The ethos of our health service changed forever as the first private A&E opened. Laura Slatteryreports
Business was brisk on the first day at the new accident and emergency department of the Beacon Hospital in Sandyford, Dublin.
As the first A&E facility in the eastern region to be attached to a private hospital swung open its doors a fortnight ago, the unit was swiftly inundated with people willing to pay €120 - double the public hospital fee - to be seen by private A&E consultants.
The A&E department is the latest addition to the 183-bed, nine-floor private (or independent) Beacon Hospital, which opened last October. It has also become the latest focus of critics who argue that the creeping privatisation of healthcare will result in a two-tier health service where care is given based on a person's ability to pay instead of their medical need.
The Beacon Emergency Department is open 8am-6pm, Monday to Saturday, with the exception of public holidays. It accepts walk-in patients as well those referred by their GPs - ambulance patients will continue to be brought solely to public hospital A&Es.
The Beacon A&E can treat a much wider range of conditions, including chest pain and major fractures, than VHI's two privately operated Swiftcare clinics in Dublin, which it describes as "urgent care" clinics and cost €95 for the initial consultation - most commonly on minor injuries such as sprains and strains, minor fractures, soft tissue injuries and cuts requiring stitches.
Another private primary care facility at Smithfield in Dublin, Charter Medical, opened last year and offers urgent care, diagnostic and screening services as well as outpatient services for the over-70s.
Unlike these urgent clinics, private patients at the Beacon A&E can be admitted to the on-site hospital.
It will not, however, be able to deal with level-one trauma cases such as victims of serious road crashes. Its opening hours also mean it will avoid an influx of intoxicated patients with alcohol-related conditions - the kind of cases that put immense pressure on public A&E departments on a Saturday night.
This fuels the argument of those who say private hospitals cherry-pick the type of cases they handle.
It is a debate that is likely to become more heated if the Minister for Health's plan, to award developers contracts to build satellite or co-located privately run hospitals on the sites of eight public hospitals, goes ahead.
These co-located hospitals, which are earmarked for Waterford, Cork, Limerick and Sligo and four in Dublin, will not have A&E departments, according to the Health Service Executive (HSE) co-location project director, Tom Finn, at a recent conference on private healthcare.
Emergency cases will continue to be handled by the existing public hospitals. Co-location will not bring about widespread private emergency care, the HSE insists.
Cherry-picking the non-trauma cases is, in a way, part of the point of private A&E and urgent care clinics.
Until now, if someone in the Dublin area fell and sprained their ankle or suffered a substantial laceration, they faced long waiting times in overcrowded, trolley-dependent A&Es because their treatment was not prioritised compared with "very urgent" emergency cases, says Dr Patrick Hyland-McGuire, emergency medicine consultant at the Beacon Hospital.
"I felt for many years that this was a deficit in the system," he says.
The initial strong demand for the Beacon's services proves that there was a gap in the market.
Private A&E units and urgent care clinics also alleviate pressure on public hospitals, Hyland-McGuire adds.
"It's not going to solve the whole problem with A&E waiting times. But if we see 20 or 30 people a day, that's going to lessen the burden on the public sector."
Similarly, VHI says its Balally Swiftcare clinic has seen 25,000 patients since it opened in November 2005, while about 10,000 patients have been treated in its Dublin City University clinic since it opened last June. The clinics treat an average of 120 patients a day, rising to 135 a day on bank holiday weekends.
The first private hospital to provide emergency services in the Republic was the Galway Clinic, at Doughiska, near Galway city. Before it opened in 2004, A&E was the one area in medicine where the 52 per cent of the population with private health insurance couldn't be treated any differently than someone without insurance.
VHI, Bupa and Vivas members had to put up with the same hellish, chaotic emergency departments as everyone else: the ability to afford a health insurance premium averaging €500 a year didn't mean you could skip the A&E queues.
But now the inequities that exist in access to elective operations are spreading into emergency care, embedding a two-tier system that is "the scandal of the Irish health service", according to Dr Fergus O'Ferrall, director of the Adelaide Hospital Society.
O'Ferrall favours the kind of universal social health insurance system that exists in countries such as Germany and Holland.
"If we had universal health insurance, it wouldn't matter if there was a small private healthcare system," he says.
"But giving extraordinary tax breaks to private developers is not the way to address the need to give everyone access to a proper health service."
There are also "issues of trust" with for-profit hospitals, he believes.
For VHI Swiftcare, the Beacon Hospital and other private operators, it is a question of choice - for those who can afford it.
The "embarrassment" of the Irish health service won't be eradicated overnight, says Hyland-McGuire.
"Hopefully, someone at Government level will come up with the perfect system of healthcare for everybody. But I don't think this will happen in three months or six months or a year or two from now. Choice is the only short-term practical option at the moment."
But critics of the Government's growing reliance on the private sector to solve its health service woes, say the current plans to speedily build co-located private hospitals, adding 1,000 beds to the system, represent a turning point. The next few pre-election months are critical for the future of the service, O'Ferrall says.
"There is a fundamental struggle over the soul and shape of Irish healthcare."