The Government has been urged in a new report commissioned by the Irish Congress of Trade Unions (Ictu) to abandon its plan to allow private hospitals to be built on the grounds of public hospital facilities.
The plan, announced by Minister for Health Mary Harney last July, aims to free up 1,000 beds in public hospitals over the next five years by transferring private beds in the public hospitals to adjacent private facilities.
But the report commissioned by Ictu, which was published yesterday, warns that "the negatives outweigh the positives" when the plan is analysed. It points out that private hospitals do not offer a complete acute care service.
"They concentrate on elective surgery in less complex and more profitable areas. For that reason, private beds in newly-constructed private hospitals on public hospital grounds will not free up private beds in public hospitals for public use on anything like a one-for-one basis," it states.
The report was compiled for Ictu by New York-based professor of economics A Dale Tussing and healthcare economist Maev-Ann Wren.
It criticises the Government's National Treatment Purchase Fund (NTPF) as neither an efficient use of public money nor an equitable way to treat patients. The fund was set up to arrange private treatment for public patients who had to spend long periods on public hospital waiting lists.
The authors recommend public hospitals with unused capacity be funded to treat more patients within the public system, not via the NTPF.
And they say the new Health Information and Quality Authority, rather than the NTPF, should be responsible for keeping hospital waiting lists.
Among a wide range of other recommendations made in the report are a lifting of the cap on recruitment in the health sector, increased health spending which they say is currently "inadequate", implementation of the Hanly report on hospital reorganisation "for the sake of efficiency, equity and, more than anything else, for patient safety", free primary care for all, reform of consultants' contracts, and the introduction of risk equalisation in the Irish health insurance market.
The report claims there are less acute hospital beds in the State now than in 2001 when the national health strategy promised to provide 3,000 additional acute beds over a 10-year period.
"Growth of population and the HSE's redefinition of some hospitals as non-acute has reduced the ratio of acute beds to population since the publication of the strategy in 2001. The increase in inpatient beds in hospitals defined as acute by the Department of Health has been 535 since 2001," it says.
It adds that the Government occasionally alludes to an increase of 475 in day beds since 2001 but claims most of this increase can be explained by the department's "redefinition of trolleys, recliners and couches as day beds, rather than by the addition of extra treatment places".
It calls for extra home helps and investment in public long-stay nursing facilities for the elderly to reduce overcrowding in A&E. "The authors have been told of one death after a patient left hospital following an inappropriately long wait for treatment in an A&E department," the report said.
The authors say the establishment of the Health Service Executive in place of health boards "removed the last vestiges of local democracy in Irish health care". They criticise the failure to set up regional forums to allow local input into health service planning.
They point to the unusual situation whereby the HSE's chief executive Prof Brendan Drumm is the accounting officer for almost all health service spending, yet Minister for Finance Brian Cowen will not deal directly with him and the HSE.