Nobody argues with the aim of making hospitals efficient. However, does the Minister accept that the current casemix system does not provide an accurate gauge whereby it can be ensured that more problems are not created for hospitals under pressure, especially in the Dublin area? The result of the Minister's approach in the east coast area has been penal. More than €2 million has been taken away from two key hospitals, St. Vincent's Hospital and St. Columcille's Hospital in Loughlinstown. That must impact on patient care.
Does the Minister acknowledge that it is not a case of inefficiency in these hospitals but that a high number of elderly patients are blocking beds because there are insufficient rehabilitation units? That is a direct result of the Minister's failure to provide such beds. Does he also acknowledge that these hospitals have complied with the appropriate public private balance of 80% and 20%? Other hospitals have disregarded that balance and have catered more for private patients who do not stay in hospital as long as public patients. They are usually not as sick or as old as public patients. The Minister may be rewarding hospitals which care more for private patients than for public patients and which provide for acute cases in accident and emergency departments because they do not have reserve beds.
I know this is technical, but perhaps the Minister would recognise that the result of what he has done is to penalise hospitals which are already under pressure. Approximately 2,400 patients are waiting for care in St. Vincent's Hospital. It is a major hospital which deals with cancer patients and is subject to huge demand from patients in the locality and its catchment area. It is also a tertiary hospital, yet it is taking a hit of more than €1.2 million. That must be absorbed within the hospital and, inevitably, will impact on patient care.
I am glad the Minister is carrying out the review, which I welcome. He must also carry out an equally forensic survey of the impact of this approach. What evidence is there that benefits accrue to patients when hospitals are rewarded? The Minister is rewarding Letterkenny General Hospital, for example, which is great for it. However, that is not of comfort to the thousands of people trying to access services in St. Vincent's Hospital. A young woman I met through my clinic needs a colostomy reversal operation and cannot get into St. Vincent's Hospital because there are no beds. She was told she had to have the operation within a year. It is now the last month of that year and there is no sign that she will receive the necessary treatment. By fining St. Vincent's Hospital, the Minister is ensuring that there is less chance of such patients' needs being met quickly.
As regards the review, I urge the Minister to examine the context in which these hospitals operate and how they ensure that public patients are treated fairly, unlike many other hospitals which are being rewarded under the casemix system.