The true cost of political decisions

he referendum pushed CervicalCheck off the front pages for only a short time. Even while it was rumbling away in the background, it was rumbling in my head too, stirring-up old thoughts.

When I was 12, people didn’t believe me when I told them of ideas I had years earlier. Being a peculiar kid, I decided to keep a diary to show myself that I really did have such thoughts.

Now I write columns for <em>Mindo</em> instead. I can look back and see my thoughts laid out in black and white. Oh dear! I can also see when I’m repeating myself.

What follows here is conjecture and opinion, not necessarily fact.

Since the CervicalCheck story broke, there have been calls to reinstate the Board of the HSE. Interesting. It brings me back to the foundation of the HSE.

When Mary Harney became Minister for Health, I felt as if I was ‘marking’ her, as on a sports field. I listened to her words: More hospital beds and consultants needed, but silently, I added ‘in the private sector’ as co-located private hospitals were announced. I looked at what she did — close cancer units in public hospitals, while welcoming private cancer units.

At that time, the CEO of the HSE said more private hospital beds were not needed and the ceiling on recruitment was a significant problem. He was publicly reminded that the role of the HSE is ‘operations’. ‘Strategy’ is the job of the Department of Health.

The health Budget increased rapidly.

It was all very clever — but that’s just my opinion. If money pours into healthcare, but you’re not allowed recruit staff, the only way to develop services is to privatise.

So the NTPF diverted patients from public waiting lists to private hospitals. And commercial companies lined-up to take on chunks of Irish public hospitals.

Companies looked at outsourcing whole radiology departments, or running minor injury units in public hospitals. There was talk of Quest Diagnostics running ‘cold’ laboratories for the whole country.

In the end, the financial crisis killed off all that commercial enthusiasm. We’re left with some oddities from that time and the contract for cervical smears is one.

The HSE Board was in place when CervicalCheck used a public tender for the cervical smear contract — an unusual step at the time. That first contract went to Quest Diagnostics; all smears from Irish women were sent to the US — another unusual step. (A second US lab and the Coombe were added later.)

I was quite distressed about it at the time, but not surprised. It fitted with my view that cancer care was to be outsourced to the private sector as much as possible. I knew several Board members personally, but they never seemed anxious to talk to me!

Back to the present.

Recently, Fergus Finlay said he couldn’t work out what sort of a corporate entity CervicalCheck is. I’ve heard it’s an ‘independent business unit’ within the HSE. That fits with privatisation; it could be cut loose at a suitable time.

I watched a Health Committee meeting on TV. Stephen Donnelly said that medics were involved in the tender result, so outsourcing to the US was not a political decision. That’s a bit naive from a former management consultant. He should know that a tender can be designed to pre-select the outcome.

The CervicalCheck tender had three elements. Accreditation was required; Irish labs had almost completed theirs.

Cervical smears had to be turned around very quickly. Irish labs had long delays and the ceiling on recruitment prevented them from fixing the problem.

The third item was cost. Ah yes, cost. When I heard the US lab was one-third of the price of the Irish labs, my Trinity MBA training kicked in. How could this be possible?

I’ve heard it’s because of pension costs, or because Irish lab scientists are more highly trained than US smear-checkers, and therefore more expensive. But I really can’t see how an American lab could be so cheap.

Then I learned there was a sister lab in Mexico. Ten years on, we know that outsourcing to the UK is allowed under the contract. I’d love to know if any smears went to South America.

And it was all done under the governance of the Board of the HSE.

I wonder who designed the tender? Did the HSE Board sign-off on it? Maybe Board members had concerns about sending Irish cancer tests overseas, but a tender result is legally binding.

There’s no open disclosure for commercially-sensitive information, so we’ll probably never know.

That’s just my opinion.