Hospital consultants have welcomed publication of the health strategy but warned the need for hospital beds may be significantly higher than allowed for, writes Dr Muiris Houston.
While medical and patient organisations broadly welcomed the strategy, unions representing healthcare workers disputed whether it would deliver equity.
Mr Finbar Fitzpatrick, Secretary General of the Irish Hospitals Consultants' Association, welcomed the strategy but had two significant reservations. "By our calculations there is a need for 5,000 rather than 3,000 beds over a 10-year period, and I am also concerned that there is no reform of the health boards, especially now that the acute hospitals are gone from their remit."
Mr Stephen McMahon, of the Irish Patients' Association, said: "This strategy is probably one of the most important pieces of social planning this country has seen. It has placed the patient truly at the centre of healthcare." However he warned that funding must be delivered if patients needs are to be met.
Irish Medical Organisation president Dr Mick Molloy was pleased with the strategy document but was concerned that its aspirations would have budgetary back-up. "The Purchase Fund looks like a good idea - it will be a pressure reliever of acute services."
He said, however, it did nothing to deal with the long waiting times experienced by patients following GP referral and before they were seen in outpatient departments.
Dr James Reilly, chairman of the IMO GP committee, said it was too early to give an in-depth comment. He welcomed the broad thrust of the document and in particular the commitment to equal access to health services. He also welcomed the emphasis on extending the out-of-hours primary care co-operatives but questioned the Taioseach's reference to "a primary care system which is underdeveloped and too rarely available out of hours".
Mr Fionβn ╙ Cuinneagβin, chief executive of the Irish College of General Practitioners, welcomed the "patient-centeredness" of the health strategy. Ms Joan Kelly, Nursing Services Manager with the Irish Cancer Society, paid tribute to the breadth of the consultation process leading up to the strategy publication.
"The Irish Cancer Society particularly welcomes the focus on the patient in this document," she said.
Dr Jane Wilde, of the Institute of Public Health, an all-Ireland body, acknowledged the emphasis on population health and recognition that health service and health policy development was not seen as a stand-alone issue. "I specifically welcome the precise targets in the area of health inequality such as the commitment that the gap in premature mortality between the lowest and highest socio-economic groups should be reduced by at least 10 per cent by 2007."
IMPACT trade union, which represents 20,000 health workers, said the Government's health strategy would be judged on how successfully it achieved equity in health service delivery.
IMPACT National Secretary Mr Kevin Callinan said: "Some of the strategy's commitments on equity are too vague. For example, there is no detail on the aim of extending medical card eligibility. "The Government says it has prioritised equity in our health services. Their success will be judged on real progress in areas like the medical card and waiting lists."
Mr Callinan welcomed the report and said service users and health workers should continue to be consulted on its implementation. "If we are really serious about creating a first-class health service we must avoid the failing of the last health strategy, which was that not enough effort went into implementation once the strategy was published."
Mr Jack O'Connor, vice-president of SIPTU, which represents 30,000 healthcare workers, said the union was disappointed the strategy did not include any initiatives to "abolish the current inequitable two-tier health system".
"The fact that half of the private hospital beds are to be found in public hospitals is a clear indication that access to healthcare is determined by the needs of private medicine rather than the health needs of patients," he said.
The concept of equality and fairness put forward in the document was "nothing more than a dream as far as the Minister for Health is concerned but its absence will be a nightmare for the users of the system", he added.
The National Disability Authority welcomed the strategy but said it was still concerned at "the time it would take to turn many of the aspirations into reality" to meet the basic needs of people with disabilities.
The business and employer group IBEC applauded the emphasis on improving quality and value-for-money. Its director-general, Mr Turlough O'Sullivan, added: "The implementation of this ambitious and comprehensive health strategy will ultimately depend on a fundamental structural overhaul of the health system."