How many hospital beds does State need to fix the overcrowding crisis?

Just how many extra hospital beds does Ireland need to sort out its overcrowding crisis?

A lot more, says Minister for Health Stephen Donnelly. At least 5,000, says a prominent member of the Irish Medical Organisation. More than 2,000 by 2028, says Sinn Féin.

Behind the numbers that tumble like confetti is the reality: hospital beds are expensive, with each costing more than €1 million a year to create and run. Every bed needs infrastructure and staff, and these take time to assemble. Simply saying a number won’t make any difference in the short term.

One-quarter of the beds funded in recent years have not been delivered. Due to this overhang, no new beds are promised in the current Health Service Executive winter plan. With multibedded wards being replaced by single rooms, not every new bed will be an additional one. For example, a 96-bed block under construction at University Hospital Limerick will create only half that number of extra beds.

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The number of hospital beds in Ireland had been falling for decades up to the time of the financial crash. In 2012, when the figure bottomed out, Ireland had 10,337 acute hospital beds; by 2021, it had exactly 1,000 more, according to the Department of Health.

Mr Donnelly says an additional 950 beds have been opened “since Covid”. According to the HSE, there were 11,892 beds last November. In 2018, a capacity review recommended an increase of 2,590 beds by 2031. In the four years since then, about 1,000 have been added, so this objective seems to be on target.

Surgery and testing

Since the start of the 21st century, countries across the world have been shedding hospital beds. Advances in testing and surgery mean many common procedures can be done more quickly than before. What once required hospital admission for a number of days can often be done in hours, so only a day bed is needed.

And yet the average length of stay in hospital has increased by 12 per cent since 2012. This may be related to an older population having more complex needs.

Ireland has 2.9 hospital beds per 1,000 inhabitants, one of the lowest rates in Europe, but the reduction in beds since 2010 has been smaller than in most countries.

A better measure of how the system is performing is the occupancy rate. In 2019, Ireland had the highest occupancy rate in the OECD, at 90 per cent, against an OECD average of 73 per cent. The accepted safe maximum occupancy level is 85 per cent.

The situation is even worse in many individual hospitals. University Hospital Galway and Sligo General Hospital had occupancy rates above 110 per cent in 2019, according to a report published by the department. (Sligo was at 118 per cent on Wednesday.)

Patient mortality

One-third of hospitals had occupancy rates above 100 per cent. These are not safe working and caring environments, with voluminous international research showing they result in higher patient mortality.

People tend not to mind queues provided they move fast. But high occupancy rates in hospitals clog up the normal patient pathway from their emergency departments, thereby creating overcrowding.

As for the prospect of quickly creating thousands of additional hospital beds, there is none. Look at the snail’s pace progress at the national children’s hospital, or the virtual non-progress of the move of the National Maternity Hospital to a new site, or the construction of promised new elective hospitals. Look at the two years the department, the HSE and consultant representatives spent talking about a much-needed new contract before ending discussions without agreement.

After more than two years in the job, Mr Donnelly realises that radical steps are needed to effect change in the health service. The process of building new facilities is taking “far, far too long”, he acknowledged on Tuesday.

“This fundamentally isn’t working for the country. It doesn’t work for patients. It doesn’t work for our healthcare professionals. We know we need to spend this money. We know we need to add these beds. We know we need to build these community facilities. We know we need these MRI machines and CT scanners.”