Cautious welcome for Fine Gael/Labour plan on A&E

The oppostion's health reforms contain innovative measures which could alleviate some serious problems – if they're implemented. By Sara Burke

Patients, nurses and hospital consultants cautiously welcome the Fine Gael and Labour joint plan on A&E. Despite some progress made in A&E units in the last year, many fundamental problems remain, such as lengthy waiting times, over-crowding, and poor access to and shortage of hospital beds. Fine Gael and Labour's new 'Agreed agenda of A&E' has some familiar elements which have been promised but not yet implemented by the current government. But the overall package and some of its innovative components, if implemented, could make the difference needed according to patients, nurses and consultants.

Jeanette Byrne, founder of the Patients Together, a patients lobby group, wants to "hope again". But she says she has no reason to "believe any plans anymore because she's been let down so many times. There are still not enough GPs in communities, people are still waiting on trolleys in terrible conditions in A&E units, people who are sick still can't get a bed in hospital without going through A&E."

The Fine Gael/Labour proposals include Medical Assessment Units that would enable patients who have ongoing conditions and are in need of hospital care to access a bed directly without having to go through A&E. A referral from a GP will get such patients a bed in hospital. For Jeanette Byrne, this would be a 'great development'. As she is currently undergoing chemotherapy, it would ensure that if she gets sick during her treatment she does not have to go through A&E to access a hospital bed.

Liam Doran of the Irish Nurses Organisation is optimistic too, stating, with the same qualified scepticism as Jeanette Byrne, that the new Fine Gael Labour document indicates it is ready to go places that this government is not. In particular, he mentions the proposals to increase the amount of beds in hospitals, the willingness to fund new buildings and ideas such as the urgent care centres. Fifteen new Urgent Care Centres are proposed, with three in Dublin as a priority. These will be open out-of-hours and will provide alternatives to A&E for treating minor medical procedures such as dressing wounds or treating an asthma attacks. Liam Doran also welcomes the minor injuries units which were long promised by this government but have yet to happen across the country.

Donal Duffy, of the Irish Hospital Consultants Association, says the plan for 1,500 'step down' beds is a 'quantum increase' on the Health Services' Executive current plans for beds which allow patients in hospital in need care but not hospital care to move in to beds suitable for them outside the hospital setting.

Laim Twomey, Fine Gael spokesperson on health talks about how Dublin currently needs '400 step down beds' and how they need to be varied to cater for people whose requirements range from short term convalescent beds to longer term continuous care beds. He talks about how patients are currently being discharged too soon and end up returning to the system often in crisis. "We are working on the long term picture which will meet current needs and we're also planning for the future". He says these beds will be built in new units on public hospital grounds attached to the public hospitals so that consultant care is near by if and when needed. Twomey confidently asserts that 80 to 90 per cent of all their measures can be complete within the two-year timescale outlined.

Fine Gael/Labour have costed these plans allowing €575m in capital (building and set up costs) and annual costs of €180m a year using current costs.

Liz McManus, Labour's spokesperson on health, says, "Imagine if we'd given the attention to health that we'd given to Northern Ireland, we'd have a world class health system. This [health] is a priority [for Fine Gael/Labour] and we are taking a lead on it. If people see that and believe it, we can do it," she says.

Jeanette Byrne has words of warning about any more promises. "If the opposition are to give us hope again, if they get into power and don't do it, we'll be banging down their doors down".