More than 4,000 extra acute hospital beds will be needed within the next 10 years, a report published by the Department of Health and Children yesterday said. The Government's national health strategy has promised 3,000 beds by 2011.
Six thousand acute beds have been lost to the system since 1980, according to the review of acute hospital bed capacity.
Despite this loss, the number of in-patients treated has not fallen - this has been achieved by reducing the average length of stay from 9.7 days in 1980 to 6.6 days at present and by a substantial increase in day cases.
It has also meant that the occupancy of Irish acute hospital beds is too high, the report, Acute Hospital Bed Capacity, A National Review, says. At most, no more than 85 per cent of beds should usually be in use so as to be able to cope with surges in demand.
But the major Irish acute hospitals are at occupancy levels of 95 per cent or more. As a result, when extra patients have to be admitted through emergency, they have to be given beds which would otherwise go to elective (planned) cases. The lack of capacity which would enable the hospitals to react to surges in demand also accounts for the lengthy wait for admission which faces many patients in emergency departments.
The increase in day cases has been dramatic - up from 8,000 in 1980 to 320,000 in 2000. It is this which has enabled hospitals to increase their activity despite a huge loss of beds in the 1980s and early 1990s.
The demand for hospital care is likely to increase, the report says. By 2011, the proportion of the population aged 65 or more will have increased by 20 per cent to 503,900. This will mean a sharply increased usage of hospital services by the people concerned. Demand for healthcare will also rise due to increased expectations on the part of the public, technological advances, better education and other factors, the report says.
To deal with all these factors, the authors estimate that 4,335 more in-patient acute beds will be needed by 2011.This is far in advance of the 3,000 beds promised in the national health strategy.
Almost 1,500 of the required beds can be found within the existing system if a number of measures are taken. These include:
Providing convalescent and rehabilitation beds for people who no longer need acute treatment but cannot go home;
Increasing the number of day surgery cases and other forms of day treatment;
Ensuring that only 20 per cent of beds in public hospitals are used for private patients.
This last measure would save 160 beds, which was lower than many people assumed, Dr Mary Codd, a clinical epidemiologist who worked on the report, said.
Twenty per cent of public hospital beds are designated as private. However, about 30 per cent of planned procedures are on private patients.
The Minister said that getting the proportion back to 20 per cent for private patients in public hospitals was a management issue for the hospitals.
The report also found that 200 beds could be found within the hospital system. But even after all efficiency measures are taken, an extra 2,840 beds will have to be put into the system on top of these, the review says. An extra 190 day beds are also needed.
The report says good services in the community, such as family doctor services, specialist services and community care, can help reduce the need for hospital beds.