Analysis:the acute l bed-capacity review is wishful thinking, writes Dr Muiris Houston
Initial media coverage of the Health Service Executive/PA Consulting acute hospital bed-capacity review may have been wide of the mark.
The startling message is not that we may need 20,000 acute hospital beds by 2020: rather it is the experts' conclusion that a more integrated health system will require some 4,000 beds less than we need today.
This must come as a surprise to the thousands of people who have had to endure unacceptable delays in emergency departments while hard-pressed nurses and bed managers search for an elusive hospital bed.
Nor is the prospect of a 60 per cent reduction of in-patient beds good news for patients with cystic fibrosis, whose unfortunate plight has been highlighted recently.
And it is of no comfort to those of us who will be 60 years of age or older in 2020, and for whom the experts reckon just 4,025 in-patient beds will meet our ever-expanding health needs.
The development of an integrated health system with far fewer acute hospital beds and a much-expanded primary care sector is the key presumption made in the review.
In theory, it is a laudable aim: in practice, however, it is difficult to see the many "ifs" the review contains becoming a reality.
The 2001 National Health Strategy stated that "primary care needs to become the central focus of the health system".
But the development of primary care teams is well behind the original schedule set out by the Department of Health.
The 500 primary care teams in development are a long way from providing services to patients.
The Irish College of General Practitioners has serious reservations about their ability to function practically.
And if we are to judge the HSE by its actions and not its words, then the executive's decision to reverse a plan to increase training places for family doctors does not bode well.
This contraction of GP training places took place in the knowledge that present GP manpower is falling short of demand.
People are having difficulty registering with a family doctor as it is: what will it be like when we have an older population with more chronic diseases attempting to source their care in the community rather than in hospital?
Cynics might also point to this week's clarification from the HSE that although the recruitment embargo is officially over, the many vacancies carried forward from last year's three-month job freeze will now not be filled.
So have the 180 or so vacancies for occupational therapists identified during this time magically disappeared?
Parents of children with autism and the families of older people trying to live independently in the community and who must now wait up to two years to see a therapist could be forgiven for taking the latest HSE plan with a pinch of salt.
Even allowing for future developments in medicine it is difficult to see how a health service could look after a population of some 5 million people, one-fifth of whom will be over 55 years of age in 2020, with 4,000 less acute hospital beds.
The ambitious review contains one welcome dose of realism.
It at least considers the possibility that a proportion of the health system improvements it proposes will not be achieved.
The report states that if just 25 per cent of the necessary move towards an integrated health system came about, then we will need 16,174 public hospital beds.
This will mean some 4,500 beds over and above our current bed stock, and represents a more likely outcome for 2020 than the Utopian conclusions of the main report.