Background An increasing and often inappropriately large proportion of the resources and attention of the healthcare system is being diverted into the Emergency and Urgent Care System (EUCS). This aim of this study was to describe the evolution of health policy relevant to EUCS in Ireland, using the Health Policy Triangle, to examine coherence between different policy documents and to assess implementation of these policies.

Methods A retrospective documentary analysis of published national and regional policy documents related to the EUCS was conducted. Current policy documents governing EUCS were included, encompassing National Health Policy (e.g. Strategy), National Reconfiguration Reports (e.g. Report on the Establishment of Hospital Groups as a Transition to Independent Hospital Trusts), Regional Reconfiguration Reports (e.g. Reconfiguration Roadmap), Regulatory Reports (HIQA), and National Clinical Programme Reports (e.g. Emergency Medicine Programme). A framework approach was used to analyse the documents, identifying context, actors, content and processes.

Results The EUCS policy context in Ireland is influenced by the socio-political, economic and cultural environment. Historically, the Churches and medical profession were dominant actors but recently national and international regulators, the media and the general public are visible. Drivers have remained consistent over time and include quality, access and equity, specialisation, patient safety, clinical governance and cost. The analysis revealed three types of evidence which informed policy formation; expert opinion, peer review research, and assessment of the status quo (a de facto limited evaluation of current policy). The use of each type of evidence in policy formation has evolved over time with increasing use of peer review research as it has become available. Public consultation and involvement has also improved over time, though this is a poorly developed area. EUCS policy demonstrates both coherence and inconsistency. The main recommendations of all current EUCS policy relate to a new model of care, which sees centralisation of acute complex care, and the development of critical enablers needed to achieve implementation. However, incoherence emerges in implementation attributable to repeatedly changing governance and management structures.

Conclusion Emergency and urgent care is a developing area. There are sustained efforts to develop a systems approach. Public opinion when expressed is often negative as service user involvement particularly in policy and health service development is piecemeal.