State must contemplate perceived flaws in Sláintecare policy

Within the next few months, the Government will have to decide on whether to press ahead with proposals which would fundamentally change the shape of Irish hospital medical practice: the removal of private patients from public hospitals.

The all-party Sláintecare health reform report last year recommended as one of its key elements the phased elimination of private care from public hospitals, leading to an expansion of the public system’s ability to provide public care.

Minister for Health Simon Harris last month indicated to the Cabinet that a decision on whether or not to implement such a move would not have to be taken until an expert group which is assessing the implications finalises its work in the autumn.

The move to end private practice in public hospitals is being opposed by organisations representing doctors such as the Irish Medical Organisation and the Irish Hospital Consultants' Association – unsurprising perhaps given that their members generate considerable sums in income under this arrangement.

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The IMO argued that eliminating private practice rights in public hospitals would affect staff retention and that many consultants would consider leaving the public health system if a ban on treating fee-paying patients was put in place.

The proposal to remove private practice from public hospitals might actually disadvantage all patient cohorts in public hospital in the long term

The IHCA contended the Sláintecare report massively underestimated the cost of implementing its proposals.

Cost of €8bn

It maintained the proposal to remove private practice income from public hospitals would cost in the region of €8 billion per decade when adjusted for inflation or about €800 million per year.

However, the papers presented to the expert group – which were released by the Department of Health this week – show that those who run the hospital system also have concerns about the potential fallout from such reforms.

The HSE is worried about the loss of about €600 million in income which hospitals currently realise from private patients treated in their facilities.

The Dublin Midlands Hospital group which includes large centres such as St James’s and Tallaght hospitals – starkly set out its anxieties about the implications of the move in its submission.

“Dublin Midlands Hospital Group, while fully supportive of the absolute need for equity of access to care in public hospitals, retain a strong concern that the proposal to remove private practice from public hospitals might actually disadvantage all patient cohorts in public hospital in the long term, including public patients if the said consultant expertise is lost from the public system as a result of the proposal.

“Dublin Midlands Hospital Group are also somewhat concerned as to the ability of the public exchequer to fund a €114 million increased allocation to Dublin Midlands Hospital Group alone and the associated potential risk to the delivery of high-quality patient care and access if this funding stream is not fully replaced.”

Cross-subsidisation removal

On the other hand, Róisín Shortall, Social Democrats TD and a key author of the Sláintecare reforms, maintained that abolishing cross-subsidisation of private practice in public hospitals would offset the loss of the €600 million in income currently generated from fee-paying patients.

In her submission to the committee, Shortall said there was “a near-total absence of transparency regarding the level of cross-subsidisation from public funds to doctors and senior managers in publicly funded hospitals, to the health insurance firms that place their clients in those hospitals, and to the supposedly separate private clinics which many voluntary hospitals operate alongside their State-sponsored operations”.

“It is impossible to establish whether we are getting value for money from our public hospital beds, for example, or from our publicly funded equipment, our consultants or other healthcare staff,” she said. “Without a clear line of sight of resources, transparent data and effective information systems, it is not possible to establish accountability at either administrative or clinical level.”

The debate will intensify after the summer when the expert group completes its work.