Dáil Éireann díospóireacht -
Wednesday, 6 May 1998

Vol. 490 No. 5

Adjournment Debate. - Hospital Accommodation.

Ms Clune

I thank the Minister of State for attending. I raise this issue in the light of numerous media reports concerning a shortage of hospital beds in Cork city. One accident and emergency unit was closed in recent weeks in one of the main city hospitals and patients had to be sent to alternative accommodation.

There seems to be a critical shortage of hospital beds in the Cork city area, which has led to growing concerns that health services are failing the people of Cork. Why, when we read in newspapers that Ireland has the fastest growing economy in Europe, do we also read frightening stories about the main accident and emergency unit in Cork city being closed to further admissions because it is full to capacity?

The reason for this, seemingly, is because not enough beds are available in the hospital to accommodate casualty admissions. Patients recovering from heart attacks, strokes or surgery are put on trolleys in corridors, or else returned to their family doctors, because of a critical shortage of hospital beds. Extremely ill people — general medical cases or cardiac patients — have been known to lie for hours in casualty or wait for days before a bed can be found.

In recent weeks the problem has reached crisis level. Is the Minister for Health and Children aware of this and, if so, what is he doing to address this serious problem? Does he recognise the additional stress and trauma this places both on patients and their families at an already stressful time?

When people become ill suddenly they need to be reassured that the State will provide adequate services for them. They should not be treated in a dismissive fashion and told they must find another hospital because there is no room.

Family doctors are also coming under extreme pressure in this situation in trying to find beds for their patients. These doctors are frustrated and angry with the situation as they find it. They have to reassure patients and their families while at the same time trying to gain admission to hospital for their patients. They must spend hours on the 'phone locating beds for their patients. In many cases they must choose between keeping patients at home under their care or having them face the discomfort of a hospital trolley.

This situation is unsatisfactory and it is placing much pressure on family doctors to take decisions they may not feel qualified to make. The manager of one hospital said many beds there tend to be taken up by elderly people awaiting discharge to geriatric units or nursing homes. The VHI's announcement that it intends to cut benefits for care in homes will only contribute to this situation.

I would like the Minister of State to address the seriousness of the situation that seems to have been compounded in Cork in recent weeks. He should also address the stress and trauma this is placing on patients who are already in a stressful situation.

Minister of State at the Department of Health and Children (Mr. Fahey)

I thank the Deputy for raising this issue and providing an opportunity to discuss the major developments in acute hospitals in Cork.

Based on the average number of in-patient beds available for use in 1997, the total bed stock in Cork city hospitals is 1,334 beds. Of this total, the average number available in the three accident and emergency hospitals — Cork University, the Mercy and the South Infirmary-Victoria — is 925 beds. The remaining 409 in-patient beds are available in St. Finbarr's, Erinville, and St. Mary's Orthopaedic and form an integral part of the acute hospital infrastructure in Cork. I am satisfied that the present level of bed availability is adequate to meet the acute hospital needs in the Cork area.

In considering the operation of these beds it is important to understand that in looking at service delivery it is opportune to consider overall levels of service rather than focus solely on bed numbers. This reflects 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 out-patient 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 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.

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, delays resulting from sudden peaks in admissions through accident and emergency departments occur from time to time, as the Deputy has stated. The increased level of admissions through accident and emergency in recent years is an international phenomenon common to many health systems and requires effective management of resources to ensure that emergency patients get priority.

The Minister's policy in this, as in other areas, 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.

With regard to the situation in Cork, the Southern Health Board has addressed the issue of effective bed management in Cork University Hospital with plans for the appointment of a bed manager to promote more effective use of the in-patient beds, and a liaison nurse with responsibility for the placement of persons who no longer require acute care but are still in need of subacute care. In addition, a study of bed utilisation at Cork University Hospital is currently in progress and will be completed at the end of this month. These measures will further promote effective bed management. As well as ensuring effective use of existing resources, the Minister made funding available for a number of significant developments in acute hospital facilities and services. New ward facilities and laboratories at the Mercy Hospital have recently been completed and are currently being equipped, while planning for the development of improved radiotherapy facilities, a new 110 bed maternity unit and a new accident and emergency department at Cork University Hospital is ongoing. These developments represent considerable enhancement of the facilities at these hospitals and will improve services and facilities for key groups of patients, including emergency patients, expectant mothers and cancer patients.

The Minister has provided significant additional resources this year for the development of services in Cork. The developments for which additional resources have been provided in 1998 include improved staffing levels in the accident and emergency and intensive care units at Cork University Hospital, the appointment of additional consultants in the areas of cardiology, oncology and accident and emergency and additional staff associated with the new development at the Mercy Hospital.

This increased development funding for the Cork region represents a marked improvement on the additional funding provided by Fine Gael, Labour and Democratic Left when in Government during 1995, 1996 and 1997. In addition, the Minister provided capital grants totalling £1.25 million to the Southern Health Board, the Mercy Hospital and the South Infirmary-Victoria Hospital this year for the purchase of medical equipment.

This considerable investment currently being made in the development of both the physical infrastructure and services of Cork's acute hospitals will help to ensure that the hospitals in this area continue to provide a service that is on a par with the best in Ireland and demonstrates this Government's commitment to the development of hospital services in Cork. It is the Minister's 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.