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Make or break year for health services as bed cuts kick in

There are hidden timebombs in the HSE's service plan for 2010, the most worrying of which is the intention to cut admissions to hospital beds through emergency departments by more than 30,000.

At the same time, hospital bed numbers are to be reduced further. This is, to put it mildly, a high risk strategy that could have serious consequences for patients if it doesn't work out.

How a plan to divert patients out of hospital beds and then reduce further the number of beds for patients who really need them will work has yet to be properly explained.

In theory, the plan to cut admission numbers actually makes sense. Many people who are eventually admitted to a bed through A&E may not need to be in that bed.

They could be in that bed simply waiting for a test or an X-ray or for a consultant opinion on their condition, or they could be treated more effectively by their GP.

In an ideal world, alternative facilities could be used to treat these patients while keeping them out of a hospital bed and relieving pressure on A&E and other hospital services.

We rely far too much on an overstretched and expensive hospital service for treating practically all our ills.

Unfortunately, our health services do not exist in an ideal world. Despite many attempts at reform, some partially successful, the old problems of trying to get quick access to services just won't go away.

So diverting some patients away from hospitals to more appropriate facilities does make some sense. The big worry is whether, in our under-resourced health service, those alternative facilities are actually there.

You can't blame the health authorities for coming up with new ideas, but in this case there's no guarantee that the cure won't be worse than the disease.

We are told that the planned reduction in admissions will be achieved by increasing access to senior doctor decision making in assessment units, and improving access to diagnostic testing such as X-rays, without having to admit the patient.

However, it is admitted that we currently don't have enough of these assessment units operating.

Nor is it clear how better access to tests will be provided.

What's more, the HSE says patients can be kept out of hospital by diverting them to primary care, where their GP and other health professionals can look after them.

The HSE says greater reliance on primary care will keep more patients with long-term illnesses out of A&Es and hospital beds.

In an ideal health system this would certainly be true, unfortunately we do not yet have such a system.

The problem, is, a well-oiled primary care machine tasked with avoiding thousands of unnecessary hospital stays does not yet exist.

A report from the Oireachtas Committee on Health and Children this week showed that a mothballed Government strategy from 2001 envisaged hundreds of new primary care teams working in brand new centres that would be "mini-hospitals" in all but name.

While some care teams were eventually created, so far only two HSE-provided primary care centres have been opened under the HSE's latest plan. Some more will be built this year, but it is a far cry from the Government's ambitious plans of nine years ago

The report said that in order for these teams to work efficiently, all the staff involved should be under the same roof. Many would feel this is a no-brainer.

One GP described the primary care teams as 'virtual' as there are few actual buildings for them to work in.

Indeed, much of the plans for hospital services this year appear to be based on 'virtual reality'. Which is OK if you are only virtually ill.

The HSE has admitted that its plans for hospital services this year are challenging.

And that is even before it takes into account problems with staff shortages which could, it admits, affect patient safety.

2010 could be a make or break year for the health services.

Niall Hunter is Editor of irishhealth.com


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