Fine Gael/Labour Joint Policy on A&E

The latest in the series and, to be quite honest, there is little in it that is disagreeable (unsurprising since there is a consensus of opinon to tap into in this regard). The ideas that are forwarded in the policy are quite interesting in and of themselves, but one particular section has me wondering.Step-down beds and urgent care centres are something that health care professionals have been pointing to regularly as key weaknesses within the system which leads to crunches at A&E. The policy document proposes to create 1,500 step-down beds and 15 urgent care centres (3 in Dublin, 12 rurally). These centres act as a mini-A&E for those who really need GP care, moderate observation and only attend A&E when GPs are closed. The idea is a grand one and seems to respond to the need for integrated GP-A&E/Admissions thinking.

Similarly, step-down beds are the theme of the health system. Not enough beds to release patients to, ergo overstaying patients, ergo backup at A&E. The policy outlines an ambitious 1,500 step down bed plan in the document.

These numbers sound great and are clearly geared to meet demand. So why am I bothering posting?

Well, costings at the end of the document suggest a captial investment of €575 million. €375 million will go on the step down beds, the rest, I’m guessing, will primarily go on the UCCs and GP services. So why haven’t government done it?

And they haven’t, they had a health strategy and at last check—thanks, Google—they haven’t come close to recognising the target in terms of additional beds and primary care units. Beds at a rate of 200 a year since 1997 is 1,800 acute beds, or 1,000 since the health strategy (1/3 of the target). And a classic piece of admission-avoidance by the Taoiseach suggests that things are a little off-track.

If it could have been done in such a way and for as little as €500 million—the health budget is €12 billion—why hasn’t it been done by now? Something of a combination of organisational drift and political inaction, I suspect, though cannot prove.