news focus: Unacceptable waiting times, too few beds and a looming general election - the Irish Republic's solution is a 10-year plan for its health service. Joe Armstrong reports

Published: 06/12/2001, Volume III, No. 5784 Page 16 17

When the Republic of Ireland launched a 10year strategy for health last week, some parallels with the NHS plan for England and Wales were quickly apparent.

The£IR10bn (£8bn) strategy to cover a population of about 3. 8 million calls for strategic partnership with the private sector, use of services overseas, drastic cuts in waiting times and increased responsibilities for primary care.

Launched by the minister for health and children - and likely future prime minister - Micheál Martin, the strategy was a year in the making following a comprehensive consultative process.

Like the NHS plan, the strategy, Quality and Fairness: a health system for you, comes in the run-up to the general election in Ireland, which must take place by next June.

It has already been lambasted by the Opposition. Fine Gael shadow health minister Gay Mitchell described it as a 'fig leaf ' for the ruling minority Fianna Fáil and Progressive Democrat coalition 'to hide the scandal of a crumbling health service at a time of economic boom'.

Prime minister Bertie Ahern admitted in the document's foreword that all is not well with the current standards : 'There is no denying the fact that our health system has many problems. '

Chief among these in the minds of the electorate is the perceived inequity in access to healthcare, whereby those with private health insurance bypass interminably long public waiting lists in Ireland's two-tier healthcare system.

To tackle the waiting lists, the health strategy plans to use private hospitals - and healthcare facilities overseas - procuring some 650 extra beds for public patients by the end of 2002.

The strategy promises an additional 3,000 public patient beds by 2011, a figure dismissed as too low by Finbarr Fitzpatrick, secretary general of the Irish Hospitals Consultants'Association, who said 5,000 beds were needed.

He also criticised the strategy for failing to propose health board reform.

A report highly critical of how health boards are run inadvertently appeared on - and was summarily removed from - the official website of the Department of Health and Children. The 'value-for-money' report, commissioned by the department from accountants Deloitte and Touche, also suggested that there might be too many beds for private patients in public hospitals.

The new health strategy establishes a treatment purchase fund with an opening balance of IR£25m (£20m) to procure bed space and treatment from private hospitals and overseas health services.

The national treatment purchase scheme is to begin 'immediate discussions'with relevant hospitals and consultants to ensure that patients can be offered the treatment they need.

'Where it is not possible to treat patients within a reasonable period in Ireland, either in public or private hospitals, health boards will make arrangements under the treatment purchase fund to refer public patients for treatment abroad, having regard to quality, availability and cost. '

Vincent Sheridan, chief executive of Voluntary Health Insurance, Ireland's largest private health insurance provider, said that private hospitals may not be able to offer treatments for conditions most prevalent on the public waiting list.

VHI is also concerned that public hospitals might turn away private patients to meet the new public patient targets.

A key new target specified in the strategy is 'all public patients will commence treatment within a maximum of three months of referral from an outpatient department' by the end of 2004.

Intermediate targets toward this aim envisage that by the end of 2002, no adult will wait longer than 12 months and no child longer than six months to start treatment following referral from an outpatient department.

By the end of 2003, no adult will wait longer than six months and no child longer than three months.

People with medical cards already have a wide range of medical provision, including free visits to GPs and free prescriptions.

Medical cards are allocated on the basis of a means assessment.

Controversially, they have in the past year been provided for everyone aged over 70, regardless of income. This is perceived as inequitable given that many people in that age range can afford to pay for healthcare, while many younger families with children, whose incomes are marginally above the thresholds are denied them.

Currently, a married couple with two children earning a little over IR£9,000 (£7,170) a year does not qualify for a medical card.

The health strategy, published last week promised an extension to the criteria for people qualifying for medical cards, without specifying what the new regulations will be.

But the sheen of this promise was lost when it emerged only three days later that there would be a freeze on extending medical card eligibility until 2003, when only 200,000 extra people will qualify - and that depends on 'budgetary considerations'. l Quality and Fairness lNo public patient to wait longer than three months by 2004.

An extra 3,000 beds by 2011.

Strategic partnership with the private sector and use of overseas services.

A National Hospitals Agency to be set up 'to plan configuration of hospital services' Department of Health and Children.