Tuesday, 29 May 2018
Ceisteanna - Questions - Priority Questions
Hospital Beds Data
37. To ask the Minister for Health if the Sláintecare estimate of 2,590 for new acute beds and which is provided for in the capital plan will be updated based on the ESRI's analysis suggesting that approximately 4,500 new acute beds are in fact required. [23764/18]
My question relates to the number of beds that are being budgeted for over the coming years based on the Department's capacity review which came out earlier this year. The capacity review put a lower estimate of 2,590 beds which has been reflected in the capital plan. The ESRI has figures, as do various other groups, that give a broad range of what might happen. Given that there are numerous, very reputable organisations providing us with a wide range of the number of new acute beds we may need, will the Minister take that into consideration and perhaps review the capital plan with this additional analysis in mind?
I thank Deputy Donnelly for the question. As the Deputy knows, the Government committed to undertaking a health service capacity review in A Programme for a Partnership Government, and this was published last January. This was the first thorough assessment of capacity needs across the health service for more than a decade. In the following month, 2,600 acute beds and 4,500 social care beds were provided for and fully funded in the national development plan, based on the capacity review findings. This is the first commitment to invest in significant additional bed capacity in many years and replaces a trend whereby, even before the troika were in town, we were reducing the number of acute hospital beds in this country.
The review process was robust. It was led by a high level steering group and drew on significant stakeholder engagement and available international and national evidence. Its methodology and findings were then validated by an international peer review group. The projections were based on examining current demand for services and projecting forward on the basis of demographic and other demand factors. The analysis also took account of the potential impact of health and well-being initiatives, a shift in the provision of certain care services from the acute to the community sector and productivity improvements in our hospitals. We all know that major improvements in these areas are needed and outlined in our Sláintecare report, and it is important that capacity is planned around a new model of service delivery and not the current one. I think we agree that if we just increase the bed capacity and do not reform the model of care, the beds will just fill up and we will not manage to create the health service we need to.
The ESRI report referred to, which was funded by my Department, is a valuable addition to our knowledge base for health policy. It contains projections of future demand for health services but does not contain any projections for capacity such as acute beds. The ESRI methodology also takes no account of future changes in models of care or in productivity improvements. It is not possible therefore to get from the ESRI model a figure comparable to the 2,590 in the capacity review report. The baseline projections for demand in both reports, however, are broadly aligned across the range of services examined. I should point out that the ESRI sat on the steering group for the bed capacity review that said we needed 2,590 more acute hospital beds.
I have stated before that I do not believe that capacity increases alone will bring improvements in our health services, but the national development plan investment programme must be matched with a programme of reform to deliver real change. To that end, work on a Sláintecare implementation plan is advancing in my Department and I expect to bring these proposals to Government in the coming weeks.
I thank the Minister for his response. Here is the problem. The capacity review says that we will need somewhere between 2,600 and 7,150 new beds. The ESRI analysis does not give us a bed number but it does give us a bed day number, so it is quite easy to turn that into beds. The Department's capacity review says somewhere between 2,600 and 7,150. The ESRI report broadly agrees with that. The capacity review says the following: "In practice the achievable shape of the future health system is likely to lie somewhere between the two extremes set out in this Capacity Review." That would mean 4,900 new beds if we take the midpoint. It describes the 2,600 as an extreme.
Is the Minister worried that the capital plan, which is being published by the Government and which states 2,600, is essentially taking the best possible conceivable outcome, an outcome that the capacity review itself describes as one of the extreme ranges and which has been provided for? Are we not setting ourselves up for continuing crisis if we assume we will only provide for the lowest number of beds that the PA Consulting report has come up with?
I thank Deputy Donnelly for the question. I welcome that there is now a political consensus in this House that we need more acute hospital beds. That was not the practice in the past, even during the previous economic boom where, and I do not mean this in a party political sense, there was a view, even within senior levels of health service management, that we had too many hospital beds in this country. Clearly, that myth has been dispelled.
We have fully funded the 2,600 beds, which is ultimately the recommendation. I take the Deputy's point because the bed capacity review does talk about lots of different figures, but it does recommend that this is the figure that would be used if a programme of reform were to be put in place also. When I talk to people across the health service and look at the document that the cross-party group, the Sláintecare committee, produced, it does say "Yes" to more hospital beds but it also says to move more into the community. If we put all our attention on a hospital-centric model, we will be lulled into a false sense of security in not needing to move more services into the community.
It is important to say also that we are not just talking about the 2,600 acute hospital beds. We are also talking about the elective only hospitals which will provide about 600 further beds, which creates more capacity, and about 4,500 social care beds, which provide transitional care opportunities. I agree that we need to front-load now and we need to look at the opportunities to get some of these beds in now, because whether it is 2,500 or a different figure, the health service cannot wait a significant period to get those beds. I will discuss with Government colleagues in the coming weeks and months how we can front-load some of those beds, be it by modular build or another form.
I thank the Minister. I will return to the numbers. The PA report does not recommend 2,600 beds. What it says is, given their assumptions, the lowest conceivable number of beds we would need is 2,600. It makes various technical assumptions, some of which are incorrect. The 2,600 assumes massive investment in primary care and post-acute care and 2,600 beds. The Irish Medical Organisation, IMO, estimates the figure is 7,000. The Irish Hospital Consultants Association believes that we are short more than 2,600 beds today. Between the Irish Hospital Consultants Association, the IMO, the ESRI and the Department of Health, no one is saying we need 2,600 beds. That has now been hardwired into the capital plan, so the Minister would appear to be providing for what his own report describes as an extreme in terms of the least possible number of beds we would need.
Is the Minister prepared to go back to the Department and to PA Consulting, if needed, and ask them, in light of the fact we have provided in the capital plan a certain amount of money for 2,600 beds, how much money would be needed if various reforms do not happen? The PA Consulting report, for example, assumes a one-to-one transfer between acute beds and primary beds. For every primary care bed that is put in the community, one less bed is needed in the acute system. Many experts say that is not a realistic assumption. It would be useful for us, as we move to implement Sláintecare, to say that while we have provided for 2,600 beds at a cost of several hundreds of millions or billions of euros, the midpoint is 4,900 beds and for that we would need an additional sum, €2 billion or whatever, that we have not provided for.
Would the Minister be able to come back to the House and the committee to provide that information to us?
I thank Deputy Donnelly. The Economic and Social Research Institute, ESRI, confirmed to me today that at no point did it refute the capacity review figures and it was represented on the steering group of the review. It has confirmed also that it is very clear that the projections on the two exercises were not comparable. The Deputy is not suggesting they are as the ESRI one did not factor in the model of care or productivity improvements.
The national development plan, the capital plan, is for the next ten years which brings us to 2028. The bed capacity review runs to 2031. We have fully funded the 2,500 three years ahead of schedule. There are three years at the end where it will be possible to do more. I am happy to always keep this under review. If we deliver this additional capacity it will be the largest increase in bed capacity in a hell of a long time, if not ever, in the Irish health service.
The Deputy made a point about costing the reform, if we are serious about making this shift to primary care and moving more services into the community. I will be putting costs on that as part of the Sláintecare implementation plan which I expect to bring to Government in the next few weeks.