"The capacity to squeeze more out of the Dublin hospitals is very limited," according to Mr Donal O'Shea, chief executive of the Eastern Regional Health Authority, the new mega-body with responsibility for the 1.4 million people in Dublin, Wicklow and Kildare.
The number of hospital beds per head of population in the east is significantly below the national average, and the State has the lowest number of hospital beds per head of population in the EU.
When the health spending cutbacks hit hardest in the 1980s, Dublin lost more beds proportionately than the rest of the State.
In small towns the local hospital is an industry, a local resource and a status symbol. Politicians generally dare not close rural hospitals, but in the confusion of Dublin's diverse hospital sector, it was easier, politically, to close hospitals. Thus historic hospitals closed with virtually no protest - Dr Steevens, Sir Patrick Dun's, Mercer's, and Baggot Street which also closed as a hospital.
The number of acute hospital beds, nationally, fell from 15,672 in 1980 to 12,142 in 1997 - a 22 per cent drop, or over 3,000 beds. In the eastern region the ERHA's figures show the number of beds falling from some 7,000 in 1980 to just under 5,000 in 1998 - a 30 per cent drop, or over 2,000 beds. So the fastest growing area of the State contributed two-thirds of the cut in beds.
In 1997, the latest year for which international figures are available, Ireland had 3.7 in-patient beds per 1,000 people - the lowest number in the EU, which had an average of 6.6 in-patient beds per thousand. Ireland's 3.3 acute hospital beds per 1,000 people compared with an EU average of 4.2.
In the rapidly growing eastern region, according to Mr O'Shea, there are in theory 3.1 acute beds per 1,000 people compared to 2.5 for the rest of the State. However, he calculates that, in practice, residents of the eastern region have access to 2.5 beds per 1,000 because at any time 20 per cent of the beds are taken up by patients from outside the region. Since half the beds get filled from accident and emergency departments, this means that only 30 per cent of the beds in Dublin hospitals are available for elective surgery for the population of the region.
Conversely, residents of the rest of the State with access to Dublin beds have therefore 3.1 beds per 1,000 people.
Outside the eastern region, there are district hospitals to cater for elderly people with flu and conditions needing nursing with a general practitioner's overview. But in Dublin such people must go to the inappropriate teaching and acute hospitals. The hospitals which closed might have been converted for these patients, Mr O'Shea suggests.
Meanwhile, the population of the eastern region at 1.3 million in 1996 is now reckoned by the Central Statistics Office to be 1.4 million and is conservatively expected to increase to 1.5 million by 2006 and 1.6 million by 2011.
"That's adding 300,000 people in 15 years, the equivalent of the North-Eastern Health Board population, a population which has a whole network of services dedicated to it," comments Mr O'Shea. "Over half the population growth in the State is taking place in this region."
Only 35 per cent of health spending in the national development plan is going to the eastern region and is likely to have virtually no impact on the number of beds.
If over half the population growth is in the east, why should the east not receive over half the increased funding? Is the national plan spending as driven by political expediency as the closures in the 1980s?