Róisín Shortall
Ceist:2 Ms Shortall asked the Minister for Health and Children the immediate steps, if any, he is taking to tackle the hospital bed crisis. [10386/98]
Ceisteanna — Questions. Priority Questions. - Hospital Accommodation.
According to the latest provisional information available, the total in-patient bed stock in 1997 was 11,861 beds. This is based on the average number of in-patient beds available for use over the full year, taking into account beds temporarily opened or closed. I am satisfied that this is adequate to meet national acute hospital needs.
In this context, I emphasise that in looking at acute hospital service delivery it is appropriate to consider overall levels of service rather than focus solely on bed numbers. This is reflective of major changes in medical practice which have resulted in shorter average in-patient lengths of stay, a marked shift from in-patient to day case surgery and increased treatment at outpatient level.
In developing service plans, the implementation of an appropriate mix between in-patient, day case and out patient care would be a major consideration for local management in seeking to maximise overall activity. The conclusions of a recent OECD comparative study which reviewed health expenditure here provide an instructive assessment of the impact of this approach on the delivery of acute hospital care in Ireland. This 1997 report found that there have been significant improvements in hospital productivity over the past 15 years, pointing to the fact that the average in-patient length of stay has been reduced by 29 per cent and that better management of resources has allowed the average bed occupancy rate to rise to nearly 85 per cent, one of the highest in the OECD area. The report also points out that the level of day care treatment has almost quadrupled here since 1986.
The report found that as a result of this combination of factors, the total number of cases treated annually in the acute hospital sector in Ireland has been rising by 3 per cent each year since 1987. In view of the fact that this increase is set against a background of a reduction in bed numbers in the late 1980s, the relevance of focusing on overall activity rather than availability of bed numbers as a measure of the hospital system's output becomes evident.
While the OECD report makes it clear that the acute hospital sector is managing well, my policy is to ensure that the productivity of the hospital system is optimised, that the hospital system continues to respond efficiently, effectively and equitably to the needs of the population and that it is resourced appropriately to provide high quality hospital services, in meeting those objectives. Towards this end, in the current year, I have made a total additional investment of £44 million in acute hospital services 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 for access to in-patient services.
I am committed to addressing unacceptably lengthy waiting times for certain procedures in acute hospitals. As part of a continuing strategy to reduce waiting lists and waiting times, I recently announced a review of the waiting list initiative. The review will be completed by the end of June so that its recommendations can be taken into account in the Estimates process for 1999 and subsequent years. It is my intention to sustain and enhance this process of investment in the acute hospital sector and, through my Department, to work with management in hospitals and health boards in continuing to seek improvements in the delivery of services.
The question related to the immediate steps the Minister might be taking to deal with the current crisis. Reading between the lines in his reply, it seems that currently he is not taking any action. Is the Minister aware there is considerable concern, particularly in the Dublin area, that significant numbers of quite ill people are being sent home from accident and emergency departments simply because there are insufficient hospital beds available?
Another area of concern to most people working in the health services and also to the general public is the fact that up to 25 per cent of operations are being cancelled in some of our major hospitals because there are insufficient hospital beds available. What information is the Minister getting from his officials because most people working in the hospitals and the health boards are aware of the underlying cause of this problem, namely, the significant numbers of bed blockages? It is estimated that in the Eastern Health Board——
Will the Deputy ask a supplementary question?
I am simply asking the Minister if he is aware of this problem because most other people seem to be aware of it. In the Eastern Health Board region alone approximately 300 people are inappropriately placed in acute hospitals, in other words, people who need nursing home care or other step-down facilities. If nursing home places were provided for those people it would free up beds and there would not be any need to cancel operations. It would then be possible to keep sick people in hospital when they present themselves at emergency departments.
Is the Minister aware of the figure of 300? I have requested the countrywide figure but, not surprisingly, the Department does not seem to have it. Given that the figure for the Eastern Health Board region is estimated to be in excess of 300, we can assume it is probably close to 1,000 countrywide. Is the Minister aware of that and what steps is he taking to provide appropriate services to those people currently blocking beds in acute hospitals?
I take the Deputy's point. The whole purpose of the review of the waiting list initiative is to see if we can provide dedicated money and beds to deal with the problem of waiting lists and to determine the reason we are not making the desired impact on waiting lists. My predecessor provided £8 million to the waiting list initiative which was not allocated to the health boards until almost the fourth quarter of that financial year. I increased the allocation for the waiting list initiative by 50 per cent, raising it to £12 million, and I gave that money to the health boards from the start of the financial year in January. Obviously we will have to wait and see what the impact of that will be. It should suggest a greater ability to plan and to deal with the bed blockage issue. There seems to have been an ad hoc approach adopted in terms of allocating money for waiting list initiatives halfway through the year. There may have been many opportunities to deal with the problem of waiting lists more effectively had the money been made available to the health boards and the hospitals in time. I am currently seeking to address that issue by having a review of the waiting list initiative to determine the reason for this.
There is much anecdotal evidence in terms of the various problems but they need to be addressed. That is the reason I have brought together a group of people, who have hands-on experience in this area, to come up with some answers. In terms of providing resources to hospitals in the future, the review will be completed by the end of June and that will enable me to make the arguments in respect of the Estimates for l999.
The Deputy seems to suggest that increasing bed numbers alone will solve the waiting list problem. That is not the case because if one examines how the health service has developed over the past ten years one can see that there has been an increase in productivity in our hospitals. When that was subjected to an OECD test it came out in a favourable light.
It is fair to say the hospital system is under pressure at any given time. We cannot plan for the peaks in every circumstance. We must plan across the board and try to provide a basic level of service. I agree waiting times for certain procedures are too long. We must get the information system in place to find out how we can resolve that problem rather than approaching it in a haphazard way which will not result in waiting lists being reduced.
The designated waiting list initiative was introduced by the former Minister, Deputy Howlin. Since that time, 70,000 people have come through the system. Rather than criticise this initiative we should realise it is being masked by the figures which show that more than 30,000 people are on the waiting list. As a result of this initiative, 70,000 procedures have taken place which may not have been carried out if money had not been designated for those specific items.
In every advanced health care system, activity levels have to be commensurate with budgets. While budgets in this year have increased by 12 per cent in gross terms compared to an overall Government policy to increase public expenditure by 4 per cent, clearly issues remain to be resolved. We must determine, in a planned way, how we can improve the efficiency of the waiting list initiative. Perhaps the review, rather than being anecdotal, will provide answers to that question.
Will the Minister accept there has been little or no forward planning to deal with the increasing age profile of our population? The Minister referred to allocating money to the waiting list initiative. The nature of the problem has been recognised by people working in the field, that is, the bed blockages. For example, a new 50 bed unit has just been completed in the Glasnevin area of my constituency. That unit was built with health board money, yet the Minister has not given a commitment to equip or staff it. That unit could have a major impact on hospital services in the north side of Dublin city, particularly Beaumont Hospital. Progress could be made on the waiting lists and in treating very ill people in casualty departments but the Minister does not seem to accept that is the way forward.
It is all very well setting up a review group but a serious crisis arose during the winter months and we are likely to face an even worse crisis next winter. Obtaining the report of a review group during the summer, which will be examined but probably put on the long finger, will not help matters next year. The Minister has an opportunity to address this problem by putting in place measures which will prevent us facing another crisis next winter. The health boards are ready to proceed with plans for nursing home units if the Minister will give the commitment to fund them. That can happen quickly. If 1,000 acute beds——
The Deputy is making a long statement as distinct from asking a question.
As Chairman of the Eastern Health Board, the Deputy will be aware — I made this clear during my meetings with representatives of the health board in December — that I am committed to trying to increase capital expenditure, for the reasons outlined by the Deputy, on the basis that we must control the current position. It is up to the health board to ensure it plans properly so that when the capital projects come on stream, the funding is made available. That involves prioritising and decision making at health board level.
People have claimed that we need to devolve functions and powers. We are doing that. As the Deputy is aware, under the new financial mechanisms, which admittedly are inflexible but clear, I gave the allocations to the health boards from 1 January and it is their job to prioritise. All the health boards claim that care for the elderly is a major issue for them so I told them they should prioritise care for the elderly in their budgets. That is the responsibility of the health boards. As Minister, I have obtained a greater amount of money from the Minister for Finance than any other Minister. One would expect so, as it is the largest Department of State and given the high priority the Government attaches to health expenditure. I have given the allocations to the health boards and they must make the decisions.
It is not on to pass the buck like that.
I am not passing the buck. The Deputy, having been supportive of the previous Administration, regards their commitment to the elderly as being what one could expect in terms of the finite resources available to any Minister for Health. I assure the Deputy that my spending on care for the elderly will reflect an increase of over 50 per cent in the capital budget over what was provided by the last Administration. Furthermore, I was successful in negotiating with the Minister for Finance a section of the Finance Bill which provides for tax relief for building more nursing homes to try to deal specifically with the issue being raised by the Deputy. In terms of taxation policy and overall health expenditure policy——
The real problem is in the GMS sector.
Even taking into account the GMS sector, in terms of health board expenditure, I assure the Deputy that the capital budgets for care for the elderly, which rated only £6 million or £7 million per annum under the Fine Gael-Labour-Democratic Left Government will be increased substantially under the Minister of State, Deputy Moffatt, who has made clear our priorities in regard to the elderly. I agree that perhaps we do not take sufficient account in our planning of the demographic profile of our population. That argument will always go on between successive Ministers for Health and Ministers for Finance of whatever political colour, because there are conflicting objectives between a high spending Minister and a Minister who is trying to run an economic and social policy with sustainable levels of expenditure which are consistent with the overall economic policy. On all objective criteria, while the Deputy highlights problems which she accepts are not of recent origin, the performance of this Government in terms of capital and current expenditure on those areas she regards as important in eliminating bed blockages will be improved upon by this Administration compared to any previous one. I have given that commitment.
Will the Minister give a commitment to tackle the problem this year to avoid a crisis next winter?
That is part of the problem. Rather than being anecdotal, we must consider the matter, and that is what the review of the waiting list issue is about. Regardless of its outcome, the Deputy suggested it would be put on the long finger. It will not. The whole purpose of the review is to arm me with arguments to deal with the Department of Finance when it comes to the Estimates. I have been far more successful in getting increased expenditure than any of my predecessors. That might sound self-serving, but is an objective criteria of fact.
On the question of care for the elderly, I agree with the Deputy. Every health board I met last December suggested that this was an area requiring attention. I told the health boards — as a chairperson of a health board the Deputy can validate this — that if it was a priority of the health boards they should make it a priority in their spending, and if that involved trimming expenditure somewhere else, let them be transparent and say their priority is care of the elderly. We cannot have it every way.
Where does the Minister suggest cutting expenditure? In child care services?
The Department of Health must deal with infinite expectations on a finite budget. I have made it clear to the health boards that their allocation has been significantly increased. Life is not made any easier for them because there will always be gaps in service. They have to prioritise. We have agreed on an all-party basis, in terms of passing legislation in the Dáil and Seanad, that the health boards will be the arbiters of that prioritisation. That is a function of health boards. It is not passing the buck. It is simply setting out the legislative framework for health expenditure.
That concludes the time allocated for Priority Questions. We cannot, therefore, take Question No. 3. I warned the House of the danger of this happening. We have to proceed now, under Standing Orders, to Question No. 4.
I apologise to Deputy Neville, because he has a genuine concern in this area.