Simon Harris seeks to shake up consultants’ private work

Hospital consultants should be paid for treating private patients as part of their annual salary rather than earning payments for individual procedures, according to Minister for Health Simon Harris.

The Minister will unveil detailed plans today for the reform of the health service at the Oireachtas committee on the future of healthcare. These include a proposal to tackle the “misalignment” of financial incentives for consultants treating public and private patients.

Mr Harris wants to eliminate the incentive for hospitals and consultants to handle more private patients by establishing set charges for procedures payable by hospitals for both public and private patients.

Annual remuneration

Under his proposal, consultants treating private patients would move away from the current fee-for-service payments to an annual remuneration for both their public workload and their permitted level of private activity.

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The dismantling of the HSE and its replacement by a “much leaner” national health agency and regional health bodies is also proposed by the Minister.

Existing hospital groups and community healthcare organisations (CHOs), which are responsible for social services, need to be “geographically aligned” and put on a statutory basis, he says. “I think we should legislate for integrated delivery systems within defined geographical areas; what, for now, we might call Hospital and Community Health Organisations.”

It is not necessary to have the same number of hospital groups and CHOs but a hospital group should cover the same geographic area as one or more CHOs.

Regional structures existed in the form of health boards until they were abolished in 2004 to make way for the HSE.

Pending the dismantling of the HSE, legislation is needed to reform the organisation to improve governance, Mr Harris says.

Free GP care

Initiatives such as the cancer programme, integrated care programmes, the Fair Deal nursing home scheme and e-health should remain in a “slimmed down” national body while other functions are devolved to the regions.

He also appears to indicate the Government’s plan to expand free GP care to the entire population could take up to a decade. Eligibility for primary care services should be expanded “on a phased and prioritised basis” over the next 10 years, he says.

Mr Harris does not refer to the cost of reforming the health service in his presentation though he does says the committee, in drawing up a 10-year plan for healthcare, needs to give consideration to cost issues where progress is dependent on the availability of resources.

Mr Harris says ways must be found to improve access to healthcare without losing focus on patient safety, efficiency or cost effectiveness. However, he adds, demand for health services will probably always challenge the provision available and the resources available will always be limited.

“That is just a reality. But I think we all agree that we need to do better than we are doing at present.”