Madam, - The proposal by the Minister for Health and Children to make 1,000 extra beds available in public hospitals by encouraging the development of new private hospitals and converting existing private beds to public use may not be the panacea to our bed capacity problem.
Tim Delaney (August 2nd) rightly points out that this proposal is in line with a Government policy to move towards a US-style system where the private hospital sector is separate from public care.
Having worked as a junior doctor, research fellow and consultant in the US from 1990 to 1998 I would like to add my voice to this debate. The US-style of health system provides the best and the worst of health care. Forty-five million Americans without health insurance have to seek treatment in city hospitals or Veteran Administration hospitals.
During my time in the US I worked in both private and public city hospitals in Manhattan. The contrast between the two is stark. In private institutions there is superb healthcare for complex medical problems. However basic nursing and medical care is poor, to say the least, in many public US institutions. This view is echoed by many of my colleagues in the US. The Irish public and government need to be aware that this US-style approach to healthcare can result in poorly funded, poorly resourced and poorly run public institutions alongside well-funded and well-resourced private institutions.
Furthermore, what will happen to Irish patients with health insurance who suffer from chronic disease? Private institutions do not have stroke units. It is a fact that patients admitted to stroke units have 20 per cent lower mortality, recover more quickly and do better than those admitted to a routine medical ward.
Therefore a patient with a stroke admitted to a private institution will miss the multidisciplinary stroke care of speech and language therapy, occupational therapy, social services, and physiotherapy. Will stroke patients with private health insurance be excluded from public stroke units?
David Sowby (July 18th and 25th) rightly points out that Irish doctors and nurses provide excellent high-tech healthcare in Irish public hospitals. The problem is one of lack of access to this care because of bed shortages and overcrowding in A&E departments, outpatients and wards. At the Mater Misericordiae University Hospital the overcrowding in A&E is simply due to delayed discharge of inpatients from the hospital wards. At time of writing there are 99 patients fit for discharge to beds in nursing home or rehabilitation facilities. However, neither the beds nor funding are available to facilitate their discharge. Thus more than 65 per cent of our acute medical beds are not available to A&E patients.
Rather than separating the public from the private sector, perhaps the Minister and Government should encourage private investment in rehabilitation and nursing-home facilities. The northside of Dublin has only one rehabilitation hospital - St Mary's Hospital, Phoenix Park. Long-term care patients currently use 48 of St Mary's 52 rehabilitation beds. The development of rehabilitation facilities and expansion of bed numbers at St Mary's Hospital, St Bricin's Hospital, St Brendan's Hospital or St Joseph's Hospital, Raheny are obvious solutions to the present problem. These developments could be relatively inexpensive, as rehabilitation facilities do not require expensive technology.
The Minister, the Government and the public need to think long and hard about moving to a US-style Darwinian healthcare system that provides excellent health care to those with insurance but poor care to patients without it.
Finally, my invitation of June 10th to the Minister to come and join our busy team at the Mater Hospital for one day to see our problems at first hand still stands. - Yours, etc,
Dr TIMOTHY LYNCH, Consultant Neurologist, Mater Misericordiae University Hospital, Dublin 7.