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Dept warns of more bed closures
[Posted: Mon 04/04/2011 by Niall Hunter, Editor www.irishhealth.com]
The Department of Health has warned new Health Minister James Reilly that more bed closures are likely this year and hundreds of existing closed beds may never reopen.
According to a Departmental briefing paper for the new Minister, there are currently 886 inpatient beds and nine day beds closed in acute hospitals. This would be in addition to hundreds of beds not available for new admissions as a result of 'delayed discharges'.
The Department said the overriding requirement this year for hospitals to manage within budget could result in additional bed closures during 2011.
It said this could result in longer waiting times and cancellation of elective (non-emergency) admissions if planned efficiencies in how hospitals are run are not delivered on.
The document states that significant changes in working practices and procedures in hositals will be needed to achieve continued improvements in efficiency.
The Department says the need for hospitals to live within budgets may lead to the implementation of 'relatively crude' measures in the short-term, such as further bed closures, before the necessary service improvements are brought to fruition.
The HSE has not published bed closure figures for a number of months. It says it is auditing bed numbers and closures at present.
The Irish Nurses and Midwives Organisation (INMO) has claimed that as many as 1,700 beds are closed.
The briefing document states that at any one time there are usually several hundred beds declared as closed, and in recent years the number has not fallen below 400-500.
"It is doubtful that many of these beds will be brought back into commission in the foreseeable future because of the financial implications, particularly in respect of costs such as nursing, pharmacy, catering and cleaning, as well as theatre and diagnostic costs where these arise."
The document states that there are currently 11,600 inpatient and 1,800 day beds in the hospital system.
It says bed numbers 'are not a meaningful currency' for measurement of hospital system performance.
"Beds represent an input rather than an output. The real issue is the number of patients treated rather than the number of beds at a given time."
The document says efficiencies are needed in areas such as average length of stay and in terms of admitting patients on the same day as their procedures are due to take place.
The Department says St James's in Dublin does this in 65% of cases but St Vincent's and Tallaght do this in only 17% and 15% of cases respectively.
The document says the focus should be on treating more/the same number of patients in the same/ fewer beds through measures such as shifting patients to lower levels of complexity (day surgery/community services etc).
Meanwhile, the Irish Hospital Consultants Association (IHCA) has said the HSE must now come up with an alternative plan to provide additional hospital beds, now that the hospital co-location project has been abandoned.
The HSE last week decided not to give any further extensions to consortia planning a number of co-located hospital projects to put funding arrangements in place.
The new Government had already indicated that it would abandon the co-location project, which was intended to free up around 1,000 beds in public hospitals by decanting private beds to co-located sites.
IHCA Secretary General Martin Varley said it is now essential for the HSE to come up with an alternative plan to ensure that a sufficient number of acute beds are available to provide care for patients.
Mr Varley said that in 2007, the HSE promised that co-location would result in 1,000 extra beds in the public system.
"Not only have these extra beds not been delivered but in recent years the number of public hospital acute beds has been cut by around one-sixth, reducing the capacity of public hospitals to provide care for patients at a time of increasing demand."
Mr Varley said the use of trolleys in our public hospitals is a direct consequence of insufficient acute bed numbers.
He pointed out that new HSE figures showed the average waiting time for patients on ED trolleys seeking admission was 11 hours.
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