James Reilly (Dublin North, Fine Gael)

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.

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