Consultants say removing private care from public hospitals is ignoring 'the elephant in the room'

HOSPITAL CONSULTANTS HAVE have said a recommendation to end private care in public hospitals amounts to ignoring “the elephant in the room” and not dealing with capacity issues.

An independent review group established to examine private activity in public hospitals recently made a number of recommendations to the government, including calling for the introduction of legislation to ensure that public hospitals are only used to treat public patients.

A report published last week stated that the treatment of private patients in public hospitals should cease upon the conclusion of the 10-year implementation period for Sláintecare, a cross-party plan to overhaul the Irish health service over the next decade.

Speaking at the launch of the Irish Hospital Consultants Association pre-Budget 2020 submission in Dublin city today, the IHCA’s Secretary General Martin Varley said the proposal is “a deflection from dealing with the elephant in the room”.

Varley said the number of private patients using public hospitals is declining and that the government’s focus should be on increasing capacity.

“The elephant in the room is capacity … They want the capacity to treat patients on time, that’s what all the consultants are telling me, that’s what’s really causing frustration. They don’t have the capacity. So let’s focus on what I’m sure will resolve the problem of waiting lists, let’s get the capacity in place, as they have done in other countries.”

The recommendations in last week’s report would cost about €650 million per year to implement, Dr Donal De Buitléir, chairperson of the review group, said.

Speaking at the IHCA press conference today, Dr Gabrielle Colleran, a paediatric radiologist at Temple Street and Holles Street hospitals in Dublin, said she is concerned about hundreds of millions of euro being “taken out” of the health service.

“My worry is that €700 million will be taken and not be replaced. And what will happen is this, the private sector will get more specialists, will be better resourced, and we will see an even further widening of the health inequality in our country.”

Colleran said if Sláintecare is going to be fully implemented and private practice removed from public hospitals, “there has to be full investment in our public hospitals so that we are staffed and equipped and have the capacity to deal with the complexity that is only dealt with in our public hospitals”.

Make no mistake, a piecemeal implementation of Sláintecare will only create more opportunity for the private sector to make more money, and will not actually help us deliver … timely access to quality care where nobody in this country waits more than six weeks.

Discussing the issue on Twitter, Dr Mark Murphy said the intersection of public and private healthcare is complex and shouldn’t just be reduced to the figures in De Buitléir’s report.

Murphy also noted that private insurance companies have lobbied against Sláintecare as it could result in them losing money, stating: “This is unsurprising as Sláintecare will mean that possessing health insurance is an optional extra.”

‘Breaking point’ 

In its pre-Budget 2020 submission, the IHCA calls on the government to urgently address record waiting lists and the “unacceptable” number of patients being treated on trolleys.

The IHCA also wants the restoration of pay parity for all consultants appointed since October 2012, saying this is essential in order to retain and recruit staff. The organisation said it may launch a legal case if this does not happen. 

More than one million people are on waiting lists nationally and over 9,500 patients had to wait on trolleys for a hospital bed last month.

At today’s launch, IHCA President Dr Donal O’Hanlon said the acute hospital system is “at breaking point due to a severe shortage of consultants and a lack of beds and other facilities”.

O’Hanlon said the quality and safety of patient care is “deteriorating further due to persistent underinvestment” and patients cannot be expected to wait for the “promised land” of Sláintecare.

One in five of all consultant posts (500 positions) are currently vacant or filled on a temporary basis. The IHCA said this is having a huge impact across Irish hospitals and mental health services, namely:

• The number of additional patients waiting to see a hospital consultant is growing, on average, by 7,000 patients per month since the start of 2019
• 200,000 more patients are now waiting to see a hospital consultant than was the case in 2014
• The number of life-enhancing elective surgeries in public hospitals have more than halved (54%) from 197,817 in 2012 to 91,815 in 2018
• The cost to the State in resolving adverse outcome claims under the Clinical Indemnity Scheme has ballooned to €246 million from €62 million in 2013

In a bid to tackle this, the IHCA, which represents over 95% of hospital consultants, said the government needs to significantly increase investment in acute hospital and mental health services in Budget 2020 – which is due to be unveiled next month.

In Budget 2019, Exchequer funding for public hospitals increased by €225 million, the IHCA said this was “far short of what is required to address the demand for care presenting and cost increases including new healthcare developments”.

The government today published the HSE’s spending plan for the next three years – 250 projects are due to be delivered at a cost of €2.1 billion.

The IHCA said that while elements of the plan are welcome, “it will deliver less than promised under the National Development Plan, particularly on beds”. The NDP promised 260 new hospital beds each year from 2019 to 2021, totalling 780 beds. Today’s plan provides for 480 beds.

The IHCA pre-Budget submission recommendations include: 

• Front-loading the delivery of the additional 2,600 acute beds promised under the NDP 
• Capital expenditure for acute hospitals must be increased to address the physical infrastructure and equipment deficits resulting from a decade of capital cuts and underinvestment
• Future overruns with the National Children’s Hospital development must also be funded separately to avoid the cancellation or delay in putting in place other essential capital projects
• Restoring pay parity for all consultants appointed since October 2012, to retain and attract consultants back to our health service
• In addition, filling all consultant posts in public hospitals on a permanent basis rather than relying on costly agency or locum consultants

The Department of Health had not replied to a request for comment about the IHCA’s recommendations at the time of publication.