Voluntary hospitals and State clashing over pay and governance

Last week highly-charged correspondence emerged in which the National Maternity Hospital Holles Street made clear its view that it is not accountable to the Health Service Executive either for its governance or day-to-day operations.

The hospital receives about €50 million annually from the Exchequer via the HSE, but it argued, in a dispute over executive pay, that it still was “a private entity” which had an independent identity and operational autonomy.

The row between the hospital and the HSE was just the latest to blow up between Ireland’s voluntary hospital sector – which is very keen to retain its independence – and the State which provides the vast bulk of funding and has increasingly been seeking to impose greater centralised control.

For decades the Irish State essentially outsourced the provision of much of its healthcare services to the private sector, whether that be to general practitioners working as independent contractors or to voluntary hospitals.

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The voluntary hospitals and health agencies, known technically as section 38 organisations, receive between them several billion euro annually from the State. Their employees are considered to be public servants, and they receive public service pensions on retiring.

However, there have been a number of controversies between these organisations and the Government in recent years, mainly over top-up pay for senior executives , governance issues and the ownership of State-funded assets.

Controversies

These controversies have thrown up a number of hugely important issues such as can individual independent voluntary hospitals pay staff – who are public servants – more than official Government limits or authorise private practice rights different to those elsewhere in the public system?

Minister for Health Simon Harris is to bring proposals to Cabinet this week for a review to be carried out as to where voluntary hospitals should fit in the future structure of the Irish health service.

This Government, and its predecessor, have been committed to establishing formal groups of hospitals, including those run by the State and by the voluntary bodies. Yet it has never been clear how exactly this structure involving State-owned and non-State-owned institutions would work given the jealously-guarded independence of the voluntary sector.

Promised legislation to give effect to such a structure had been delayed pending the recently-published report of the Oireachtas committee on the future of healthcare.

At present the board of the various hospital groups do not have statutory powers, and according to the Department of Health "are mandated to assist and advise in respect of acute hospital services".

Social services

Sources expect the Minster to ask the Government this week to authorise the establishment of a review group to inquire into the current role and status of voluntary organisations in the operation of health and social services in Ireland.

It would also look at the issues which arise in connection with the provision of services to the public through such organisations, and to make recommendations on how the relationship between them and the State in the arena of health and social services should evolve in the future.

It is likely the voluntary sector will press hard to retain its existing autonomy, but the review could result in the most fundamental shake-up of the structure of the Irish health service in decades.