Community nursing unit beds
Rabbitte challenges the delay in providing promised community nursing beds and asks why the Government chose a PPP and when beds will be available. The Taoiseach says the Departments are weighing PPP provision against contracting hospital facilities; Ryan warns that elderly people will face long waits for nursing-home care.
We all know that the provision of step-down services for patients ready to be discharged from hospital is a key element of ensuring that health services are matched exactly to patient needs. It is a priority to increase the availability of community nursing and other units which would meet the needs of people who need care and would not be adequately provided for at home. As the Deputy stated, the Minister made the announcement in question two years ago. Work on the proposal for a public private partnership investment for 850 beds in community nursing units in two locations has continued in the Departments of Health and Children and Finance where discussions on how best to obtain the beds, whether through a PPP scheme with a developer or by some other means, continue.
As the schemes are complex, it is important to have a clear view of the benefit which would accrue given the complexity of the PPP structure. Instead of constructing the units, the previous Minister and the Tánaiste and Minister for Health and Children have continued, in 2003 and 2004, to use a better, more direct approach of providing money to the health boards and, in the most pressing area, the Eastern Regional Health Authority to facilitate the discharge of some 280 patients, mainly elderly people, into private nursing homes and other more appropriate settings. An additional €5 million was provided in recent months to facilitate the transfer of a further 200 patients, including some chronically disabled patients. In August this year the Department provided a further €3 million to the ERHA to transfer a further 120 patients.
I understand the Tánaiste stated in a recent parliamentary question that she was examining whether the work being done on the PPP is the best approach to this issue or whether it would be much quicker and better to continue to try to use the facilities already available, as has been the case for two years, and transfer patients directly. The Department of Health and Children takes the view that having some stand alone community nursing units outside the private area is a better approach. This is the issue the Tánaiste and Minister for Health and Children is examining and on which she will report back.
None of the 850 community nursing home beds has emerged using the public private partnership approach. We have taken a different approach by sourcing and using the facilities in the private sector.
Comment on this
The Taoiseach has rambled off into a number of areas about which I did not ask him. I referred to a particular announcement by the former Minister for Health and Children, Deputy Martin, that he would provide a number of 50-bed community nursing units specifically for the purpose I have outlined. Not one of the beds has been provided, as the answer to a parliamentary question on 28 October makes clear, nor has any work been done — certainly not according to the reply — which suggests a breakthrough is imminent.
Why was it resolved to go down the PPP road? When will beds come on stream? The Taoiseach said he knows all about the issue and noted the Tánaiste is examining whether the PPP route is the correct one. Her predecessor made the announcement with much fanfare in July 2002. The Taoiseach seems to want to give the impression that he has just moved over to the Government benches and somebody on this side is responsible for this matter. I do not care when the Tánaiste became Minister for Health and Children. The Government has been in power for seven and a half years and we still have a crisis in the health service.
My questions relate to a specific announcement by a specific Minister. The Tánaiste, the current Minister for Health and Children, stated she would examine the matter in detail very soon. When will the beds come on stream? Where will they be? How many will there be? Why did the Minister go down the PPP route? Is the public land in question still available? When will the crisis in our acute hospitals be alleviated?
Comment on this
The public land, which belongs to the Department of Health and Children, is available. The question which has arisen between the Departments of Finance and Health and Children is whether this is the best way of providing stand-down facilities or whether it would be better to use facilities available on a contract basis with the hospitals. That is what has been happening in 2003 and 2004.
The Tánaiste has the benefit of the work undertaken on the PPP process in doing this. As the Deputy is aware, we have had a number of difficulties with some of the PPP schemes in a number of areas. The Tánaiste must report on whether this is the best, most cost-effective and speedy approach. In the meantime, we continue to discharge patients from hospitals and the State, through the ERHA and the health boards, continues to fund their beds in different private facilities. The argument is that we should continue to do this as it may be a better approach.
