Thursday, 11 November 2010
The most recent information on bed closures in the acute hospital system is for the week ending 7 November. At that point 892 inpatient beds and 19 day beds were closed for reasons of infection control, refurbishment or cost containment. This is from a complement of approximately 11,800 inpatient beds and 1,800 day beds in the public hospital system.
Access to appropriate care for patients is not about the number of beds in the hospital but about providing quality care and improving outcomes for patients. Previously many procedures such as varicose vein surgery and hernia procedures required patients to stay in hospital. These can now be provided, in the main, on a day-case basis. This is better for patients and a more efficient use of resources. The average cost of an inpatient bed is €889 per day or €324,485 per year.
There is a significant variation between hospitals on the length of stay of patients in hospital for similar procedures. Reducing the length of stay in hospitals whcih have above average lengths of stay will be good for patients, as well as being more cost-effective. Hospitals are also working to reduce admissions by, for example, identifying patients who may only need diagnostics and should not require an inpatient stay in hospital.
In 2009 the combined number of inpatient and day case discharges was 3% greater than in 2008. The HSE's national plan for 2010 maintains the focus on increased efficiency and is committed to delivering broadly the same level of overall hospital activity as in 2009. It is important that the clear focus of the health service is on the number of patients we treat, not on the number of beds. Increasingly our focus is on measuring patient outcomes. This will continue to be the focus in the coming years.
To a great extent, I agree with the philosophy that it is better for patients to spend as little time in hospital as possible. However, last night there were 31 patients on trolleys in Cork University Hospital. Regardless of how good we become or how speedy the procedure is, we will still need beds in hospitals for those who still need to be in hospital. We cannot continue to cut back on the numbers of beds.
If we continue in this vein, what point will we need to reach before the closing of beds will stop? Do we have 30,000 beds in the system? Can the Minister provide a figure? Clearly, we do not have sufficient beds to meet the needs of patients.
Over the past several years we have increasingly relied on day case activity rather than inpatient accommodation as a way of providing treatment. Last year, the HSE devised a basket of 24 procedures with the British Association of Day Surgery and set targets for hospitals to increase day activity on these procedures from 62% to 75%. There are huge variations in performance across the country. Tallaght hospital does best in the treatment of hernias, with 84% treated on a day case bases, whereas some hospitals have rates of as low as 37%. Mayo had 16% day rates and an average stay of three days for its 138 patients. Some hospitals are better than others at carrying out procedures on a day case basis.
I will not pretend some beds are not being closed for cost containment reasons. Next year will be even more challenging given the reductions required in public and health expenditure. The fiscal adjustment of €6 billion will have a major impact on the resources available for health services, which account for 27% of current Government spending. The quicker we move to best practice on day activity, the better. This year, the HSE committed in its service plan to carrying out 10,000 diagnostic tests on an outpatient basis and to moving 33,000 people from accident and emergency departments to day case diagnostic activity. I look forward to learning the outcome of these commitments and understand the HSE is on target in delivering on them.
In regard to the variation between Tallaght and Mayo, hernias are more common among older people and I do not doubt social isolation, age, lack of carers and remoteness play a large part in explaining why patients cannot be treated on a day case basis.
Will the Minister acknowledge that the number of beds in the system has decreased from 18,000 20 years ago to fewer than 11,000 today despite a population increase of 750,000 during the same period? There have been repeated calls from this side of the House to provide rehabilitation facilities so that people can move to the next phase of treatment after leaving hospital. Last night in Beaumont hospital, 47 patients were lying on trolleys. Another hospital in Dublin had 175 people in what it called delayed discharge situations for up to nine months. The CEO of this hospital advised me that 30 of the patients could avail of rehabilitation services but that the remaining 140 would need long-term care. When pressed as to whether they received appropriate care at the time of discharge, he admitted that at least 50% of them could have gone home with the support of rehabilitation. Not only are we costing the taxpayer money, but we are also doing a terrible disservice to patients. I ask the Minister why she does not provide additional rehabilitation beds for the greater Dublin area, where they are needed.
I accept what the Deputy said about the shortage of rehabilitation facilities. Acute rehabilitation could be provided in a more localised environment and an enormous amount of work has been done on requirements at both national and local levels. Fantastic rehabilitation facilities have been developed in the mid-west for stroke and other patients in order to bring them home and get them better more quickly. I accept that deficits remain to be addressed, however.
The fair deal scheme has reduced by 33% the number of delayed discharges in the Dublin area. I hope to see the scheme being expedited over the latter months of this year and early 2011. The system is up and running and over 12,000 people have availed of it because people who could be in long-term care continue to occupy hospital beds.
Can the Minister estimate the number of hospital beds that will be lost as a result of the cuts she has signalled to front line spending in the health services? In response to previous parliamentary questions she estimated these cuts at between €600 million and €1 billion. How will she explain the ongoing abuse and waste within our two tier system to patients who depend on public hospitals? Clinical directors and hospital managers have had to write to almost 300 consultants regarding blatant breaches of contractual obligations on the ratio of public to private practice. I could provide a list of issues which are causing tremendous vexation and deep anger in many quarters.
The Deputy is correct that the reductions in health spending next year will be a minimum of €600 million but, as the Government has not finalised the four year plan or the Estimates for next year, I am not in a position to confirm the exact figure. When I know the figure, I will sit down with the HSE to work out how the budgetary parameters can be implemented. I do not pretend it will be easy and it will be particularly challenging for the acute hospital system.
Consultants are obliged to meet the terms of their contracts and it is a matter for hospitals and the HSE to pursue breaches. As the Deputy will be aware, it is my ambition not to have private activity in public hospitals. The reason for the co-location model was to ensure beds currently being occupied by private patients who have alternatives can be used instead by public patients. I recognise the Deputy does not agree with that policy but in a country where half the population has private health insurance, we are going to have large numbers of private patients in public hospitals.
Is consideration being given to people who do not require hospitalisation for surgical procedures when stress tests are carried out? I have found that such people have to stay longer in hospital than other patients.
Cork University Hospital is probably at the higher end of the list of bed costs because it is that type of hospital. How many are occupying beds in the hospital who could instead be in rehabilitation and what is the position for HSE south?
Cork University Hospital is at the higher end because of the acuity and complexity of the work carried out there relative to other hospitals. I set out the average costs but they vary depending on staff levels and other factors.
We have been making advances on an agreed policy approach for the country as a whole. Heretofore the approach was to send everybody to a single national rehabilitation hospital for acute rehabilitation treatment. That is being rethought and there is more emphasis on developing a national tertiary facility and a hub and spoke pattern of outreach services in the regions.