Consensus favours more hospital beds and less spending on administration

Reaction: from health workers and patients conducted in interviews by Kitty Holland.

Reaction: from health workers and patients conducted in interviews by Kitty Holland.

Eileen O'Farrell: public health nurse in the eastern region

I welcome the fact the reports propose that frontline servers have their own budgets. That's the first time that has happened and is something that would make our jobs a lot easier.

We would also agree there should be less administration and hope that would come with a reduction in the number of health boards. There is far too much bureaucracy. For instance, if I want to order some equipment, it has to go to my line manager, then passed to administrators and then management to be passed. For some items it can take months.

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Immediately we need more staff and more resources in the community care. We were long ago promised more consultants and we do need them. There is no point in promising new administrative structures if there are not going to be more resources, more beds to back them up. My greatest fear would be with these reforms that the public expects they will get better care and that is not going to happen without more resources

Dr Éamonn Faller: family GP in Galway

I agree with the prospectus proposal that the Department of Health should focus on strategy rather than on the day-to-day running of the service. And I think the running of the service should be left to professional managers.

On taking politicians off health boards, I think that's a good thing, though I do think local politicians should be in a position to lobby.

On the Brennan proposal that GPs should have greater financial responsibility, I think that's a good thing, though I would point out we are very careful prescribers, compared with the rest of Europe. My fear would be that it hasn't worked well in Britain and that it might land more paper work on our laps.

I absolutely agree about proposals for examining alternative means of accommodating long-stay patients other than in acute beds. If I have an elderly patient who has a bit of flu but lives alone, I have to send them to hospital when they all they really need is bed rest, feeding and simple nursing. And that's ridiculous.

Dr Éamon Brazil: consultant in emergency medicine at the Mater Hospital, Dublin

We certainly need radical reform from an emergency point of view. We have of course had reforms proposed before, such as the Comhairle na nOspidéal report a few years ago, and there have been few enough of the plans there implemented.

Our main problem is overcrowding in the emergency department and the Government is right to say it's not just an emergency department issue and to approach it from as many angles as possible.

We have to get rid of the 'exit blocks'. There are about 100 beds upstairs, out of 500 altogether, being occupied by people who could and should be cared for in the community.

If we could get them into convalescent homes or nursing homes it would ease pressure.

Services in the community need to be made a lot better and the public encouraged to go to them, to ease the number of people coming to A&E departments.

Ursula Tackaberry: patient awaiting admittance at Beaumont

I came in at 2 o'clock Tuesday afternoon with really bad chest pains and I was left in a chair until 6.30 this morning (yesterday).

I'm on a trolley now and I don't think I'm going to get a bed today.

I've had heart problems all my life, so I've been in and out over the years. It's just got worse over the years.

I think the main thing \ is less managers and more staff and more beds. If you go back a year, it was easier to get a bed. And years ago there would be six doctors in the emergency. Last night there was only one and today there's two. You have to be almost killed now. There's no bed and hardly any wards open and the patient is just stuck in the middle.

It's no so bad for me but for older people it isn't fair.

Karen Ann Nolan: agency nurse, Dublin

As far as I can see this restructuring of the health service is really about downsizing it. It is placing patient care after cost-cutting and saving lives behind saving money.

The Brennan Report talks about saving money for the health service when the Department of Health itself is wasting money and resources.

The proposals to reduce the number of health boards from 11 to four means local needs will be neglected. For instance, I would say services in the west will be run down.

I don't think any of this is about greater efficiency. One thing I do welcome though is the move to make consultants more accountable, because at the moment they are able to put private patients in public beds. They are serving themselves. But again I would say financial concerns are more at the root of all this than concerns about patient care.