HEART BEAT/Maurice Neligan: The interpretation of dreams is the royal road to knowledge of the unconscious activities of the mind - Sigmund Freud.
The dreams in this case are apparently those of Ms Harney, the Minister for Health. She states that she wants to move 1,000 private beds in public hospitals into new private hospitals on the same hospital campus. She says that this is the essence of the plan that she is advancing to provide extra beds in the most cost-effective way. The article, in this newspaper last week, then outlines in a very sketchy way how this will be achieved. It has already elicited views for and against.
To the proponents and opponents alike, I would urge caution. Let us see the plan and the costings, which we are told have been subjected to rigorous health policy and financial analysis, and that it stands up as beneficial for all patients and for public finances. Are these the same people within the civil service, particularly the Department of Health, who are responsible for the present catastrophe? If so, why should we believe them now? Needless to say, successive ministers bear no responsibility.
One cannot comment adequately on such a plan until we see it in its entirety. It should be quickly unveiled, discussed, debated in Dáil Éireann, and, above all, independently costed.
There are many curious things in the Minister's article and much, unfortunately, that is simply rhetoric. For instance: "The plan will also bring about better working arrangements for public hospital consultants. Working in teams, consultants will deliver a better service to patients." This reveals almost total ignorance of the way in which big hospitals actually work. In most, consultants are organised in appropriate specialty departments to work together to provide a comprehensive, all-inclusive service. They lack, however, the beds and, in many cases, the equipment to do the job adequately.
This article represents a vision. In my opinion, it is deeply flawed and many statements and presumptions within it must be seriously questioned. Firstly - and I place these questions in no order of priority - the medical insurers, VHI, BUPA and so on, have difficulties even now covering the present pool of private patients and hospitals, at current subscription rates. Witness VHI's fears that it may become insolvent if risk equalisation is not introduced. Equally, BUPA's avowed intention to quit the market if the same is introduced.
Leaving this problem to one side, it would seem to indicate that things are difficult enough for the health insurance companies. How then do they assume responsibility for an unspecified number of new private institutions who must recover their investment costs and also generate their profits from the funds of the insurers, and, ultimately, us?
If the State is to buy services from the profit-driven private hospitals, it raises the question as to why such services are not provided in the public hospitals. If the private management ethos has to be imported into public hospitals in order to efficiently provide a comprehensive service, so be it. Letting what we have fester and decline while you chase rainbows is not the answer to our problems.
Where are these new hospitals to be located? In what areas will public land be ceded to private developers to build hospitals for their profit? Will such developments have any relationship to the Hanly report, or is that now officially a dead duck? What are the implications for the consultant contract? The questions posed are endless.
The Minister further states that services provided in such hospitals must be available to the public sector at competitive prices. She asserts this is the way the National Treatment Purchase Fund works. Now, that is very interesting Minister. Nobody else knows how the NTPF works. In a letter to this newspaper, Dr Cyril Daly, one of the most respected practitioners in Dublin, relates his attempts to gain information into the workings of this fund. He wished to know how the monies were disbursed amongst the present private hospitals and consultants. He was told that such information was "commercially sensitive". He was further gratuitously told that such information would not be available under the emasculated Freedom of Information Act.
What nonsense is this? It is not your money Minister, nor that of the fund or Government. It is our money and we want to know it is being properly spent. This fund must be properly accountable. The secrecy surrounding its activities is scandalous and cannot be justified by weak claims of "commercial sensitivity".
Here's another question I would like answered, Minister. What becomes of the existing private hospitals located in areas other than on a major campus? The Bon Secours group, Blackrock Clinic, Beacon Clinic, Galway Clinic, Hermitage, Aut Even, etc. Where do they fit in to your mystical melange of the future? How many private, and, indeed, public hospitals will we have eventually?
I will pretend that questions about the acquisition of staff do not arise. I will equally gloss over the iniquity of the fact that these private hospitals have made no contribution to the training and teaching of such staff. I wonder, however, about the quality of the advice you have been given. I wonder also why you did not wait for some meaningful input from your newly established HSE. I feel, in all honesty, that you should refrain from promulgating this sketchy plan until all the dots have been joined up and we can see the whole picture.
You state that it "will reduce the two-tier system in our country rather than exacerbate it". I can think of nothing more calculated to reinforce it.
You also state - surprise, surprise - that it will take about five years to implement. Live horse and you'll get grass.
Lastly, Minister, I resent the hectoring Thatcherite bit at the end: "It will work". I don't think it will. I think it will make a bad situation worse.
Maurice Neligan is a cardiac surgeon.