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Private patients should not be treated in public hospitals, report finds

A new report says all new consultants should move to a contract that will end private clinics in public hospitals.

St Vincent's Hospital, Dublin
St Vincent's Hospital, Dublin
Image: Shutterstock/Lloyd Carr

THE LONG-AWAITED REPORT into the care of private patients in public hospitals has found that public hospitals should be exclusively used for the treatment of public patients.

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

It states that the treatment of private patients in public hospitals should cease upon the conclusion of the ten-year Sláintecare implementation period.

Sláintecare is the cross-party plan to overhaul the Irish health service over the next ten years.

The report also calls for pay caps for doctors in specialist roles to end, as well as calling for all new consultant appointments to be made under the Sláintecare consultant contract, which ensures that doctors can only carry out public activity in public hospitals.

Private clinics in public hospitals

Currently, many hospital consultants have contracts allowing them to treat public and private patients.

Pay levels that were in place pre-October 2012 should be restored for certain staff as well as new entrants hired under the Sláintecare plan, states the review. 

In order to end consultants operating private clinics in public hospitals, the report recommends that those holding contracts from 2008 or earlier should be offered a “contract change payment” to move to the new Sláintecare consultant contract.

The review group, chaired by Donal de Buitléir, a former board member of the Health Service Executive, was established by the Minister for Health Simon Harris following the recommendation by the Oireachtas Committee on the Future of Healthcare. 

The committee recommended that private care should be progressively removed from public hospitals and called for an independent impact analysis to be conducted.

Speaking at a briefing today, de Buitléir said unfairness in the system between public and private patients needs to be eliminated:

Ireland is unusual in that those with private health insurance or who can pay out of pocket are able to access services in public hospitals quicker than those who do not have private health insurance or who cannot afford to pay. This is not fair. 
It is difficult to think of any other public service where people are treated more favorably simply because they can pay more for the service.

He added that there are significant recruitment issues in the Irish health system with approximately 370 vacancies, with a further 380 posts occupied by non-permanent staff.

Pay levels

If his recommendations are implemented, he said a consultant on a Type B contract, who gets paid €131,000 would see a pay bump of €50,000 to €182,000.

This salary would compare favorably with salaries in other countries, he said.

The recommendations will come at a cost, said de Buitléir, estimating it will cost at the end of the ten years will be about €650 million per year.

The main element is the loss of income to public hospitals which is currently paid by private insurers. However, he said this income is already decreasing due to campaigns being launched advising the public that they gain no advantage from using their private health insurance in a public hospital. 

He said the loss of this income is already being felt in people seeing their health insurance premiums rise. In the long-term, the loss of this income will result in higher taxes, but lower insurance costs. 

Reacting to the report, the Irish Medical Organisation (IMO) said it will be “hugely expensive” to remove private care from public acute hospitals. 

The organisation added that there is no evidence that capacity will improve or that waiting lists will be alleviated by removing private care from public hospitals. 

The IMO also stated that “complex contractual issues will need to be addressed to attract consultants to work in Ireland as the working environment, terms and conditions are much more attractive in other health systems abroad”.

President of the IMO Dr Padraig McGarry said the government will not be able to implement any meaningful change without enough doctors to deliver care to patients.

He added:

“The government can commission all the reports it likes, but the reality is that if we do not see better working conditions and an end to the gaping pay inequality between consultants as a matter of urgency, then we will never come close to any real reform in the system.

“Our doctors are understandably fleeing our health system in their thousands while the Government looks the other way and patients suffer. This cannot continue.” 

The IMO said that the government cannot use the report as “another delaying tactic” adding that it was “positive to see that the report’s authors acknowledge that additional resources were needed”.

McGarry said Ireland has the lowest rate of medical specialists per capita in the EU, adding that there are currently over 520 consultant posts unfilled.

“This is completely unsustainable and unacceptable,” he concluded.

Complexities 

Harris welcomed the publication of the report today stating that “it is clear that removing private care from public hospitals is complex”.

The minister said it will take time and money to separate the two healthcare models, stating that developing a single-tier public hospital system is one of the fundamental reforms envisaged in Sláintecare.

“I intend to consult with key stakeholders and my colleagues in government to consider further key implementation issues and return to government in due course,” he said.

Envisaging future difficulties with implementation of some of the recommendations, Harris said:

Undoubtedly, implementing the recommendations poses some difficult choices but it is clear that this would be a significant step towards achieving single tier health care for all public patients envisaged in Sláintecare.

Separately, the Health Department also published a report by Deloitte analysing the impact a ban on private care in public hospitals would have on private health insurance.

The report finds that premiums could rise, with predictions the costs could jump by between 1% and 34%.

With reporting by Orla Dwyer

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