LAST UPDATE | 25 Nov 2021

IN AN ADDRESS this week to the Private Hospitals Association, Minister Stephen Donnelly described Universal Healthcare as the most important project of our times and that everyone he spoke to in private practice believed in too and that together “we must make it a reality in our country”.

He spoke of enhancing the “strategy relationship” with private providers and “intensifying engagement” with them.

None of this is new. The National Treatment Purchase Fund has been around since 2004 and the outsourcing of healthcare delivery to private operators has been steadily gathering a head of steam since then.

The CEO of the HSE Paul Reid in a recent interview on the This Week programme on RTÉ radio made repeated reference to private providers as a way to reduce waiting times.

Money goes to private

In the HSE Winter Plan, for what most frontline workers feel is likely to be the worst, most challenging season we have ever seen of the €30 million allocated to acute hospitals, more than two-thirds are to be spent in the private hospitals with the remainder allocated to the public sector.

It is undoubted that this has been of great benefit to a number of individual patients. It is equally true that now that our hospital waiting lists stand at 900,000 citizens,  intensifying that engagement with private providers – which is usually but not exclusively around single episodes of diagnostics or care – is having no impact whatsoever at a strategic level on waiting lists that have long since spiralled out of control.

It is difficult therefore to understand how the government and the HSE could have arrived at the conclusion that we can outsource our way out of a problem that has grown exponentially in spite of a steady increase in investment in outsourcing.

It is a belief that also betrays a poor grasp of the rudimentary challenges of modern healthcare. Our winter pressures and waiting list issues are not caused by our inability to provide episodic, low-risk, high-turnover care to ambulatory patients.

The real source of these problems is the failure of the system to reorient itself at scale to the unscheduled care of a rapidly rising number of chronically ill and frail patients with many diseases. These patients require a very broad range of specialists and health and social care professionals to guide them through prevention, acute care and rehabilitation. This is simply not the forte of the private sector.

When I write things like this I frequently get angry, and occasionally abusive responses from colleagues working in private practice who feel personally hurt and insulted. This is not my intention. Let me be clear. These are excellent, dedicated professionals who work in progressive, modern institutions.

In the last year or two I myself have taken out private insurance and would feel very safe and glad to attend one should a need arise that I feel would be addressed there. I am simply saying that in the context of the challenges facing the public healthcare service there needs to be a reality check about what can and can’t be done with outsourcing.

What’s the model here?

If the government believes that enhanced public-private partnership is the best model for our health services then that is a legitimate and valid view for them to hold, albeit one that I do not, but they must be honest with people.

It is in no way congruent with the spirit of the Sláintecare report which all the government parties are signed up to. They reaffirmed that commitment at the last general election and as recently as last month the Taoiseach Micheál Martin again emphasised his personal and the government’s collective fealty to Universal Healthcare.

However, the voracious appetite for outsourcing suggests there is a considerable gap emerging between professed values and observed behaviours.

Since the departure of Laura Magahy and Tom Keane from the Sláintecare office and the disbandment of the Sláintecare Implementation Advisory Council, and with no plans to replace those individuals or bodies, ownership of the project has been placed entirely with the Department of Health and the HSE.

Those who worked the frontline of the public health service during the years of austerity are entitled to raise an eyebrow that notwithstanding their considerable ability and experience, a handful of civil servants who designed and implemented austerity in the Department of Public Expenditure have been moved en masse to key roles in the DoH and HSE to implement universal healthcare.

If it can be shared with the private hospitals association, then equally patients and the public have a right to know if the plan has changed or not from what the Oireachtas outlined in 2017 and they affirmed at the last general election.

If it is no longer Sláintecare and is now significantly enhanced public-private partnership then explain to us exactly how that is going to work in a way that it has not in the past.

Otherwise, our political leaders begin to resemble a group of befuddled priests on Craggy Island staring at a blackboard wondering if there is anything, anything at all to be said for another round of the NTPF, but calling it Sláintecare this time?

Dr Anthony O’Connor MD, MRCPI is a Consultant Gastroenterologist at Tallaght Hospital.