C&AG recommends HSE bed census to save time and money

The practice of sourcing beds for mental health patients in other facilities or purchasing access to private beds tomanage short-term capacity issues can be time consuming and raises potential value-for-money issues, according to the latest spending report by the Comptroller & Auditor General (C&AG).

According to the spending watchdog, the HSE informed the examination team that in 2024 it sourced 385 external placements, for varying lengths of time, in private facilities at a total cost of approximately €80 million.

The C&AG examination team observed high occupancy rates at three of the four acute adult mental health facilities they visited in April this year.

The team also noted several instances of units sourcing beds in other facilities or purchasing access to private beds to manage short-term capacity issues.

The number of acute adult inpatient mental health beds in Ireland has reduced significantly over the last 40 years.

This has been a conscious decision reflecting a policy aim to move away from mental health institutions and towards more community-based services for mental health.

The examination team undertook site visits to four facilitiesin April, together accounting for 161 (16%) of the national total of publicly registered general acute adult inpatient beds according to HSE figures.

The main purpose of the visits was to test whether the number of beds reported was an accurate reflection of the beds available and operational at each facility. The occupancy rate shown relates to the night before each site visit.

Notes: a. Cluain Mhuire is a community-based adult mental health service. It purchases access to inpatient beds on an annual basis from

b. St John of God University Hospital. In 2025, there were funds for the purchase of access to 28 beds. The funding provided in 2026 was increased to an amount that would allow the purchase of access to up to 34 beds.

c. Twenty-seven beds were occupied, twenty-six by Cluain Mhuire patients and one by a patient of St John of God University Hospital. Seven beds were vacant.

d. The Lakeview Unit has 29 beds. There is an agreement with Midlands Regional Hospital for the use of ten additional beds, if necessary.

e. Five beds were not operational due to ongoing construction work. The occupancy rate is by reference to the operational beds.

The report found three of the facilities visited had occupancy rates higher than 90%, and that all of the
facilities identified the occasional need to negotiate and source beds from other public facilities or to purchase access to private beds from other centres.

The Mental Health Commission publishes high-level information on bed capacity in its annual reports, based on registration reporting.

The most recent census on mental health beds was carried out by the HSE in November 2021.

The C&AG concluded that accurate and up-to-date information on all types of available beds and community-based services across the country is required.

It said this is information is needed to evaluate current service levels and to inform decisions on future capacity, especially in the context of a rapidly growing and shifting population.

In its recommendations the C&AG said the HSE should carry out another bed census to establish the numbers and locations of all categories of mental health beds (including acute adult inpatient beds, child and adolescent beds, private beds, continuing care beds and speciality beds); and should put a procedure in place for regular censuses thereafter.

In response the HSE Chief Executive Officer said a comprehensive mental health bed census is planned for November
2026.

The CEO said that as part of this work, scoping will be carried out in relation to putting a robust procedure in place for regular bed censuses, and that further censuses will be planned on a biannual basis.