15% of hospital beds to go

  • Niall Hunter, Editor

The HSE plans to have removed around 15% of the total number of public beds from the hospital system by the end of this year, it has been confirmed.

It has emerged that the HSE is doing the opposite of what its 2008 bed capacity review recommended, by cutting beds well in excess of the number by which the review said beds should actually be increased.

In addition to around 750 planned bed cuts from the system to date, the HSE, as part of its 2010 service plan, intends to close a further 1,100 beds this year, to reduce hospital admissions through A&Es by around 33,000 and to reduce in-patient hospital attendances by 54,000.

The HSE wants the beds to be replaced by the provision of alternatives to hospital care, many of which do not yet appear to be in place.

The 1,100 bed number reduction this year alone, coincidentally, is roughly the same figure for additional bed numbers the HSE was told were needed to cope with pressures in the system in 2008. This was one of the recommendations of the bed capacity report produced for the HSE.

In 2008, the report said that based on current practices in hospitals, which presumably still largely exist, a further 1,118 hospital beds were required.

Now, two years later, and with similar if not greater pressures in hospitals, the HSE is in the process of planning for a hospital system with nearly 2,000 fewer inpatient beds in it by the end of this year.

Health Minister Mary Harney appears to be playing down this huge cull of hospital beds.

Discussing the HSE's service plan in the Dail recently, she denied that the plan contained any proposal to close "X or Y number of beds".

However, HSE CEO Prof Brendan Drumm had stated just after the publication of the HSE's 2010 service plan earlier this month that 1,100 beds would be closed this year as part of the plan.

The HSE has since confirmed to irishhealth.com that these are in addition to the beds that have already been closed on a planned basis within the system.

According to the  the HSE's latest published statistics, not counting seasonal bed closures, there were 1,034 beds closed at the end of December - 743 of these were "planned" closures, which remain in place, and there were 381 seasonal closures, many of which would not now be in place.

The HSE has now confirmed that there would be a further 1,100 planned closures this year.

This means that in terms of planned closures, if the further 1,100 beds are closed on top of the existing 743, 1,843, or 15% of the total public bed stock, reckoned to be just under 12,000, will have been removed by the end of the year.

The number of unavailable beds increases further if "delayed discharge" patients are counted. There were  around 740 of these patients in hospital beds awaiting alternative accommodation at the end of December, according to the latest statistics.

The HSE is pinning its hopes on the new Fair Deal nursing home funding scheme helping to provide this accommodation and reduce delayed discharges in the system this year.

A HSE spokesman told irishhealth.com it is hoped that some of the planned bed closures will be offset by beds currently occupied by delayed discharged patients being freed up as the Fair Deal scheme kicks in and provides additional long-stay accommodation outside hospitals.

Ss yet, there are no estimates on how many of these beds will be freed up in this way.

However, if the delayed discharge numbers continue at the current level, in addition to the planned closures, over one-fifth of the total public hospital bed stock may not be available by the end of this year.

The spokesman said some of the inpatient beds earmarked for closure will be converted from inpatient to five-day and day beds.

The HSE spokesman said a clearer picture of how the HSE's bed plans were progressing would emerge by mid-year.

Alarm bells are beginning to sound over exactly what services will be put in place to replace over 1,800 beds that will have been actively closed down by the end of the year.

Under the HSE's 2010 plans, as an alternative to inpatient care, more alternatives to hospital treatment are to be provided including day care, more chronic disease management in primary care, and through quicker direct access to x-rays and other diagnostic testing services.

However, details on how these alternatives to inpatient hospital care are to be put in place this year have been to date fairly vague or non-existent. It is difficult to see how the planned expansion of primary care and changes to chronic disease management will be sufficient to compensate for 1,100 fewer beds in the system this year.

And there is already considerable pressure on day care - there has been a 15% increase in day case waiting lists in hospitals over the past year, although presumably some of the closed inpatient beds may be converted to day beds.

The HSE spokesman said every hospital in the country was being asked to develop a plan on how it will deliver alternative types of care with fewer inpatient beds. As yet there are no figures for how many beds will be closed in each hospital.

The HSE has said up to 30% of patients admitted through emergency departments only stay in hospital for two days, often just for an x-ray or consultant opinion.

The vast majority of these patients do not need to be be in hospital, according to the HSE.

Many are now wondering exactly where these patients are now supposed to go.

The Irish Medical Organisation (IMO) has expressed concern at the HSE's plan to close more than 1,000 additional beds this year. IMO Vice-President Prof Sean Tierney said the closure was a major cause for concern.

He said we cannot compensate for the proposed loss of 1,000 bed equivalents out of our public hospital system by the rolling out of primary care centres and through planned chronic disease management strategies.

"It is not just the IMO that is saying this. Independent reports commissioned by the Government have told us this," Prof Tierney said.

"We have all welcomed the plans to deliver care to patients in their own homes and in the community. Indeed, most of the plans to do this have come from doctors and health professionals working in the front line and there is much more that can be done."

Prof Tierney said while the move away from unnecessary hospital care to primary care was welcome, the introduction of primary care centres and integrated pathways for those with chronic diseases tomorrow will not eliminate the need for acute hospitals today.

He pointed out that there are still problems with trolley waits for admission to emergency departments.

"While the Minister for Health has said there are no problems in coping with emergency admissions, this is not the experience of our members working in acute hospitals and emergency departments around the country."

A recent report from the Comptroller and Auditor General highlighted continuing problems with A&E capacity and long trolley waits and while it has recommended a number of reforms in the way A&Es and hospitals are run, it also says some additional bed capacity may be necessary to deal with the A&E problem.

According to Donal Duffy of the Irish Hospital Consultants Association, up to 900 beds may already be closed for various reasons, mostly due to planned cutbacks.

He said many of the beds closed were literally being left empty and idle.

Mr Duffy said even before any further planned bed closures were taken into account, there are already considerable pressures on hospital beds, especially when the large numbers of delayed discharges are accounted for.

Fine Gael health spokesperson Dr James Reilly, says the HSE should scrap its plan to cut admissions and beds, especially in view of persistent hospital emergency department overcrowding.

He has called on Health Minister Mary Harney to reject plans for the HSE to close around 1,000 beds this year and to stop the "mythical mathematics and madcap plans" including reducing emergency department admissions by 33,000 and inpatient procedures by 54,000, while somehow replacing this with 10,000 day case admissions.

The 2008 bed capacity report prepared for the HSE banked quite a lot on the promised co-located private hospitals freeing up 1,000 additional public beds.

However, nearly five years after the co-location plan was announced, building work has yet to begin on any of the co-located hospitals and their future is still uncertain as the recession continues.

One prediction made in the 2008 bed capacity report is worth repeating, as the HSE tries to implement its 2010 service plan.

The report said if the healthcare system was changed to one more reliant on community care, long term care and more efficient hospital care, the need for hospital beds would be reduced to just under 9,000 by 2020.

The Department of Health and HSE appears to be reaching this downward beds target 10 years early. However, the adequacy of the level of community and long-term care alternatives to hospital care is being questioned by many.

Some would feel the level of alternative "care pathways" in place to compensate for major bed cuts exists only in virtual reality.

Which is all very well, provided you are only virtually ill.

It is certainly going to be a challenging year, as the HSE puts it in its service plan.


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