The Department of Health and Children aims to provide 1,500 extra public beds within two years, and to encourage developers to build private hospitals on public-hospital lands.
"We need, where possible, to speed up the present processes for planning, designing and building our capital projects," says the health strategy document seen by The Irish Times.
The Finance Bill, 2001 offered major tax breaks to private hospital developers, letting them write off 100 per cent of the cost of new buildings, or refurbishing old ones and equipping them, over seven years.
In order to qualify, the hospitals must have a minimum of 100 beds, all-year surgical and medical services, an accident-and-emergency unit, and at least five specialist services, such as oncology or cardiology.
However, the 1,500 extra public beds will be no more than a temporary boost as some 500 extra beds will be required to cope with waiting lists, while an additional 500 will be needed every year to cope with Ireland's ageing population, the report says.
"There is increasing evidence that the system does not have the capacity to meet the current demands being placed upon it," concludes the report, adding that diverting patients elsewhere would not properly relieve the stresses.
Under the plan, £2 billion will be spent on capital projects up to 2006.
However, the authors express fears that construction inflation, which is above the national average, could erode much of this.
Demands on the health system will grow sharply in coming years. By 2031, the population will rise to 4.75 million, while the numbers of over 65s are growing by 6,000 a year.
In 1996, 402,000 people, or 11.5 per cent of the population, were over 65. By 2031, depending on the estimates used, this will more than double to between 837,000 and 858,000 people, or between 18 and 21 per cent of the population.
"In addition, there is already a disproportionate concentration of the country's population in the greater Dublin area, and without intervention this trend is set to increase over the next 10 years."
However, the Department of Health recommends the Government does not guarantee to link health spending to a fixed percentage of income, as some have called for.
"It may be unwise to link health expenditure to a specified proportion of national income, since this is dependent on economic performance. A downturn in the national financial situation could place serious pressure on health spending under this approach, especially if national income were actually to decline." In any event, such a link may be simply artificial, the report says, as it would take no account of private health spending.
The Government is committed to devoting "sufficient resources" to health in line with people's needs.
Before the 1980s cutbacks, the hospital service had 15,000 acute beds. By 1994, this had fallen to 11,853. By 1999 it had fallen again, though marginally, to 11,783. Admissions, however, jumped between 1994 and 1999, from 715,000 to 868,000, largely because of a greater use of day beds and a rise in staffing.
On average, 83 per cent of acute hospital beds are occupied at any one time, a figure that is extremely high by international standards. In some places, the daily average is even higher. "One of the most significant advances in acute hospital performance is the increase in the number of day beds and day cases, representing 36 per cent of all admissions in 1999.
"However, bed-blocking persists, caused by the lack of minor-injuries and chest-pain units, triage units, out-of-hours decision making, 24 GP cover, observation bed capacity and ring-fencing of A&E bed stock," the report adds.
