Waiting times for hospital treatment are to be reduced to three months by the end of 2004, according to the targets set out in the health strategy published yesterday.
It lays down that:
by the end of next year no adult will wait longer than 12 months, and no child longer than six months, to begin 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; and
by the end of 2004, no public patient will wait longer than three months.
The strategy states that an extra 3,000 beds will be provided in acute hospitals over the next decade. It is intended that 650 of them, all designated solely for public patients, will become available next year.
Key decisions about the specialities in which these extra beds will be provided, and their location around the State, will be taken by a new national hospitals agency which is to be established on a statutory basis under the Department of Health.
The agency will also develop a national waiting time database to help "streamline the system and help avoid any potential duplication of patients on the waiting lists of various hospitals".
It will also develop guidelines for referral and prioritisation of patients within and between specialities.
The reduced waiting times, according to the strategy, will be achieved through the expansion in bed capacity and the establishment of a treatment purchase fund which will be used to purchase treatment for public patients from private hospitals in Ireland and from international providers.
The fund will have a budget of £25 million (€31.74m) next year.
A national treatment purchase team appointed by the Minister for Health will manage the fund and work closely with health boards.
"The national treatment purchase team will enter into immediate discussions with relevant hospitals and consultants to make streamlined arrangements to ensure that patients are 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.
This will always be subject to the patient's prior agreement and will be done in co-operation with the patient's consultant and or GP," according to the strategy document.
The strategy acknowledges the difficulties which have faced hospitals in recruiting and retaining staff.
There will be "substantial increases" in the number of consultants recruited across a range of specialities, the strategy says, but it does not specify how many.
There will be 10,000 nurses trained over the duration of the strategy. It is proposed that newly-appointed consultants will work exclusively for public patients for a specified number of years. Negotiations on the terms of consultant contracts are pending.
"The terms of the common contract for hospital consultants are central to the establishment of an appropriate balance between public and private care in public hospitals. The forthcoming negotiations on the contract must be undertaken using a developmental agenda which will involve restructuring of key elements of the current system to promote equity of access, organisational improvements and more clinical involvement in and responsibility for management programmes.
"In addition, the introduction of more flexible work practices, including teamworking, rostering, cover arrangements, competence assurance and accountability initiatives must be addressed. The aim will be to build on the strengths of the present system while also providing the necessary flexibility to implement the improvements which are required in the provision of health services to public patients," the document says.
It states that the rules governing access by private patients to public beds will be clarified.
"A hospital may be directed to suspend admission of private patients for elective procedures in a speciality until the waiting time for public patients is restored to within the target period of time".
In addition, health boards and the Eastern Regional Health Authority will optimise the use of operating theatres by extending their hours of work at evenings and weekends.
Hospital diagnostic departments such as radiology and laboratory will also have extended hours to provide services as quickly as possible to patients.
Procedures at outpatient departments are earmarked for improvement.
Acute hospitals will allocate individual appointments to each out-patient, changing the current situation where a number of patients are given the same appointment time and may experience lengthy delays before being seen.
Steps are also to be taken to improve the operation of accident and emergency departments. Additional A&E consultants will be appointed to facilitate rapid clinical decision-making.
Advanced Nurse Practitioners (ANPs) will be appointed to treat certain groups of patients in casualty.
Several different types of clinic will also be established within casualty departments to reduce waiting times including minor injury units, chest pain clinics and respiratory clinics.