Supplying beds immediately is a tall financial order

One thing ministers for health can count on is that each year they can announce that the Government plans record spending on the health service. This year the pleasure belonged to Mr Micheal Martin, who announced a 17 per cent increase of £718 million (€912 million) in projected health spending for 2001.

This will bring health spending to more than £5 billion for the first time.

It is tempting to say this illustrates the horrendous cost of keeping an increasingly unsatisfactory health system going. In fact, our spending on health is low by European standards - and that extra money is being used to bring some aspects of the service up to a reasonable standard.

Pay and conditions will account for the bulk of the £4,730 million in revenue provided for the service for next year. Within that are improvements for non-consultant hospital doctors, home helps, nurses and paramedics.

Politically, the problem is that the effect of this spending is not readily noticed by the public.

For instance, the extra £80 million to be spent on working conditions and training for NCHDs is a vital investment for the future. We are facing intense competition from Britain's National Health Service for doctors.

If we are to stand a chance we must be able to provide a level of training and conditions which can compare favourably with that provided in Britain. Moreover, the Medical Council is putting pressure on hospitals to meet training standards and not simply to regard NCHDs as a source of labour.

But the patient lying on a trolley will not be too happy at the Government spending an extra £80 million on training for NCHDs or an extra £12 million to implement the core recommendations of the Commission on Nursing.

The patient wants a bed and wants it now. Financially, that's a tall order.

Figures supplied recently by the Minister to Fine Gael TDs Mr Michael Noonan and Mr Richard Bruton illustrate how expensive it will be to get the health service we want.

The cost of keeping and treating a patient in a bed in Beaumont Hospital, Dublin is £273 a day or nearly £100,000 a year. The cost of that same patient in Sligo General would be £210 a day.

To add a ward bed to a major public hospital also carries a capital cost of around £100,000.

To add a consultant costs £800,000 a year when you factor in support staff, drugs and medicines and other support services.

The Irish Hospital Consultants' Association (IHCA) argues the cost is closer to £400,000 a year because in many cases the support services already exist.

Either way, the cost is high, especially when you consider that the IHCA believes we need about 1,000 extra consultants in the service.

Already, the Medical Manpower Forum - set up by the former minister for health and children, Mr Cowen - has recommended a substantial, unspecified increase in consultant numbers. Consequently, we can expect spending on health to remain exceptionally high for some years to come.

Nursing unions, doctors and others speak of the need for "step-down" units to free up beds in the acute hospitals. These would mainly be units run by nurses without medical staff. It sounds great until it's your mother or father "marooned" in a step-down unit. Even this does not come without a cost. To build a step-down unit costs about £150,000 a bed. Thereafter, the cost of maintaining a patient varies from £30 to £91 a day, according to their level of dependency.

That's far cheaper than a bed in an acute hospital - but the cost of adding, say 1,000 stepdown beds to the system would be in the region of £150 million. And, of course, the acute beds vacated by the people going into step-down beds will also become more expensive, because people with acute illnesses will be accommodated in them.

There are no cheap or quick solutions to the crisis, whatever about the gesture politics we can expect from all parties as an election nears.