patients entering public hospitals.
No, I am not.
Surely, then, she accepts that what she is talking about is absolute nonsense.
They will not have preferential entry.
There will still be private patients in the public hospital system because they can be there as of right. I suggest that the Minister publish every scrap of evidence because she will need to make her case to the public and those working in the health service. She will admit that these are not privately funded hospitals but State-subsidised hospitals over which the State will have no direct control. Those hospitals could care for patients from Asia apart from those earmarked by the Minister. An entirely new business could be created and we will have no control over it. All we will have done is handed over a great deal of money, which could have been used to invest in the health service, to private for-profit organisations interested in making money.
It does not require rocket science to realise that one can provide 1,000 public beds for less than half the cost of building them in the traditional way, yet the Deputy says this does not make sense and suggests we should instead pay €1 million per bed to build the 1,000 beds, which sum we are currently paying.
The public hospitals will either lease or sell the required land and will not invest any money in the beds. At present, the public system is funding the entire cost of the private beds. Patients have to enter a public hospital on the basis of equity and not on the basis of whether one can pay and another cannot. My policy is one of total equity in respect of facilities provided by the taxpayer. We do not have this at present.
Most consultants to whom I have spoken, comprising at least 100 from hospitals around the country, totally support this initiative. They regard it as the most effective way of getting——
They regard it as an opportunity for themselves.
At present they bring——
Order, please.
Under the Deputy's proposal, the consultants will do all their private work in the public hospitals and the State will continue to subsidise the beds to the tune of 40%. She obviously believes this is a good idea.
No, I believe patients should all be the same.
I do not believe it is a good idea. Instead of wearing ideological blinkers, the Deputy should consider solutions.
Patients should not be public or private.
She should take off her ideological blinkers at least once in a lifetime.
That is rich coming from the Minister. Once upon a time——
What I say is true. The Deputy believes my proposal is stupid although it involves providing the beds at half the cost that would be incurred in the traditional way.
It is a waste of public money.
50 Mr. Connolly asked the Tánaiste and Minister for Health and Children if the recently established health fora are to be sidetracked by the Health Service Executive in the issuing of protocols, such as occurred recently in the executive’s north-east region in respect of its removal of paediatric services from Louth, Navan and Monaghan general hospitals without prior consultation or discussion with the health forum; and if she will make a statement on the matter. [15561/06]
The function of regional health fora is clearly set out in section 42 of the Health Act 2004, which provides for the establishment of the fora to make representations to the Health Service Executive as they consider appropriate on the range and operation of health and personal social services provided within their functional areas. I understand the first meeting of the forum for the north east took place on 27 March 2006 and that a wide range of issues was discussed.
On the specific service referred to by the Deputy, I am advised there has been no change in the provision of paediatric services in the north east region in recent times. A paediatric transfer protocol was developed by a multidisciplinary regional group, established by the North Eastern Health Board in 2003, to establish clear, concise and workable guidelines for the assessment and management of all children under the age of 14 presenting at a non-paediatric facility in the north east. This protocol has been operational as a draft protocol since spring 2005 and was formally implemented on 10 April, with a review date of six months from that date.
In accordance with its terms of reference, it is open to the Dublin and north-east forum to make representations on this matter to the CEO of the Health Service Executive.
I thank the Tánaiste for her response. The major decision to remove paediatric admissions from Dundalk, Navan and Monaghan hospitals, which was implemented on 10 April, should have been discussed at forum level. The forum members should have been given the opportunity to make representations or observations prior to a service being removed. It is any parent's nightmare to be forced to drive past Dundalk, Navan or Monaghan hospital with a critically ill child, suffering from an asthmatic attack, meningitis, an epileptic seizure or choking. The forum members should have been able to discuss the matter and give assurances to people that these children would be looked after if they were taken to the nearest hospital, where they could be stabilised. If necessary, they could subsequently be transferred. There is no point in the next meeting of the forum discussing or making an observation on a decision that has already been taken. From the executive's point of view it would be somewhat like a thunderstorm, something that will pass after an hour or two and the air will clear afterwards. This is why I believe these new fora——
The Deputy should put a question.
Does the Tánaiste agree that these fora are completely irrelevant if they are not allowed to discuss matters of policy or service delivery to the public and the effects they have on the public? We talked about appropriate observations. Would the Tánaiste agree nothing could be more appropriate than wanting to save the life of a child while being forced to drive past a hospital, which represents the worst nightmare for any parent?
The fora are free to discuss policy issues. However, the fora are prohibited from having a role when it comes to clinical judgment issues and the appointment of staff. This issue falls into the broad area of policy, on the one hand, and patient safety and clinical judgment on the other hand. This is why it was decided this service should not be supplied in four different hospitals covering a relatively small population base. As the Deputy is aware, these services are provided in Cavan and Drogheda.
The protocol came into effect in April and it will be reviewed in six months' time. In the meantime, perhaps the matter could be discussed at the next meeting of the forum.
Can the Tánaiste give an assurance that a critically ill child may be brought to any hospital in the region to be stabilised?
Obviously, anybody who is critically ill may be brought to a hospital with an accident and emergency unit that is on call for emergencies. Clearly for all patients, the sooner they are brought to the most appropriate place for treatment the better. The sooner a patient can get to the place that can deal with his or her difficulty, the better the outcome. If a patient is brought to a hospital that is not able to provide the kind of service required, the delay in taking him or her to the more appropriate setting, in this case Cavan or Drogheda, could cause serious difficulties for him or her.
I ask the Tánaiste to call on the HSE to make this fact public and reassure people that a critically ill person is allowed to be brought to any hospital. The public need that reassurance.
A review of what happened to the late Pat Joe Walsh in Monaghan General Hospital is expected to be complete next month. The review of services in the region will also be available in May. As a matter of urgency we need greater clarity as to what should happen in the north east because there have been major difficulties. For almost as long as I have been a Member of this House, the hospital services in that region have been the source of much debate here. Many of the problems stem from having so many hospitals for such a small population base, which causes great confusion and difficulty.
51 Dr. Twomey asked the Tánaiste and Minister for Health and Children if actions 4 and 5 of table 3 of the primary health care strategy remain her policy; the progress to date on achieving these actions; and if she will make a statement on the matter. [15608/06]
The Government is fully committed to the implementation of the principles contained in the primary care strategy and this includes the development of primary care teams and networks. The implementation process at operational level is a function of the HSE, whose chief executive officer has identified as a priority the development of multidisciplinary primary care teams. The 2006 Estimate for the HSE includes an additional €10 million in revenue funding to enable the establishment of up to 100 new primary care teams. This will enable the provision of 300 additional front-line personnel to work alongside GPs to provide integrated and accessible services in the community. Work by the HSE to establish these teams is under way. In planning for the establishment of these teams, the executive intends to focus where possible on areas of disadvantage and with significant health inequalities.
I am encouraged to learn that in excess of 1,000 general practitioners have responded positively to an invitation from the HSE seeking expressions of interest. Following the identification by the executive of the GPs to be involved in the development of the teams, work will be required to realign HSE services to give best efficiencies for teamwork and to determine ideal team compositions to meet the needs of identified areas.
Ongoing implementation of the primary care strategy will focus on the reorganisation of the resources already available. This whole-system approach to implementation means change will be required in many sectors in the health service and not solely within primary care.
It is difficult to know where to start regarding this report. Much of this stems from what Mr. Derek Davis said at the IMO conference and the Tánaiste's comments afterwards criticising GPs. Again she was acting as if she was an outsider and not involved. As legislators we have responsibility for patients with medical cards and a moral responsibility for private patients. What will the Tánaiste do to ensure the country has a GP service in five years' time? This is the next crisis brewing after that in accident and emergency services. Medical card patients have difficulty in accessing GPs in some areas, which usually indicates the start of a developing crisis. It will soon start to affect private patients.
Where does the Tánaiste stand regarding the primary care strategy? We seem to be back at square one. When the former Minister for Health and Children, Deputy Martin, announced the primary care strategy in 2001, he said that 60 primary care teams would be established within five years. The Tánaiste is now making the same promise to establish 75 primary care teams five years later. When the primary care strategy was published it was a ten-year plan. Is it Government policy that it is now a 15-year plan because nothing has been done in the past five years?
The Tánaiste needs to be honest in admitting that there is a major problem in general practice and in primary care. The Tánaiste has said that GPs are not available outside of office hours and are not on call. However, Members of this House have a responsibility for one third of the population with medical cards. It is not good enough simply to pass the buck on the matter. We must determine what the Government has or has not done in this case and what it will do to correct this problem. There is no point in us coming back to the House in three years' time with the same crisis in general practice as exists in the accident and emergency service now. Accident and emergency units only cater for 3,000 patients per day whereas general practice deals with 20,000. We cannot blame the people working in the area. As the Tánaiste indicated, 1,000 GPs applied for these new posts.
I will tell the Deputy what we are doing. This year current expenditure on health care will be €12 billion, €7 billion of which will be on primary continuing community care. Of the €7 billion, primary care and community health services get approximately €3.2 billion, which is a considerable amount of money. We are trying to strengthen the personnel and expertise available to general practitioners. As the Deputy will be aware, we made provision this year for 300 people, including physiotherapists and other therapists to be made available to primary care teams.
We also need to improve the organisation of services on the ground. At the moment, when leaving a hospital a patient's case will be reviewed by a hospital's occupational therapist. However, the occupational therapist in the community needs to go to the patient's house and those people rarely meet or talk to each other. The HSE is seeking to bring many people together. Let us consider the recently opened Ballymun health centre. Instead of people operating in many different offices in the area, they are now together. The same number of people can now provide a much better service. I understand one of the public health nurses has said that since moving to the new centre, she now spends approximately 10% of her time on the phone as opposed to the 25% she used to spend trying to talk to other colleagues. Much of what needs to be done involves bringing together the existing people on the ground. We are also increasing the number of university places for medical students and the number of training places for general practitioners. We intend to introduce graduate entry into medical school from the 2007 academic year. We are reducing the number of points required to 450, although we are still talking about the top group because the top 16% of students who do the leaving certificate get 450 points or more. We are investing in more clinical placements with a view to increasing the number of people who intend to pursue medicine as a career. It is obvious that a new contract of employment is being negotiated with the Irish Medical Organisation, which is working on behalf of general practitioners. I am a strong fan of trying to empower general practitioners to have a greater role, particularly in respect of things like chronic illness and smear testing which are more appropriate for primary care. It is clear that we have to put in place a contract of employment that incentivises that happening at that level.
I am also a great fan of things being done at primary care level, but we do not have the personnel. I am sure the Tánaiste is aware that a small percentage of patients are having difficulty in accessing general practice. This is the beginning of the problem. It takes four or five years to train a general practitioner. If we wait that long, it will not be good enough. I would like the Government to propose how we can correct the manpower problem that is starting to lead to problems in accessing services.
We need to ensure we do not limit the number of people who can access general medical service contracts, which is something we have done. I regularly meet doctors who would love to have general medical service practices, but are prohibited from doing so under the current rules which were agreed with the IMO. I met two such doctors last week. We have to use our existing capacity as best we can. I share the view that was expressed by the Deputy. It is clear there will be a focus on primary care in the future. I understand there are approximately 18 million contacts between doctors and patients under the general medical service each year. When one considers that approximately 1.1 million people have medical cards, it is clear that each of them makes an average of almost 18 visits each year. There is a huge level of contact between doctors and patients at that level. It is clear we have to resource the general medical service, in which the greatest amount of activity takes place, in a better manner.
52 Mr. Gormley asked the Tánaiste and Minister for Health and Children if the state of emergency in relation to accident and emergency will continue for the foreseeable future; her views on whether the lack of bed capacity is the main cause of the accident and emergency crisis; the status of her ten-point plan; the reason she has failed to deal with the accident and emergency crisis; and if she will make a statement on the matter. [15634/06]
The Government's top health service priority is to tackle the difficulties with accident and emergency services. I said I wanted the accident and emergency situation to be treated as an emergency to increase the pace with which better outcomes are achieved for patients. The Government's objectives are to reduce the number of people waiting for admission, the amount of time they spend waiting for admission and the turnaround time for those who can be treated without requiring admission. As the Minister for Health and Children, it is appropriate for me to exhort maximum effort and speed from all concerned to improve care for patients. The HSE, which is continuing to implement the ten-point action plan, is also implementing other initiatives, including the establishment of performance targets for individual hospitals and the development of financial incentives which are linked to performance. In the immediate term, the HSE is introducing a series of measures to improve facilities for patients and staff in accident and emergency departments. Long-term care beds are being secured from the private sector to facilitate the discharge of patients who have completed the acute phase of their care. Additional acute beds and day places have been provided in recent years and more beds are in various stages of planning. I share Professor Drumm's view that the achievement of improvements in accident and emergency services depends on fundamental changes being made in hospitals and in other areas of the health service. It is not just a question of putting extra acute beds in place. The measures being examined by the HSE include improvements in hospital processes and procedures to ensure they operate more effectively, the introduction of rigorous admission and discharge planning processes, the broadening of access to diagnostic facilities and the enhancement and development of primary and community care services.
I asked the Tánaiste whether she thinks the state of emergency in accident and emergency services will continue for the foreseeable future. What does she consider to be an acceptable number of patients on trolleys? When will she declare the state of emergency to have come to an end? What is an acceptable number of people on trolleys? I think the Tánaiste said at one time that it was not acceptable for anybody to be on a trolley. At what stage will she declare that the state of emergency is finally finished? Can we expect it to continue for the next 12 months, until the general election? When the Tánaiste published the ten-point plan, she said we would see tangible results in 2005, but the problem has got much worse since then. When will we see the results of the ten-point plan?
We will see results when there is a change of Government.
It is just not happening. Deputies have received a number of replies from the Tánaiste in response to questions about beds. She said this afternoon that 1,000 public beds will be freed up as a result of her privatisation proposals. Was she referring to 1,000 public beds? She said at another stage that she was talking about 1,000 beds which could be used by private and public patients. Does she see the proposal as a genuine option? Why is she continuing with this policy when she and Professor Drumm have said that beds are not the main source of the problem?
I remind Deputy Gormley that the conversion of 1,000 private beds into public beds is not privatisation. He does not seem to understand what is privatisation. It would be privatisation if I was doing the reverse, by converting some public beds to private beds.
What are they?
I wish to make that clear.
Are they public beds or private beds?
There are 2,500 private beds in our public hospitals at present. That some 46% of the elective work at Tallaght Hospital last year involved private patients does not cast any reflection on its catchment area or on its accident and emergency activities. The beds in question were entirely funded and are 40% subsidised by the taxpayer. The wages of the nursing and other staff are paid by the taxpayer.
I want to reduce the amount of private activity in public hospitals so patients are seen on the basis of medical need. Ireland has more beds pro rata than Finland or Sweden and the same number as Britain, even though 18% of the population of Britain is over the age of 65 and just 11% of the population of Ireland is over the age of 65. It almost does not matter how many beds one has if they are not being used efficiently. The results of the process mapping exercise at Cork University Hospital, which were published last week, highlighted that 2,280 bed days were lost at that hospital because people who were fit to be medically discharged were not discharged for all kinds of reasons. Very few people are discharged from our hospitals, particularly those in Dublin, on Saturdays or Sundays. If one is not seen by a consultant until late in the evening, one will not be able to go home until the following day.
We need to change many aspects of how we use our beds. While there are fewer beds in Finland than in Ireland, there is more hospital activity in that country than there is here. When one talks about beds one has to consider how they are used. The number of procedures carried out on a day case basis doubled from 250,000 in 1997 to 500,000 in 2004. That means there should not be as much need for inpatient beds. Deputy Gormley asked me to outline the extent to which it is acceptable that there are patients on trolleys. People will always be treated on trolleys — that is a fact throughout the world. Many treatments are performed while patients are on trolleys. We are trying to ensure that people who are waiting to be admitted to acute beds in hospitals do not have to wait for more than six hours. That is the aim and the ambition. In autumn 2005, there was a reduction of 20% in the number of people waiting on trolleys.
The care of the elderly is one of the issues that arises in this regard. Approximately 4.5% of those over the age of 65 are in long-term care, which is in line with the international average. Some people who are in care could be at home if a set of measures had been in place in the past to support such people. We do not have such supports, however, and it will take some time for us to catch up. We are putting them in place at present because we understand that over the next few years we will have to expand the services we provide to older people in the community. We need to provide home help and home support and to recruit additional chiropodists, physiotherapists and other professionals who can help people to stay in the community. I have given the HSE additional resources to procure beds for older people in the acute system. There were approximately 440 such people in the Dublin area a few weeks ago. Older people who have been medically discharged are being moved from the acute system to alternative settings. That will continue for the rest of this year. It will have a major impact on accident and emergency services as the year progresses.
The Tánaiste is saying that six hours is now the benchmark as far as she is concerned.
I said that earlier but the Deputy was not listening.
It does not matter to the Tánaiste, therefore, if there are 450 people lying on trolleys as long as they are there for no more than six hours. Is that okay as far as she is concerned?
Such targets are in place in the best health care systems in the world. Under our system, before a patient even gets to see a doctor, he or she can have to wait quite some time. Many of the processes within accident and emergency departments can, I hope, expedite the time period before a patient gets to see a doctor. Remember that 75% of those presenting at accident and emergency departments do not need to be admitted to hospital. Equally, we want to ensure that these patients are dealt with quickly. It is not just a question of the people being admitted to hospital. We want to see more rapid responses as regards all activity in accident and emergency departments.
