THE CEO OF the HSE has said that he “doesn’t accept” that he was “too late” in approaching the Private Hospitals Association (PHA) on contracting additional bed capacity from them for the busy winter months ahead.
Bernard Gloster said he was “surprised” by the stance of the PHA that has “come into the public domain”, after the association wrote to him, informing the HSE that it may not be possible for private hospitals to provide additional beds this year “at such short notice”.
Gloster told the oireachtas health committee that the HSE would not be acting in the public interest if it contracted additional beds at “any cost”.
He added that if more beds cannot be secured for the winter period, the health service will continue to provide care as best as it can.
PHA CEO Jim Daly told The Journal that it remains committed to helping the public health system, but added that it is “very challenging” for the association to accommodate requests for additional beds over a four month period “with two to three weeks notice”.
He added that the PHA has repeatedly asked the Department of Health and the HSE to work towards “a more longer-term strategic partnership that allows the private hospitals to scale up capacity and staffing levels within their hospitals to accommodate the HSE’s requests for more beds”.
However, Gloster today told questioning TDs at an oireachtas health committee meeting this morning that it isn’t the case that he “just picked up the phone and ask for a couple of beds. “
The PHA told Gloster last week that it may not be possible for private hospitals to provide the capacity required by the public system for a four month stretch over the winter during the busiest period of the year.
It said that these hospitals would have to rely wholly on agency staff to cover publicly contracted beds within their wards, which would come at a considerable cost.
Gloster disputed the reported narrative of the negotiations between the HSE and the PHA.
He informed the committee that the HSE, since last February, has been paying for 160 beds within the private system every day, at a cost of roughly €1400 – €1500 a day.
“I dont accept that we turned up last week and picked up the phone and asked them for beds, we are spending serious, serious money every quarter on these beds,” Gloster said.
When asked if the current arrangement between private hospitals and the HSE is “highly lucrative” for the private sector, Gloster said: “Of course it is”.
Jim Daly of the PHA stated that it has no issues around “cost or price” as a representative body, as it has “no role in this function”.
He said that the PHA is advocating for a longer-term approach to the arrangement between the sectors, that will ensure “the highest levels of clinical governance and patient safety”.
His comments come as medical organisations, including the Irish Nurses and Midwives Organisation, has expressed fears about the HSE’s preparedness for the levels of overcrowding that will inevitably hit the health service over the winter months.
Gloster said that the HSE approached the PHA from a planned position, but that it was “just not the planned position they would have liked”.
He explained that as a part of ongoing discussions, the HSE was to approach the PHA with a pre-procurement briefing for more beds on top of the 160 it is currently contracting, for the winter “surge” months.
He admitted that the HSE was “a few weeks late” in producing this promised framework, but added that it offers a “fair and reasonable” outline for the price to be paid for additional beds.
Gloster added that the PHA is seeking a long term purchasing agreement with the HSE, that would see the health service invest in building beds in the private system as well.
He said that the HSE is not prepared to go into talks on this agreement until it has conducted a review on the “efficacy and impact” of private hospital beds for the public health system.
Gloster added that he hopes the PHA will “revisit its position” on providing capacity to the public system over the winter months.
He clarified that the HSE is spending tens of millions on the beds it is already contracting from private hospitals.
The HSE’s budgetary deficit also came under questioning during the committee meeting, which representatives from the Department of Health were also present at.
Gloster clarified that the deficit for the HSE is likely to hit over €1.1 billion by the end of this year.
Sinn Féin’s spokesperson on Health, TD David Cullinane, said that he had received minutes of a Department of Health ministerial briefing that took place on 23 March on the HSE’s National Service Plan.
He said that the HSE had advised the Department that the calculated level of financial risk, which projected a potential deficit in the region of one billion.
Cullinane added that in the briefing, the Department informed the Health Minister that the deficit was likely to be in the region of €400 - €500 million, and that in the Department’s view, the service plan should omit any mention of “financial risk”.
Cullinane asked the Department’s General Secretary Robert Watt if he accepted that the Department’s estimate had been “grossly inaccurate”.
Watt said that the Department accepted that the current model of budgeting for the HSE is “not fit for purpose” and “needs to change”.
He disputed that the Department advised the Minister that the National Service Plan should not mention financial risk.
Cullinane retorted: “That is what is says in the briefing”, and told him he was “dancing on the head of a pin”.
Gloster told the committee that the overspend within the HSE falls into four main categories – health inflation (which relates to the price of drugs and other healthcare related costs), general inflation, additional demand, and financial governance issues.
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