The Estimates published yesterday include the biggest-ever annual increase in health spending, which makes it all the more strange that much of the exercise has about it a feeling of things standing still.
This is not altogether a bad thing. The feeling of standing still comes from the fact that a lot of money is being spent to bring aspects of the health service up to a reasonable standard.
Much of the money will go to paying for costs arising out of the settlement of the nurses' and hospital doctors' disputes. Money will also go to such projects as providing a much-needed new casualty department at Cork University Hospital, upgrading the infrastructure at Holles Street Hospital, Dublin, and upgrading medical wards at Portlaoise General Hospital.
The extra money for home helps is an especially welcome move in bringing things up to a reasonable level. The £6.50 an hour they will get from January contrasts dramatically with the £2.50 an hour some of them were earning a couple of years ago.
It is, in many respects, good that the Minister is choosing to make investments to bring facilities and conditions into the 21st century, instead of engaging in flashy political gestures, though he might be saving one or two of these for Budget day.
It must be acknowledged that 3,000 extra posts in the health services are being funded next year on top of the 3,000 this year. It is a great pity many of these will have to be funded by agency staff or overtime because of staff shortages. Nevertheless, the move represents an intent to substantially improve health services.
The great leap forward which we are not getting, however, is an increase in acute beds. One of the most gruelling experiences faced by people engaging with the hospital system is the business of waiting for a bed. A lengthy wait in the casualty department is bad enough: it is compounded mercilessly by the many hours spent on a trolley in a casualty department waiting for a bed to be free.
Behind the trolley experience is the uncomfortable fact that 3,000 acute beds were lost out of the system in the 1980s and 1990s. Fewer beds and a bigger population add up to excruciating queues in casualty departments and lengthier waiting lists.
It isn't hard to see why there hasn't been a dramatic rise in acute bed numbers. The capital cost of adding a new acute bed to a hospital is around £100,000. After all, you don't just buy a new bed and shove it in a corner. The bed has to be housed, the housing (an extra wing, say) has to be designed and the equipment has to be provided to treat the patient in the new bed. So to get back 3,000 beds would carry a capital cost of £300 million. That's a lot of money.
Then there's the running cost including staff, drugs, surgery and so on for the patient in the new bed. This varies a good deal from city hospitals such as Cork University Hospital (£292 a day), Beaumont, Dublin (£273 a day), University College Hospital, Galway (£247 a day) to hospitals outside the main cities such as Tullamore General, Co Offaly (£187 a day) and St Luke's, Kilkenny (£180 a day).
Taking a cost of £250 a day (because the biggest demand is in the big cities) the cost of running those 3,000 beds, if we got them, would be about £274 million a year.
That's an impossible aspiration - or is it? We spend about half as much of our national income on health as the French who, in a World Health Organisation survey, came out as having the best health service in the world.
We can have the beds if we are prepared to pay substantially more for our health service.
That reforming the health service will be a costly business is, it has to be said, recognised by the Minister, Mr Martin. Speaking yesterday evening at the announcement of guidelines for the care of children with special needs in hospital, by Children in Hospital Ireland, he referred to the increase in health spending projected for next year.
"We are going to have to spend more on health now and in the future if we are to have the kind of standards of care we expect in this day and age," he said.
What is under way, and what these Estimates are, is a longterm and laudable project. But where are the extra beds we need?
pomorain@irish-times.ie