Sir, – Dr Fergal Hickey makes an eloquent case for more accident and emergency funding by citing the situation in Australia ("Australian emergency care the State's best template", Opinion & Analysis, January 8th).
What he doesn’t say is that Australia has invested heavily in primary care with GPs resourced to deal with much of the work that Dr Hickey and his colleagues currently see in their departments. Every A&E department that has been extended and better resourced here in Ireland is too small and too busy within 18 months because of a culture of attending A&E in our cities and consequent lack of development of out of hours care in the community. Dr Hickey is making a good case for emergency care for trauma such as serious road traffic accidents and acute cardiac and respiratory illnesses. These are relatively uncommon situations. Indeed to deal with such urgent cases we don’t need all our A&E departments. Our improved road access and increasingly professionalised ambulance service now makes this reduction possible with very sick patients having much better outcomes with such a specialized service. What rightly upsets Dr Hickey and his colleagues are the vast numbers attending A&E that could be dealt with by general practitioners. This is now happening nationally with GP co-operatives seeing over a million patients out of hours last year. I know of one long-established co-op that sees twice as many patients as does its local A&E department and another new co-op that sees nearly 30 per cent of the numbers seen at its local adult A&E. In an experiment in St James’s Hospital in Dublin some years ago, employing GPs in A&E meant far fewer patients were referred into the hospital system when compared with the usual care. The decision-making ability of the more experienced GPs led to more patients being discharged back to their own doctor for further care. A&E as it is currently functioning has senior staff trained to deal with trauma and very sick patients. The majority of patients don’t need that level of care. Our A&E departments are currently functioning as primary care facilities but with access to diagnostic and inpatient facilities denied to GPs. This puts GPs at a clinical disadvantage in terms of resources and in providing an appropriate level of care to patients. The country cannot afford more of the same in A&E departments which will never solve the problem. It needs to rationalise our existing A&E departments into a few well-placed trauma centres. But most of all the system needs to strengthen primary care to let Dr Hickey and his colleagues do what they have been trained to do in a few well-placed specialised centres. – Yours, etc,
TOM O’DOWD, MD
Professor of
General Practice,
Trinity College Dublin.
Sir, – Planning for emergencies should be done in advance. The annual crisis in our hospitals takes place each winter and planning should begin at least six months beforehand and all contingencies should be factored into the plan to be implemented as and when appropriate. When next winter arrives, as it will, perhaps Minister for Health Leo Varadkar and his handlers , advisers (special and otherwise), civil servants, etc, will be prepared? Probably not. – Yours, etc,
HUGH PIERCE,
Celbridge, Co Kildare.
Sir, – In future when our Defence Forces deploy overseas, will they be bringing field hospitals with them or will portable corridors suffice? – Yours, etc,
HUGH T HYNES,
Limerick.