I propose to take Questions Nos. 125 and 157 together.
Details of the number of bed closures and resulting bed days lost in 1999 are set out in the table attached. It should be noted that, for the purposes of accurate comparison, the figures exclude closures which occurred as a result of the nurses strike.
Under the Health (Amendment) (No. 3) Act, 1996, each health board is obliged to produce an annual service plan for the year on the basis of the financial determination notified to them. This requirement is also applied to voluntary hospitals on an administrative basis. These service plans are agreed with my Department at the beginning of each year. Responsibility for delivering the plans rests with management in each agency. As part of the process of delivering service plans activity in the acute hospital sector is planned by agencies over a twelve month period having regard to anticipated levels of emergency admissions and the overall resources available.
In considering the delivery of service in the acute hospital sector, it is appropriate to examine the overall level of service provided in the sector rather than to simply focus on the number of beds available at any given time. This reflects major changes that have been taking place in medical practice, resulting in reduced average in-patient lengths of stay, a continuing shift in the delivery of care from an in-patient to day case basis and the increasing provision of treatment at out-patient level. In developing and delivering service plans, the implementation of an appropriate mix between in-patient, day case and out-patient care is a major consideration for local management in seeking to maximise overall activity.