Brendan Smith
Question:10 Mr. B. Smith asked the Minister for Health the criteria used in determining the number of beds to be provided in general and regional hospitals. [9448/95]
Ceisteanna—Questions. Oral Answers. - Hospital Accommodation.
(Limerick East): The Deputy will be aware that since 1987 an extensive national programme of hospital rationalisation has taken place. The number of acute consultant staffed beds was reduced from over 15,000 in 1986 to 12,000 by early 1990. In February 1990 the then Minister undertook to maintain acute bed availability at approximately 12,000 beds, and this remains the policy. The current number of acute hospital beds stands at 12,431.
Because of increased productivity and efficiency gains within the hospital service, the current level of bed stock enabled hospitals to treat approximately 522,000 in-patients and 187,000 day patients in 1993. This compares favourably with a total of 512,000 in-patients and 88,500 day patients treated in 1987 prior to the rationalisation. This represents an increase of 18 per cent in total numbers of patients treated.
In recent years there has been a marked shift towards day case surgery and treatment of patients at out-patient level. This trend is very much in line with general developments in medical practice and is supported by my Department. The Deputy may wish to know that in 1993 there was a total of 1.8 million attendances at out-patient level.
In looking at acute hospital service delivery it is inappropriate to focus solely on in-patient beds as a measure of hospital resources. The emphasis is on overall activity levels and throughput, whether this is achieved by in-patient care, day care or out-patient attendances.
Will the Minister accept that, in view of the great need for additional beds in areas where the number of people in the 65 plus age group is above the national average, provision will be made for such beds?
(Limerick East): The Deputy is entering another area relating to care of the aged. A strong case can be made for increasing the number of sub-acute beds in certain parts of the country and for the involvement of district nurses, as Deputy Geoghegan-Quinn suggested. I am considering a series of initiatives, including the provision of step-down facilities, to support the acute beds already available. That would ensure that acute beds are used to their maximum effect and that adequate step-down facilities are available for an increasingly ageing population.
I accept the Minister's point, but according to reports from medical people it is not only step-down facilities that are needed, the elderly population by its nature demands more acute beds. In Northern Ireland and Britain the needs of the elderly population are taken into account in determining the medical beds to be provided in acute hospitals. In areas such as Cavan and Monaghan where 15 per cent of the population is over the age of 65 there is a greater need for beds than in areas with a lower percentage over the 65 year age group.
(Limerick East): Practically every part of the country makes a case for extra facilities, including extra beds, and consultants in practically all specialities will say they require extra beds. That is an indication of the demand. On the supply side, internationally there is increasing movement towards ambulatory and outpatient facilities, and treatments one would not dream of undergoing previously without spending a week in hospital are carried out now on a visit to out-patient facilities or ambulatory care. I do not consider it necessary to increase the number of acute beds nationally, but I accept the point that with better use of acute beds and step-down facilities we might meet the prospective needs of an ageing population. The Deputy has identified a factor which will become increasingly relevant. As the years go by the proportion of people in higher age groups will increase from the present 15 per cent the Deputy talked about in Cavan to almost 30 per cent.
It is generally thought that the criterion used by the Department is that a medical bed is provided per 8 per cent per 1,000 of the population. Is that figure correct?
(Limerick East): I do not have that figure in my brief. In 1987 it was decided to reduce the number of hospital beds from approximately 15,000 to 12,000 and we consider that the present number, approximately 12,300, is about adequate for our needs, but there is a problem regarding back-up facilities which I stated on a number of occasions, particularly with step-down accommodation.
Will the Minister indicate if a national survey has been carried out to ascertain how far one day and five day care surgery facilities could be developed to improve matters in hospitals? Will he agree that the increase in numbers attending out-patient clinics is a serious problem and there is a need for greater co-operation to ensure that GP practices have more funding to develop their practices so that fewer patients will need to attend hospital clinics and more will be seen to in doctors' surgeries as was the position 20 or 30 years ago?
(Limerick East): The provisions in the health strategy, if implemented effectively, will involve a move back towards community care. As I said earlier, that would incorporate greater involvement of district nurses and family doctors. I agree that the line Deputy Leonard suggests is the direction we should follow. Regarding his question as to whether studies have been carried out to ascertain the scope of day care facilities as against patients staying in hospital for a period of days, some figures are available, but we are significantly behind as regards present international trends. It appears that there is significant scope in Ireland to develop that further.