Analysis: Reward for hard work and efficiency appears to be less funds, writes Dr Muiris Houston, Medical Correspondent
The level of clinical activity in Dublin's teaching hospitals, outlined in the Irish Patients' Association Management Survey, is the first concrete evidence of how the slowdown in health service funding is beginning to bite.
With a Cabinet sub-committee due to discuss the thorny way forward in a major restructuring of the health system, there could not be a better starting point for tomorrow's discussions than today's figures.
While all acute hospitals are suffering because of a decision to award current funding on the basis of planned activity in 2002, rather than the treatments each one carried out, the situation is particularly bad in one of the capital's flagship medical institutions.
The Mater Hospital officially has 500 beds. It is a university teaching hospital with a long tradition as one of the finest in the State.
The national centre for specialities, such as cardiac surgery, it is about to assume the mantle of the national lung transplant centre in the Republic.
However, it has been forced to close 104 beds, with persistent rumours that at least another 20 will disappear from service.
It has 80 beds effectively put out of commission for acute treatment; the (mainly) older patients are medically fit for discharge but have nowhere to go in the community.
In reality, therefore, the Mater will soon be operating with almost 50 per cent less beds that it did in 2002.
With its elective admissions down by 34.5 per cent in March compared with the same period last year, it is only a matter of time before its number of planned admissions drops by between 40 and 50 per cent.
It begs the question, how can one of the State's premier hospitals continue to function in any meaningful way? And why is the Mater being singled out over and above the capital's other teaching hospitals?
Ironically, the answer to this question may lie in the very quality that the Brennan Commission Report - one of those due before the Cabinet sub-committee meeting - is seeking to introduce.
Transparent value for money is the key message underlying Prof Niamh Brennan's conclusion as the way forward for the health system. How ironic if the Mater - renowned as a hospital where professional staff routinely go the "extra mile" for patients - is now being penalised for exceeding its clinical targets in 2002.
Rather than being rewarded for its hard work and efficiency, the Mater Misericordiae seems to be suffering for it.
The people who should be most worried about this state of affairs are those who live in the hospital's catchment area. As well as the inner city, the Mater's hinterland includes areas such as Finglas, Drumcondra and Glasnevin.
It is an area which has an above average population of older (and consequently sicker) people.
The inner-city end of its "constituency" has seen a huge influx of refugees and immigrants. They too are high-demand patients in terms of medical need.
Without taking credit from its performance in the latest figures, it is surely reasonable to ask why funding for Beaumont Hospital, with a more affluent population, appears to allow it to weather the fiscal storms which threaten the health of the disadvantaged, who turn to the Mater for their healthcare needs.
Across all Dublin hospitals there is one statistic of concern. That is the finding that the number of return attendances to the accident and emergency departments of all six hospitals has increased to 9.4 per cent compared with 2002.
Increased return visits to accident and emergency almost certainly signify doctors reluctantly discharging patients who they would prefer to admit to hospital.
The best they can do is to see them again within days when a deterioration in the patient's condition turns them into "absolute" candidates for admission.
This is a dangerous game of Russian roulette which has no part in a developed health service.