Billy Kelleher (Cork North Central, Fianna Fail)
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Question 33: To ask the Minister for Health and Children the number of beds in hospitals here that are currently closed; if more bed closures are likely in 2011; and if existing closed beds will be reopened [7610/11]

James Reilly (Dublin North, Fine Gael)
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There are approximately 11,600 inpatient beds and 1,800 day beds in the public hospital system. The number of beds available at any one time fluctuates, depending on planned activity levels, maintenance and refurbishment requirements and staff leave arrangements. Beds may also be closed from time to time to control expenditure, given the need for every hospital to operate within its allotted budget. I am advised that based on the existing methodology, approximately 960 acute beds are closed at present, but this cannot be regarded as a precise figure because hospitals have been using different criteria to measure bed closures. This is an issue I wish to address and I have spoken to the Secretary General and the HSE about it. The issue will be addressed because we cannot allow a situation where we cannot compare like with like. I want to examine closely the practice of closing beds to control expenditure, because this does not make economic sense. The HSE is at present reviewing the existing methodology for measuring bed closures in acute hospitals to ensure that a consistent approach is applied across the public hospital system.

It is important in any case to emphasise that hospital beds represent a service input and are not in themselves a measure of how the system is performing. By this I mean that while hospital beds are a measure, they are not a measure of the overall activity. Many of the procedures we undertook in the past which required admission and inpatient beds can now be performed without admission, through single day surgery and so on. In recent years there has been a much increased emphasis on improved efficiency in acute hospitals. In particular, the focus has been on reducing inpatient care activity levels through the provision of more appropriate service responses, delivering a shift to care on a day case basis where appropriate and on performance improvements such as surgery on the day of admission and reducing inappropriate lengths of stay. Specific targets under these heading are included in the HSE's National Service Plan 2011. Clinical directors are looking at this closely. Much of what happened in the past in terms of admitting patients the night before surgery was unnecessary.

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In this context the HSE's directorate of clinical strategy and programmes is leading a coordinated programme of work to improve service quality, cost-effectiveness and patient access and to ensure that care is provided in the setting most appropriate to individuals' needs, with due regard to patient safety considerations. I have met the clinicians leading this multidisciplinary process and strongly support their work, which I believe will enable services to be delivered in a manner that is appropriate and sustainable into the future.

Billy Kelleher (Cork North Central, Fianna Fail)
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There are approximately 13,400 beds in the public hospital system and the Minister has said that approximately 960 of these are closed at present. While this may not be an accurate measurement, we can take it that the number is between 890 and 960. Does the Minister suggest that to address the closure of hospital beds, he proposes reducing the overall number of beds and keeping the reduced number of beds open all the time? Does he intend to reduce the capacity and the number of beds in the system as opposed to having a large number and sometimes closing them when hospitals run into difficulties?

James Reilly (Dublin North, Fine Gael)
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There is no intention on my part to reduce the capacity any further. I believe we have the waiting lists we have because we do not have sufficient capacity. Before there is any reopening of beds, I want to ensure we get the maximum value from the beds we have. I have met the clinical teams and in many cases we could have many more discharges within 48 hours of admission to hospital. We could organise our situations in a very different fashion. If a surgeon arrives in the morning and can only do three out of the eight cases he or she was supposed to do, that is a management issue in failing to provide the nurse, intensive care bed or theatre staff. Those situations will be addressed and we are reviewing that with management. In fairness, there has been a problem for some time and there will be considerable change. I am very pleased that the change has started already and I am very encouraged by the appetite for change of many of the people working within the system. By the end of this year I hope to be able to give the Deputy much better news than the news we are experiencing today.

Billy Kelleher (Cork North Central, Fianna Fail)
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Does the Minister concur with most of the opinions expressed in the 2011 national service plan with regard to the increased capacity required in the hospital service and more importantly the efficiencies, including people coming in on time, being treated and then leaving as opposed to waiting for procedures over a number of days? Is the plan sufficiently detailed and to his satisfaction?

James Reilly (Dublin North, Fine Gael)
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The best way to answer that is to say we are working through the plan at the moment. As the Deputy knows, it is quite a complex plan. I hear loudly what he is saying. I only recently heard about a case of a person who was fasting for two and a half days waiting for a procedure. That is just not good enough and that sort of issue cannot be allowed arise again. That also requires a change in management attitude and more real-time information, which is a major issue throughout the health service, a matter to which I will return on one of the other questions.