'Lack of clarity' on use of private beds

Private hospital beds should be completely separate from the public health system to guarantee public patients do not suffer second-class treatment, the strategy report recommends.

Highlighting waiting lists as one of the main priorities, it says the National Quality Authority should set standards to ensure patients "with the greatest need are offered treatment first".

Under 1991 rules, 20 per cent of public beds were made available to consultants for their private patients, though in reality the figure currently may now be nearer to 30 per cent. "The system was meant to ensure that private patients only attracted charges and fees when they elected to be private and when they occupied a private bed. However, there is now a lack of clarity around the issue," the health strategy says.

Contracts with consultants, the report notes, covers "the hours committed to public hospitals - 13 sessions per week - and not the hours committed to public patients".

In the Eastern Health Regional Authority, which includes Dublin city, 75 per cent of consultants practice in more than one hospital, while "a significant number" are involved with more than one.

All major accident and emergency units should have observation wards alongside, though patients in the latter should be kept in for no more than 24 hours to ensure medical patients are no longer admitted through A&E.

Half of all patients should be treated by day and not kept overnight, while better systems should be put in place to ensure that patients are discharged quickly and safely.

The report commits the Department of Health to "work towards a system where all private beds would be in a separate discrete building, ideally on an acute hospital site". Private equipment should be available to public patients for a fee.

Definite appointments should be offered in out-patient departments, along with extended opening hours, rather than the current system where multiple appointments lead to long delays.

During public consultations, the Department of Health found three-quarters of those attending out-patient clinics were unhappy, while an even higher number expressed dissatisfaction with accident and emergency units.

Most problems were with waiting times, but not all. "The public consultation identified the need for more courtesy, respect, and more time to listen, to reassure." Even when the public does complain, it gets little response, the report accepts.