Thousands of public patients will be treated annually in private hospitals as part of a Government commitment to cut waiting times for treatment.
By the end of next year, no adult will spend more than 12 months on a waiting list and no child more than six months, the national health strategy promises.
Public hospitals could be told to stop admitting private patients for treatment if the targets for public patients are not being met.
The £10 billion strategy also promises a substantial increase in the number of people who qualify for the medical card - though it does not say what the new income limits will be. And improved financial assistance is to be given to those who care for an older person at home.
Measures to reform the way in which primary care - mainly family doctor services - works will be published tomorrow. The plan is likely to envisage the creation of "primary care teams" in which a patient might be seen by a physiotherapist, nurse or other health professional as well as by a doctor.
Three thousand extra beds are to become available for public patients within the next 10 years, according to the document. Some of these will be in public hospitals and some in private hospitals.
Of the 650 extra beds to be provided next year, 450 will be in public hospitals. Given the amount of time involved in providing the extra public beds, private sector sources were predicting last night that the State will rely heavily on beds and operating theatres rented in private hospitals next year to meet its targets.
Similarly, the promise that by the end of 2003 no adult will wait longer than six months and no child longer than three months is likely to mean a heavy reliance on private beds, sources predicted. It is also thought that a substantial number of the 3,000 promised extra beds could be in private hospitals which will have contracts with health boards.
The most ambitious promise on waiting times - no public patient waiting more than three months - is not due to be delivered on until the end of 2004. The promise is that treatment will begin not more than three months after a person is put on a waiting list from an outpatient clinic. There is no commitment on how long it will take to get an outpatient appointment - from next year every outpatient must be given individual appointments.
The strategy says new public beds will be for private patients only except in intensive care, coronary care and certain other specialities. The Minister, Mr Martin, yesterday complained that though private beds account for 20 per cent of beds in public and voluntary hospitals, 30 per cent of the procedures are on private patients.
Under the plan, a hospital could be told to stop admitting private patients for particular treatments if it is failing to meet waiting time targets for public patients.
The Minister said the private hospitals had assured him they could do the extra work without impinging on the work of public hospitals. Private hospitals largely rely on consultants who work in the public system and who could face sharply increased demands on their time from both their private and public employers. The document proposes that newly appointed consultants will work exclusively for public patients for a number of years. This , if it can be agreed with doctors' unions, may free their colleagues to do more work in the private hospitals.
A key aim of the strategy is to treat people at home without the necessity for them to be hospitalised as in-patients or institutionalised.
For this reason up to 600 primary care teams will be established in the next 10 years. In such a setting, the family doctor could refer a patient to the physiotherapist, occupational therapist, home help or other health professional who might very well work in the same building. The theory is that the help given to patients in this way, before a crisis occurs, will help to keep them out of hospital.
Also aimed at keeping people out of institutions - particularly nursing homes - will be the enhanced financial support for those who look after an older person in the home. As with many other measures in the strategy no details have been given as to how much this financial support will be worth. An extra 7,000 day centre places are to be provided.
If patients are unhappy with their treatment they will have a complaints system to which to bring that complaint. This will have statutory backing and will include a right to appeal to the Ombudsman about treatment in voluntary as well as - as at present - public hospitals.
For older people a wide range of measures is promised. They include 5,600 extended care/community nursing beds over seven years, 1,370 additional assessment and rehabilitation beds and 600 extra day hospital beds. The thousands of community nursing beds will be built in partnership with the private sector.
Such beds, by providing suitable placements for people currently on acute wards because they have nowhere to go that can meet their needs, could have a dramatic effect both on surgery and on emergency departments. Emergency departments currently have little option but to admit patients to surgical beds because other beds are occupied by people who no longer need acute treatment. As a result, planned operations have to be cancelled because the surgical bed is occupied by emergency cases.
Currently, State-run residential services for older people are not subject to inspection as private nursing homes are. Residential care for older people will in future be inspected by the Irish Social Services Inspectorate.
A national hospitals agency would advise the Minister on which hospitals should get specialities and would manage waiting lists. This could see the agency, not health boards, recommending the closure or amalgamation of hospitals or the establishment of new hospitals.