Dáil Éireann debate -
Thursday, 8 Oct 1998

Vol. 494 No. 6

Written Answers. - Hospital Accommodation.

Jack Wall

Question:

22 Mr. Wall asked the Minister for Health and Children the number of operations or procedures cancelled due to bed shortages in each of the main hospitals over the past six months; the number of elective bed closures in each case; and if he will make a statement on the matter. [18880/98]

Ivor Callely

Question:

49 Mr. Callely asked the Minister for Health and Children if his attention has been drawn to the cancellation of appointments and ward closure in hospitals, reported to be due to inadequate budget allocation to meet the demand, with particular reference to the Mater and Beaumont hospitals; and if he will make a statement on the matter. [18850/98]

Minister for Health and Children (Mr. Cowen)

I propose to take Questions Nos. 22 and 49 together.

My Department does not collect information in relation to numbers of postponed elective procedures or appointments.

The level of elective activity in the acute hospital system is planned by local management over a 12 month period having regard to anticipated levels of emergency admissions and the overall resources available. This forms a central part of the service planning process which is required of health boards under the Health (Amendment) Act, 1996, and which is also engaged in by other agencies not at this stage covered by the Act, including the two, Beaumont and the Mater Hospitals, referred to specifically by Deputy Callely. In 1998, for the first time, hospitals were advised of their funding allocation under the waiting list initiative at the beginning of the year. This has enabled improved planning of elective activity for the year as agencies can take account, from the outset, of both projected core activity and activity to be performed under the waiting list initiative in the target specialities.

In achieving activity targets set out in the annual service plan, temporary bed closures form a part of the normal bed management function performed by local hospital management within an overall budgetary management strategy. These temporary closures also facilitate annual leave and refurbishment works. It is important, therefore, that they are viewed in the context of overall levels of activity delivered in the acute hospital sector against agreed service plans for the 12 month period. In this context, it should be noted that the total number of discharges, both in-patient and day-patient, for all hospitals for the first six months of this year was almost 4 per cent up on the same period last year.

It is important to realise that the number of overnight beds in the system at any given time does not reflect the complete picture of activity in modern hospitals. For example, trends in medical practice in recent years have been for a marked shift in care from in-patient level to day care and out-patient level together with reduced average lengths of stay and increased bed occupancy rates. To illustrate this point, overall acute hospital in-patient activity for January to June 1998 shows an increase of 1.11 per cent over the same period in 1997, while the corresponding increase in day activity is 9.78 per cent. This significant increase in day work clearly underlines the fact that a temporary reduction in bed numbers in any given location will not necessarily correlate to a similar reduction in activity in terms of total bed days used.

It has to be understood also that the unpredictable nature of activity generated by emergency admissions means that cancellations of elective procedures are inevitable from time to time in any event as the system tries to cope with unexpected peaks. As part of the service planning process, it is a matter for agencies to attempt to take account of these peaks and troughs when planning their elective activity levels and temporary bed closures over a 12 month period.