Hospital beds to top Cabinet meeting agenda

The B word is likely to be heard a lot around the Ballymascanlon Hotel in Dundalk today as the Cabinet holds an all-day meeting…

The B word is likely to be heard a lot around the Ballymascanlon Hotel in Dundalk today as the Cabinet holds an all-day meeting on the future of the health services.

B is for beds, the absence of which is clogging emergency departments and stranding people on waiting lists.

Minister for Health and Children Mr Martin said at last week's Irish Nurses' Organisation (INO) conference that the review of bed capacity currently being completed would take into account the beds lost from the system in the health cuts, the current demand and the future make-up of the population.

That seems to suggest that the review will recommend the introduction of more than 3,000 beds (the number taken out in the 1980s and early 1990s) over a number of years.

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But don't count your beds before they are installed, staffed and filled. The cost of providing 3,000 beds is about £300m by the time they are built, equipped and staffed.

Some of these beds could be found by sending patients off to nursing homes where, as nurses in the INO pointed out last week, they will get little in the way of physiotherapy, occupational therapy or any other kind of therapy.

Nursing homes, however, are filling up. Dublin hospitals are placing patients 30 to 40 miles away because they cannot find suitable places in the city. The situation is no better elsewhere. Many towns haven't even got a nursing home.

One way or another, more beds will have to be provided by extending existing hospitals or building new ones. Many of these are likely to be rehabilitation or long-stay beds for patients who would otherwise have to stay on acute wards.

But who will staff them? This is one of the most crucial questions faced by the Government today and by health planners in the future. Already some hospitals have had to close beds because of nurse shortages.

We can go on recruiting from abroad, but while foreign nurses have enabled hospitals to reopen many wards, the supply is not inexhaustible. Other countries are looking for nurses too and, if the views of nurses who have worked there are anything to go by, treat them with a great deal more respect than they get in the Irish system.

The Minister has acknowledged that keeping nurses in the system is, in large part, the answer to the nursing shortage. That will require a great deal of detailed and determined work to ensure the system becomes one in which nurses want to stay.

No doubt much discussion today will centre on the report of the Medical Manpower Forum. If this is implemented, as many as 1,000 extra consultants will be appointed, replacing almost that many non-consultant hospital doctors.

The thinking is that they will provide a better level of service and that outpatient clinics will work from early morning to late at night.

But that brings us back to beds and nurses. Extra consultants without extra beds and nurses will be unable to deliver the improvements which the forum hoped for.

And then there is the medical card for the over-70s. So far, the Irish Medical Organisation is sticking to its threat not to implement the planned issuing of medical cards to everyone over 70 because 250,000 low-paid people are unable to get medical cards.

This doesn't necessarily mean that all doctors would welcome a free GP service for everyone or that it could be negotiated quickly. Yet we need a much-enhanced GP service in which many tests and procedures now taking place in hospitals occur instead in the family doctor's surgery.

In the meantime, though, a radical shake-up of the means test for the medical card may be the way through the current impasse.

Finally, the disclaimer: none of the above applies if Fianna Fail is cooking up one of its strokes for the next election, though they are unlikely to share that stroke with us, the electorate, or their partners in Government, the PDs, just yet.

pomorain@irish-times.ie