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Capacity for change?

As revealed in this issue of the Medical Independent, the International Peer Review Group (IPRG) questioned why the review would not include an assessment of workforce planning in the acute sector. Although the Review did consider projections of people working in primary and community services, the experts advised that a comprehensive capacity review would have to address staffing levels in hospitals. The group also expressed concern about the level of focus on beds as a measure of capacity.

As Maeve Ann Wren’s seminal Unhealthy State: Anatomy of a Sick Society shows, the health service never really recovered from the hospital and bed closures of the 1980s and early 1990s. During Rory O’Hanlon’s first term as Minister for Health, 3,244 acute beds were removed, a 19 per cent reduction, while a further 13 per cent reduction took place under Fianna Fáil Ministers up until 1993. Over the next decade, the number of beds remained almost static.

There was hope that bolstering primary care services would reduce the need for beds. However, the widespread reform envisaged in the Primary Care Strategy, which was based on evidence on the importance of keeping patients out of hospital, never materialised.

The recession meant that the promise of reform was put on hold. The consequent lack of investment has had a variety of negative consequences, including contractual disputes and recruitment and retention problems, all of which have meant that long waiting lists seem an intractable feature of the health service.

In fairness to the Government, the capacity review was undertaken to address a major element that has contributed to the situation.

The Review, which was published earlier this year, estimated that without reform, 7,000 extra hospital beds will be needed by 2031. However, this number reduces to 2,600 if reforms are implemented.

Not to have included workforce planning in hospitals as part of the review was a major oversight. As the document states again and again, structural reform is essential for the future of the health service. Problems in primary care become problems in secondary care. Funding for new buildings in capital budgets will soon require funding for staff. Capacity encompasses more than built infrastructure.

To address waiting lists, there needs to be recognition that the health system is a vast, inter-connected network. The need for more beds can be attributed to failures elsewhere in the system.

For too long, different parts of the health service have been viewed in isolation. This needs to change if meaningful reform is ever going to happen.

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