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. As part of this process, activity in the acute hospital sector is planned over a 12 month period having regard to anticipated levels of emergency admissions and the overall resources available. In achieving the activity targets set out in the annual service plan, temporary bed closures would form a part of the normal bed management function performed by local management as part of their efforts to optimise the overall activity delivered within the resources available. They also, of course, facilitate staff annual leave, refurbishment works and the scaling down of elective activity at times of low demand, such as the high summer period and at Christmas. I am confident, however, that, given the level of increased funds I have made available to the acute hospital sector this year over last year, the level of temporary bed closures will be kept to a minimum.
The total number of discharges, both in-patient and day case, in the acute hospital system for the period January to October 1998 was 676,635 which was an increase of over 3 per cent over the same period in 1997. In other words, irrespective of any temporary bed closures that occurred during that time, over 3 per cent more patients received treatment in our acute hospitals. It is in this context that the performance of acute hospitals in 1998 should be judged. In agreeing service plans for 1999 with agencies in the acute hospital sector, my fundamental concern is to ensure that they will again deliver a level of service to patients commensurate with the funding being provided to them.
The ability of the acute hospital system to provide treatment to an increased number of patients in 1998 bears out my view that the system is continuing to perform productively. This is also evidenced in a recent OECD comparative study on health expenditure which found that hospital productivity here has increased significantly over the past 15 years. The report found that, over that period, the average in-patient length of stay had reduced by 29 per cent, better management of resources had allowed the average bed occupancy rate to rise to 85 per cent and the level of day care treatment had almost quadrupled since 1986.
As a result of a combination of these factors, the total number of cases being treated in acute hospitals in Ireland has been rising by 3 per cent each year since 1987, against a background of a reduction of in-patient bed numbers in the late 1980s. This again emphasises the inappropriateness of available bed numbers as an accurate measure of what is happening in the acute hospital sector.
While the OECD report makes it clear that the acute hospital system is being managed well, my policy is to ensure that the productivity of the system continues to be optimised to the benefit of patients everywhere. That means ensuring that the system is appropriately resourced to provide high quality services that respond efficiently, effectively and equitably to the needs of the population.
In this regard, I have provided additional funding of almost £71 million in 1999 to meet the cost of specific acute hospital service developments in areas such as accident and emergency services, cancer services and cardiovascular services, to commission new units completed under the capital programme under which investment is now at a historically high level, to meet costs associated with rising birth rates, to replace medical equipment and to seriously address the problem of unacceptably lengthy waiting times for particular procedures as part of my strategy of implementing the report of the review group on the waiting list initiative. The strategy in the waiting list review group report is a comprehensive one aimed at addressing the problem of hospital waiting lists in a broad based approach which also encompasses the primary health and continuing care dimensions of the problem.
I am conscious of the conflict between available resources and the competing demands for ever increasing expenditure on health and social services. In recognising that, the scale of increase in overall resources devoted to the public health services in 1998 and 1999 reflects the strong commitment of this Government to addressing the genuine needs that exist. In 1999, non-capital expenditure on health will be £3.4 billion, an increase of approximately 10 per cent on the 1998 outturn level when hepatitis C compensation payments are excluded. This follows on a similar increase of 7 per cent in 1998 over 1997.
When considered in the context of overall Government spending policy, these significant increases represent a major statement of priority on our part. In working with health boards and hospitals to maximise the impact of this investment on the health and social status of the population, it is my intention to continue to develop services and to seek improvements wherever possible in the delivery of care.