James Reilly (Dublin North, Fine Gael)
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Question 47: To ask the Minister for Health and Children the number of acute hospital beds closed nationally; the reason those beds are closed; the details of her plans to close an additional 1,100 hospital beds in 2010; the location of those beds; her views on the impact that will have on patient services; and if she will make a statement on the matter. [10866/10]

Mary Harney (Dublin Mid West, Independent)
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The most recent information on bed closures in the acute hospital system refers to the week ended 17 January 2010. At that time, 689 inpatient beds and 37 day beds were closed for reasons of cost-containment, infection control, refurbishment and seasonal closure of facilities.

While public debate tends to focus on bed numbers, it is much more meaningful to measure the number of patients treated. In 2009, the combined number of inpatient and day case discharges was 3% greater than the equivalent figure in 2008, despite the difficult situation in regard to resources.

The preparation of the Health Service Executive's 2010 national service plan, which I approved on 5 February, maintains the focus on increased efficiency and targets broadly the same level of overall hospital activity as in 2009. This involves a shift from inpatient to day cases, a reduction in emergency admissions and a further increase in day cases.

While there is no proposal in the service plan to close a specific number of beds, the reduction in inpatient treatments will mean that less capacity will be required in this area during 2010. The exact number of beds available at any one time will fluctuate depending on such factors as planned activity levels, maintenance and refurbishment requirements and staff leave arrangements. Beds may be also closed from time to time to control expenditure, given the need for every hospital to operate within its allocated budget for the year.

Meeting the agreed efficiency targets will require increased access to the specialist skills and senior clinical decision-making available in medical assessment units, to diagnostics and to other ambulatory care services. The HSE will also focus on minimising length of stay, with a particular focus on reducing the current variation across different hospitals for similar procedures. It will also work to increase same day of surgery admission and to protect inpatient beds for elective surgery to reduce waiting times.

By reforming the manner in which services are provided, I am confident the HSE can deliver the volumes of service provided for in the plan, while at the same time continuing to improve service quality and patient outcomes.

James Reilly (Dublin North, Fine Gael)
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Despite what Professor Drumm has to say, I fail to see how one can possibly reduce emergency admissions by 33,000. I have spoken to accident and emergency consultants the length and breadth of this country and they are not admitting any patients that are not emergencies and that in medical terms need admission. In Galway, one of the dedicated centres for cancer care, they have reached a record level of an average of 18 patients overnighting on trolleys every single night this year to the end of February. Yesterday, according to the Irish Nurses and Midwives Organisation, 368 people were lying on trolleys. We learnt of a man who died in an accident and emergency department having waited there for seven hours.

A reduction of 54,000 inpatient procedures will be compensated for by an increase of 10,000 outpatient procedures. The maths does not add up. Professor Drumm has confirmed that 1,100 more beds will be closed. How is the Minister going to achieve that? Will she give us a breakdown of where the beds will be closed and what hospitals will be affected?

Mary Harney (Dublin Mid West, Independent)
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I wish to explain something to the Deputy because it makes a difference. Many procedures can be done on a day case basis that are currently done on an inpatient basis. I will outline some data. For example, 37% of hernia repairs happen on a day case basis. It varies from Tallaght where 84% of them happen on a day case basis to Mayo where only 16% happen on a day case basis. The length of stay in Mayo is on average three days. In the case of varicose vein procedures, 56% are done on a day case basis, varying from 99% at St. Columcille's Hospital, Loughlinstown, County Dublin, to 57% at Mercy Hospital, Cork. For cataracts, the day case rate varies from 90% in the Mater, Waterford, Sligo and Letterkenny hospitals to 42% in St. Vincent's Hospital. In the case of hip replacements, it goes from seven days in Croom to 18 days in Waterford.

If all facilities could operate to the level of best practice within the country, that in itself would have enormous potential to decrease dependence on inpatient activity. Dr. Barry White has been appointed clinical affairs director of the Health Service Executive and is now appointing clinical leads, particularly in area of chronic illness, to devise and work with clinicians on care pathways. For example, as part of that process, the intention is to ring-fence surgical beds for surgeons so that they are not obliged to have patients admitted one or two days in advance in order to ensure a bed is available. These reforms will generate much increased activity in 2010.

James Reilly (Dublin North, Fine Gael)
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With all due respect, it is necessary to observe that the Minister has been in office for four years and the Health Service Executive in existence longer. The purpose of the reorganisation of the management of health services was to bring about a uniformity in the delivery of care. We can only look to the Minister herself in assessing the failure to address the issue she has just raised, namely, the lack of uniformity of approach, where particular procedures can be done on an outpatient basis in some hospitals but require inpatient admittance in others. No attempt has been made to resolve this problem.

The Minister has not answered the core question, which is a simple arithmetic question. How does one tally a reduction in inpatient procedures of 50,000 with an increase of 10,000 in outpatient procedures? Will the Minister explain how the apparent net deficit of 40,000 will be overcome and how it will not result in longer waiting times and increased pain and worry for patients?

Mary Harney (Dublin Mid West, Independent)
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The Deputy, if he is being fair, must acknowledge the substantial progress that has been made in the delivery of health services, particularly in regard to day case activity which has virtually doubled since 2000. In regard to the service plan, the main element of the change is that 33,000 fewer people will be admitted to hospital in the first place. Those people will either receive hospital-in-the-home services or be provided with diagnostic access without requiring hospital admission. As Professor Drumm has pointed out, a large proportion of those who go into hospital are there for less than 48 hours; in some cases it is less than 24 hours. It is well established that many of these people do not need to be hospitalised but are admitted in order to access diagnostics and so on. Those types of services will be provided in an alternative way.

James Reilly (Dublin North, Fine Gael)
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That is not true.

Mary Harney (Dublin Mid West, Independent)
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It has been confirmed by the bed utilisation study and so on.

James Reilly (Dublin North, Fine Gael)
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It is ludicrous to conclude that a patient admitted for 48 hours with acute cardiac failure and discharged after 48 hours did not need to be admitted in the first place.

Mary Harney (Dublin Mid West, Independent)
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I said that "many" of those admitted for less than 48 hours do not require hospitalisation.