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Bed capacity to top IHCA agenda at DPER meeting

01 Jun 2017

The IHCA is to inform the Department of Public Expenditure & Reform today of an “overwhelming need” to address the mismatch between levels of demand and the levels of capital funding being made available to the health service.

Top of the agenda when a delegation from the IHCA meets with senior officials in DPER today (June 2) will be the need for an additional 4,000 acute hospital beds, 290 ICU beds and a further 500 rehabilitation beds to meet demand.

With the cost of each new acute bed being around €1 million, an estimated capital cost of €4 billion will be required for this additional bed stock, with two further tranches of €360m and €500m needed to pay for the ICU and rehab beds respectively.

The meeting is due to held to discuss the mid-term review of the 2016-2021 Capital Plan, which provides for just over €3 billion of investment in healthcare infrastructure. The review of the Plan was brought forward due to such issues as Brexit and the provisional results of Census 2016.

In a submission to DPER, seen by Irish Medical Times, the IHCA warns of an overall capital deficit, given that the promised €3bn was €2bn below the equivalent level of funding provided in 2008 – despite the significant growth in the demand for health services that had arisen in the interim.

The current capital provision also represented “gross underfunding” in the context of the estimated cost of €1.8bn to build the new Children’s Hospital and to relocate the National Maternity Hospital and the Rotunda Hospital.

“The balance of €1.2bn does not even fund the estimated cost of maintaining and replacing essential acute hospital equipment. In addition, it critically does not provide for a significant increase in funding for urgently required additional acute and ICU beds, expanded theatre capacity and other essential hospital facilities,” the Association warned.

Between 2008 and 2017, cumulative cuts of €576m were made to the acute hospital capital budget against a backdrop of increasing demand, the IHCA added, while the overall health capital budget suffered cumulative cuts of €1,889m.

“Without significant revision to the current capital plan, the projected cumulative cuts to the overall health capital budget, using 2008 as a base, will increase by another €199m by 2021 bringing the total cumulative cuts between 2008 and 2021 to €2,086m,” the IHCA submission claims.

IHCA Secretary General Martin Varley told IMT that in 2009, the HSE commissioned a Prospectus report to examine ICU bed numbers, which recommended an additional 290 ICU beds, at an overall cost of €360m. “To date, no additional ICU beds have been provided some eight years later. In fact, there are fewer beds today than we had then.”

Ireland has one of the lowest numbers of acute hospital beds in the OECD at 2.4 per 1,000 of population compared with the OECD average of 3.6 per 1,000 in 2014, while the number of acute rehabilitation beds stood at just 0.03 per 1,000 of population in 2014 – compared with 2.05 and 1.58 per 1,000 of population in Germany and France respectively.

Ireland’s average bed occupancy rate at 94 per cent was also far in excess of the internationally recommended 85 per cent, and the OECD average of 77 per cent, which the IHCA said was jeopardising the safety and quality of care that could be provided.

The 4,000 additional acute beds called for by the IHCA is equivalent to the number of beds provided by six large teaching hospitals.

The Association has also highlighted the failure to maintain and replace essential acute hospital equipment over the past decade, which it says has had serious implications for patient care. “The HSE indicated that €2.25bn would be available in the capital space between 2017 and 2021 but that this would not meet the €3.64bn that will actually be required for priority replacements.”

It said that the HSE had confirmed that the National Equipment Replacement Programme required a significant increase in investment to replace equipment over a five-year period. “Furthermore, it is reported that a confidential internal assessment drawn up by the HSE confirms that there is a backlog of 9,000 pieces of aged and ‘at-risk’ equipment which needs to be replaced.”

Urgent investment is also required to address the inadequate outpatient clinic capacity across the entire acute hospital infrastructure, along with significant increased investment in diagnostics and operating theatre capacity.

The Association pointed to inspections carried out in 32 acute hospitals by HIQA last year, which highlighted outdated infrastructures and designs in operating theatres that were not fit for purpose, did not comply with contemporary standards, and were not suitable for the increased demands placed on the clinical service.

“In six hospitals where re-inspections were required, infrastructural deficiencies were identified as high risks, with many of the issues remaining outstanding due primarily to the limited availability of capital funding.

“The revised capital plan must provide the necessary capital funding to bring operating theatre capacity up to acceptable standards in each of the hospitals subject to re-inspection,” the IHCA stressed to DPER in its submission.

And while the Association welcomed the earmarking of €300 million for the replacement, upgrade and refurbishment of long-term care facilities for older people and those with disabilities, this would not address the demand for nursing home care that would inevitably increase over the coming years in line with the projected increases in the population aged over 65.

If the health service is to deal with the major increases in patient demand for care, both current and projected, arising from the general growth in population, higher numbers of patients requiring more complex care and an increasingly ageing population, it must be properly resourced and funded, according to the consultants’ group.

“If the Mid-Term Capital Review fails to address these issues, it will represent a missed opportunity as increased capital investment has a pivotal role to play in terms of alleviating existing and projected capacity deficits.”

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