asked the Minister for Health and Children the total anticipated hospital bed closures that will take place in December 1998; the hospitals concerned and the relevant health board areas; the length of time during which beds will be closed; the total number of bed days lost to date in 1998 arising from bed closures and the projected number as at 31 December 1998; and the action, if any, he proposes to obviate the necessity for bed closures in December 1998. [24140/98]
Priority Questions. - Hospital Bed Closures.
Details of the anticipated temporary hospital bed closures that will take place in December 1998, the hospitals and health board areas concerned and the length of time for which beds will be closed will be circulated in the Official Report.
Temporary bed closures to date in 1998 have accounted for 74,379 bed days nationally. The total projected number of bed days associated with temporary closures for the whole of 1998 is 90,398. This amounts to less that 2.5 per cent of the total number of bed days available in the system. The figure represents an average monthly number of temporarily closed beds of 207 or almost 1.7 per cent of the total number of 12,267 acute hospital beds available nationally.
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) (No. 3) Act, 1996, and which is also engaged in by other agencies not at this stage covered by the Act. 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 manage-ment within an overall budgetary management strategy. These temporary closures also facilitate annual leave, the usual scaling down of elective activity during the summer months and the Christmas season, and on-going 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 nine months of this year was almost 3 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 modem hospitals. For example, trends in medical practice in recent years have been for a marked shift in care from in-patient level to day case 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 September 1998 shows an increase of just over 1 per cent over the same period in 1997, while the corresponding increase in day activity is almost 7 per cent. This significant increase in day work clearly underlines 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.
My policy since taking office has been to ensure that the hospital system continues to respond efficiently, effectively and equitably to the needs of the population and that it is appropriately resourced to provide high quality hospital services in meeting these objectives. Towards this end, I provided an additional £44 million for acute hospital services at the beginning of 1998 to provide for ongoing developments, including improvements in accident and emergency services, to commission new units completed under the capital programme and to tackle waiting lists and waiting times. It is my intention to build further on this in 1999.
Hospital Bed Closures, December 1998
|
Number of bed closures in December 1998 |
Period of bed closures |
|
|
Eastern Health Board Area |
||
|
Beaumont Hospital |
96 |
1/12/98-31/12/98 |
|
National Maternity Hospital, Holles Street |
32 |
18/12/98-31/12/98 |
|
Mater |
35 |
1/12/98-31/12/98 |
|
Rotunda |
17 |
22/12/98-31/12/98 |
|
St. Colmcille's |
10 |
1/12/98-31/12/98 |
|
St. James's |
113 |
21/12/98-31/12/98 |
|
St. Michael's |
8 |
1/12/98-31/12/98 |
|
St. Vincent's |
60 |
18/12/98-31/12/98 |
|
Temple Street |
7 |
1/12/98-31/12/98 |
|
Totals |
378 |
|
|
Midland Health Board Area |
||
|
Mullingar |
40 |
5/12/98-31/12/98 |
|
Tullamore |
40 |
5/12/98-31/12/98 |
|
Totals |
80 |
|
|
Mid-Western Health Board Area |
||
|
Croom |
27 |
1/12/98-31/12/98 |
|
Limerick Regional |
45 |
1/12/98-31/12/98 |
|
Totals |
72 |
|
|
North-Western Health Board Area |
||
|
Letterkenny |
19 |
15/12/98-31/12/98 |
|
Sligo |
40 |
15/12/98-31/12/98 |
|
Totals |
59 |
|
|
South-Eastern Health Board |
||
|
Cashel |
25 |
17/12/98-31/12/98 |
|
Kilkenny |
4 |
17/12/98-31/12/98 |
|
Waterford |
31 |
17/12/98-31/12/98 |
|
Wexford |
32 |
1/12/98-31/12/98 |
|
Totals |
92 |
|
|
Southern Health Board |
||
|
Tralee |
30 |
23/12/98-31/12/98 |
|
Mercy |
18 |
24/12/98-31/12/98 |
|
South Victoria |
89 |
1/12/98-31/12/98 |
|
Totals |
137 |
|
|
Western Health Board |
||
|
UCHG |
58* |
|
|
Portiuncula |
36 |
18/12/98-31/12/98 |
|
Totals |
94 |
|
|
Overall Totals |
912 |
*Under discussion.
Will the Minister confirm that the number of bed days which will be lost in December will be approximately 16,000?
Based on my reply, the present total of bed days lost is 74,279 and the projected total is 90,398. There are about 16,000 bed days involved. Of the total number of beds throughout the system of 12,267, the number that will be closed in December according to the tabular statement, is 912 in total.
Some 912 beds will close in December. Does the Minister know — he did not appear to know yesterday because his Department did not have the information — the state of the waiting lists as of 30 September 1998?
I do not have that information available to me in the supplementary information to hand.
In determining whether additional funding should be made available to hospitals to keep beds open in December, it would be instructive both to the Minister and to his Department if he had put in place the necessary data collection base to ensure that at least by the middle of November he would be aware of the state of the waiting lists at the end of September 1998. Would he accept it is gross incompetence and inefficiency that the only waiting list figures currently available to him and to Members of this House are the figures as they stood at 30 June 1998?
The Deputy asked me to get data for the purposes of putting more money into the hospital system. I have made it clear no more money will be going into the hospital system other than what has been approved expenditure since the beginning of the year. I am not prepared to ask health boards to collect data for the purposes of putting further back in the queue people like those availing of services for mental handicap, services for the elderly and all of the community based services, which also require allocations. These services work within their budgets despite the fact that, similar to the hospital services, they would like more funds. On the basis of finite resources, at the end of the day despite gross non-capital expenditure, day-to-day revenue expenditure will exceed £3 billion for the first time this year. The allocation of further resources above those which have been budgeted for the hospital system would be at the expense of these community based services and that is not a just solution.
Clearly this is the first year in which the accountability legislation is in operation. It is important that it is seen to work. The discipline which it imposes will be instructive to everybody for next year's allocation.
Would the Minister agree that in the absence of finalised figures from the Department it is reasonable to calculate that as at the end of this year the waiting lists will have grown to in the region of 38,500, which will be an increase of 10,000 during his term of office? Would he accept that in the context of such a huge escalation in the waiting lists it is completely unacceptable that 90,398 bed days are lost in 1998 because insufficient funding has been made available to the acute hospitals to meet the real demands being made by patients in need of essential surgery and in-hospital treatment and care?
With regard to the waiting lists, the waiting times are more instructive for patients. These are unacceptably long at present and need to be improved. The 1997 rises were in respect of allocations of just £8 million made by the previous Administration. We increased that by 50 per cent for 1998 at which time we stabilised those lists give or take 1,000 or 2,000.
The lists continue to escalate.