Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health when the review of bed capacity in the hospital sector will take place; if the review will be independent of the HSE; if those persons conducting the review will be asked to examine Ireland’s public bed capacity in the context of both the position in other OECD countries and the bed-occupancy levels that obtain in those countries; and if he will make a statement on the matter. [38165/16]

Billy Kelleher (Cork North Central, Fianna Fail)
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I have raised this issue previously, particularly in respect of ensuring that the review will be independent and at one remove from the HSE in order that there can be no accusations of agendas being set, of demands on the State for extra bed capacity or that the HSE would try to cover up failings in the system in terms of the planning problems it may have encountered regarding demands for bed capacity in the coming years.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Kelleher for tabling this important question on a matter which he has raised on a number of occasions. A Programme for a Partnership Government commits to the undertaking of a national hospital bed capacity review "to establish the number, type and location of beds required into the future recognising the need for a range of beds including critical care, palliative and day case bed stock", with the intention that this would form part of the preparations for the Government's review of the capital plan 2016-2021.This is important work that will enable the determination of future capacity requirements, provide a basis for planning our health and social care services and assist in informing investment decisions over the coming period.

While A Programme for a Partnership Government explicitly commits to a review of hospital bed capacity, I believe this also presents us with an opportunity to consider capacity requirements across the health service generally. We have talked in the House in the past about the shift to primary care and social care, and we have to look at all of the beds within all of the health service. While I appreciate that there are immediate strains within the acute hospital system, I am also conscious that our growing and ageing population is going to drive demand for health and social care services more broadly. The overall population increased by 6.8% over the period 2007 to 2016, while the numbers over the age of 65 increased by nearly 33%. This demographic pattern will continue in the coming years.

A comprehensive review that will assess current capacity and future capacity requirements across primary, social and acute care services will allow us to properly examine and determine how the system, as a whole, can respond to these challenges. My Department has commenced work on an overall model of care which will inform the assessment of future capacity requirements across the different parts of the health sector. This model of care will be informed by international best practice and the work underway has included engagement with experts from the European Observatory on Health Systems and Policies in this regard.

My intention is that the capacity review will be undertaken by my Department rather than the HSE, with suitable external expert inputs as required. Initial work on scoping the project is already under way. I envisage that the review will commence very early in the new year and will be advanced sufficiently to enable it to contribute to next year’s mid-term review of the current capital plan.

Billy Kelleher (Cork North Central, Fianna Fail)
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We heard evidence from Mr. Tony O'Brien at yesterday's meeting of the Committee on the Future of Healthcare on the future needs of health care provision and the investment requirements. It is quite alarming, taking into account the demographics and the changing nature of how we will provide medical care in the years ahead, that our capacity system could just fall over. It is important that we get it right and that we base it on what we believe will be the challenges and demands on the health service in the years ahead. More importantly, however, we need to take into account that we will need more community care and primary care investment to help ensure the acute hospital system is functioning in the way that is intended, namely, with a focus on acute care.

Overall, for this review to be done right, it has to be at one remove from those who will be making the decisions on funding. My concern is that they would perhaps talk down the demand that will have to be met in order that it would not look like they were raising the bar too high and that the funding would not be put in place as a result. There might then be accusations from this side of the House that this had been done for other reasons. We want the review to be impartial and to have integrity. This will be the bedrock on the capital investment side of health care in the acute hospital system for the next number of years but also in the community care and primary care systems.

Simon Harris (Wicklow, Fine Gael)
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I agree with the Deputy about the importance of ensuring that expertise is brought in and that this review will be independent and impartial. While my Department will obviously be scoping the review, we will bring on board external support. It is not in anyone's interest for this not to be absolutely factual because we all need to get serious about the bed needs for our health service right across the spectrum.

In order to ensure that the review is as effective as possible, my Department has been undertaking preliminary work to define both its scope and the broad parameters for assessing capacity. This includes a review of similar types of exercises undertaken internationally. We have already started a number of strands of work defining the scope of the review, the parameters in assessing capacity, benchmarking Ireland against international comparators, the impact of population growth and the ageing population, for which the census 2016 data will be available in March of next year, and the likely changes required in our model of care to most effectively meet future health care requirements. The Department is considering various approaches for undertaking the review. This includes governance and oversight in respect of the role of the HSE and the requirement for external expertise. I will keep the House informed.

Billy Kelleher (Cork North Central, Fianna Fail)
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In view of the fact the Minister has given a commitment that it will be benchmarked against best international practice and that there will be comparisons with standards in other countries, we need to take into account where we believe health care will be going in the years ahead in terms of primary care, community care and feeding into the acute hospital system, as well as, for example, the important area of palliative care. The review needs to be robust and to have integrity.

The point I am making is that people sometimes express a view that the policymakers setting the policy are also the ones who are obligated to fund it, which means there can at times be conflicts of interest. If one sets the policy and then fails to fund it, there might be an incentive to reduce the ambitions in the policy area.

Simon Harris (Wicklow, Fine Gael)
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As of July of this year there were 12,733 beds in the health service, 10,579 of them being inpatient beds and 2,154 day beds. There has been a range of reviews, with the most recent bed capacity review carried out by PA Consulting in 2007. It was commissioned by the HSE at the time to carry out an independent review of the acute bed capacity requirements for Ireland until 2020. Interestingly, it said that if we continued with the current model, we would need to increase the bed stock to 19,822, an increase of 70% at the time. It also said that if we shifted care from hospitals to the community, the projected number of acute hospital beds could fall to 8,834, a fall of 25%. Those are not my views or statistics but those of an independent external company. I agree with the Deputy’s point about needing to consider the full spectrum because the more we can do outside the acute setting, the better the impact on the numbers. We need to get this right.