Bernard Durkan (Kildare North, Fine Gael)
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Question 55: To ask the Minister for Health and Children the number of staff employed throughout the country in the delivery of health services; the number of consultants, doctors, nurses or others involved in delivery of community care, special hospital or general hospital services; the staffing levels and structures on a local, national or regional basis of the Health Service Executive; the degree to which these numbers have increased in the past six years; the extent to which the delivery of services has improved or deteriorated in the same period; the number of patients catered for in the 12 months to date and in each of the previous five years; the degree to which hospital beds have been increased in this period; and if she will make a statement on the matter. [16247/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The main source of employment data in the health services is the Health Service Executive's Health Services Personnel Census which is derived from payroll history in each agency. The census collects data on actual staffing level for each staff grade in each health agency at a given point in time. Up to and including 2002 the census was conducted annually. Since 2003 the census has been carried out quarterly at the end of March, June, September and December each year.

The data in relation to the number of staff employed by grade category including the increase in the past six years (Table 1), the number of staff employed by service pillars (Table 2), and the numbers employed on a regional basis (Table 3) are set out as follows (source — Health Service Personnel Census):

The activity levels for each of the last 5 years is as set out in the following table.

As the Deputy will be aware operational responsibility for the management and delivery of health and personal social services was assigned to the Health Service Executive under the Health Act 2004. In this regard, the Executive has advised that since its establishment it has undertaken a number of initiatives aimed at improving the provision of services to patients and clients and aimed at improving the health and social well being of people living in Ireland. These have included the enhancement and reconfiguration of services in line with national policies (e.g. Health Strategy, Primary Care Strategy, A Vision for Change) and funding of new services across all sectors. It has also undertaken many reviews that have and will continue to shape the way services are delivered into the future. For example, the national review of bed capacity showed how acute capacity needs to be re-configured in the future, the need to build a new national children's hospital was identified and re-configuration of services in the North East was identified as a priority by the HSE. The HSE has further advised that it has also tried to re-engineer how it gathers views and opinions from patients and staff through the establishment of Expert Advisory Groups.

The OECD report on the Irish Public Service — 'Towards an Integrated Public Service' notes that the health of the Irish is good and improving at an exceptionally rapid pace. Ireland is the European country which had the most spectacular increase in its life expectancy at birth since 1990: almost five years in 15 years, an average of four months a year. There are a number of other indicators which show how services have improved, for example:

The rate of heart disease as a cause of death is down 42% between 1997 and 2005.

Cancer survival is improving: five-year survival rates for breast cancer are rising at one of the highest rates in Europe.

Five times more home care for the elderly since 2004: Approximately 11,000 clients benefited from Home Care Supports in the period January 2006 — July 2007, and an additional 800 people will benefit in 2008. Almost 12 million home help hours were provided in 2007 benefiting about 53,000 people. Approximately 200,000 Home Help hours will be added this year.

In relation to the performance of the HSE in the delivery of services, I would like to outline that the HSE has commissioned a report by McKinsey consultants in this regard. I have had recent discussions with the Chairman of the Board of the HSE in relation to optimising the HSE's operational capability by addressing the following issues:

robust governance and management structures, processes and procedures;

clear reporting relationships and lines of accountability;

having permanent top level managers in key posts;

good systems of delegation; and

a strong sense of corporate identity which permeates all levels of the organisation.

The Board is currently considering these issues and will report to me on its proposals to address the situation as soon as possible.

In 2001, the year of the publication of the Health Strategy, the average number of in-patient beds and day places available in the 53 public acute hospitals was 12,145, based on returns to the Department (11,374 in-patient beds and 771 day places). The provisional number of acute hospital beds recorded by the Health Service Executive for 2006 was 13,771 (12,574 in-patient beds and 1,197 day places) based on a total bed complement. The Programme for Government includes a commitment to provide an additional 1,500 public acute hospital beds. In this context the co-location initiative which was announced in July 2005, aims to make available approximately 1000 additional acute beds for public patients through the transfer of private activity from public hospitals to co-located private hospitals. Additional acute beds, which are at various stages of planning, will be made available through the Health Service Executive's capital plan.

The provision of private care in public acute hospitals is a long standing feature of the Irish healthcare system. Over 2,500 beds in public hospitals are designated as private and semi-private. There is an 80:20 public/private ratio average across the entire acute system. The percentage of beds designated as private varies between individual hospitals; for example, there is a higher ratio of private beds in maternity and paediatric hospitals and a lower ratio in other hospitals.

The Health Service Executive recently published a Review of Acute Bed Capacity carried out by PA Consulting together with a HSE discussion document which proposes an integrated approach to health service delivery that seeks to achieve the right balance between in-patient, day case and community based care.

The Review found that with future challenges, such as our ageing population and the increase in chronic diseases, we will need to plan for a 60% increase in demand for health care by 2020. It suggests that if current practices and processes continue the demand for public hospital beds would escalate to nearly 20,000 by 2020. To meet this need we would have to provide the equivalent of twelve new 600-bed hospitals over the next thirteen years. It concludes that such reliance on acute hospitals for service delivery is neither sustainable nor in the best interests of patients.

The Review examined alternative approaches to meeting this demand. It recommends an integrated approach to health service delivery involving substantial change in the way care is provided. Among the measures proposed are significant increases in day beds in hospitals, more long-term care beds, more rehabilitation beds and more services in community-based, non-acute hospital settings.

The Review outlines a number of bed demand scenarios ranging from partial to full delivery of an integrated health service. It makes the point that other developed countries, such as Australia, Canada, Denmark and England have achieved significant results through their reform programmes. It also points out that some of our hospitals are already achieving the required efficiencies, such as shorter lengths of stay, more day surgery and admission on day of surgery. The challenge is to achieve these standards of service across the entire acute system.

Pending the implementation of such reforms, the Review estimates that 1,100 additional acute hospital beds are needed to meet current demand. The Review also advises that services in acute hospitals should not be altered until viable and appropriate community based alternatives are in place. I believe that the Review forms a basis for discussion with key stakeholders on how best to plan for the provision of public health care delivery to 2020.

My Department has requested the Parliamentary Affairs Division of the HSE to provide direct to the Deputy the number of staff involved in the delivery of community care, special hospital or general hospital services.