Read my lips:Even if the FF-PD coalition keeps its word, it will leave the health system 1,100 beds short of its target, writes Fintan O'Toole
If health is the key issue in the election, then the key issue in health is hospital beds. The 2001 health strategy promised 3,000 new acute beds in public hospitals by 2011. In its 2002 manifesto Fianna Fáil pledged to "implement our health strategy to permanently end waiting lists". The obvious question is whether the outgoing Government parties are delivering on this promise.
One of the difficulties in answering this question is that the Government's own progress reports have been rather confusing. In November, Mary Harney told the Dáil that "the Government's commitment to increase total acute bed capacity is virtually complete". Yet in their manifesto the PDs say that by the end of the next government's term, they "will be more than four-fifths of the way towards the Health Strategy 2011 goal of 3,000 new beds". So a commitment that was "virtually complete" last November will be 80 per cent complete in five years' time.
The contradiction is partly explained by the fact that Mary Harney's figures last November include two major elements that are, shall we say, intangible: 450 beds that are, according to the small print, "in various stages of planning and development" and 1,000 beds in public hospitals that are to be freed up by building, on public land and with public subsidies, private for-profit hospitals. Even if these plans work out, the figure for new acute beds would be 1,450 plus the 1,110 beds that Mary Harney says she has actually delivered in public hospitals, making for 2,560 beds and not the 3,000 deemed necessary in 2001.
Let's look, however, at the public beds that Mary Harney identifies are the tangible product of the outgoing Government's investment. She says that "since 1997, we have increased acute hospital beds by about 200 per year". This seems, on the face of it, to be an exaggeration, but not a massive one. In 1997, there were 11,727 acute beds in the system. In the middle of last year, when she made this specific claim, there were 13,255 - an increase that falls short of the 2,000 beds she seemed to claim but that might be compatible with her use of the word "about".
So, on the face of it, it looks as if the Government is, as Mary Harney claims, on course to get about 80 per cent of the way towards the necessary 3,000 beds. But, and here's the rub, it depends on what you mean by a bed. Here we enter an Alice in Wonderland world where a bed can also mean a trolley, a reclining chair or a couch. According to the health strategy, just 200 of the 3,000 beds to be provided would be "day places" - trolleys and the like, which are fine for someone going into hospital for a few hours, but not for real in-patients in wards. What's clear is that the PDs and Fianna Fáil have been reaching their figure of 1,100 beds provided since 2001 by adding in vastly more "day places" than the strategy allows, and then claiming them as acute hospital beds.
In November, in the Dáil, Mary Harney claimed that since 2001, the number of beds had "increased by 1,204 to a total of 13,349" (confusingly, a higher figure than she is now claiming). She added in parenthesis the crucial qualification: "an additional 724 in-patient beds and 480 day places". Her junior Minister, Fianna Fáil's Brian Lenihan, told the Dáil last May that "since 1997, the number of public acute hospital beds has increased by 1,528, up from 11,727 inpatient and day treatment places. Most of the increase - over 900 - comprised inpatient beds." So here's the reality: 620 of the "beds" provided between 1997 and 2005 were actually "day places". And 480 of the "beds" provided between 2001 and last November were "day places".
This massaging of the figures has involved some Olympic-class linguistic gymnastics. In 2004, Mary Harney gave her official definition of a day bed to the Dáil: "A day bed or day place is the bed, trolley, reclining chair or couch, located in a dedicated, named day-ward unit, allocated to patients who are admitted as a result of their condition. It is used to allow the patient to rest, recline or recover in the course of an elective day-case admission." So a trolley is a bed, a couch is a bed and a chair is a bed. And a day-patient resting after a minor day procedure is occupying an acute hospital bed.
The health analyst Maev-Ann Wren and the US economist Dale Tussing have calculated that the real number of new acute beds provided over the last five years is, at most, 720 - almost the same figure as Mary Harney gave in the Dáil last November. So a third of the "beds" claimed by Fianna Fáil and the PDs are really "day places". Applying this percentage to the 1,450 "beds" promised for the next five years, the real figure, even assuming that all the tenative plans come to fruition, would be 967 beds. This will make for a total of 1,687 real acute beds provided over ten years. The health strategy demands 3,000 beds overall - 2,800 of them real acute beds. So even if the PDs and Fianna Fáil do what they say they'll do, they will be more than 1,100 beds short of what the system needs.