Editorial 12 Sept 2019

There probably is never an ideal time to introduce major reform in healthcare. The unrelenting demand for services makes implementing policy changes difficult. There is the danger that the transition to new arrangements could lead to service disruption, at least in the short-term. Yet, it is often only through a long-term strategy that a solution to the chronic day-to-day problems of emergency department overcrowding and high waiting lists can be found.

The de Buitléir report into removing private practice from public hospitals, which was published on 26 August, comes in the middle of a crisis in the recruitment and retention of consultants. This crisis, which has resulted in approximately 500 vacant consultant posts, has been highlighted repeatedly by the IHCA and the IMO. For both medical representative bodies, the key to addressing the problem is ending the pay cut imposed on new-entrant consultants in 2012 and making consultant posts more attractive. Although the de Buitléir report acknowledges these issues, it arguably complicates matters as much as pointing toward a solution.

Most consultants in the public system have type B contracts, which allow for a certain amount of private work to be conducted on-site. Removing this privilege runs the risk of making consultant posts less, not more, attractive. This risk is heightened given the existing difficulty in recruiting and retaining consultants.  One of the main recommendations is the creation of a new Sláintecare contract for consultants, which would compensate for the loss of private work. Negotiating such a contract will not be easy, especially considering the sceptical remarks made by the IHCA and the IMO following the launch of the report. The topic is sure to be discussed at the IHCA’s upcoming AGM, which takes place in Dublin later this month.

There are also financial issues to consider. The de Buitléir report estimates that removing private healthcare from public hospitals would cost around €650 million a year. Given the financial overrun the HSE is experiencing, it would hardly be surprising if the Government lacks enthusiasm for implementing the proposals. The delay in publishing the report, which was completed in February, raises questions about the level of Ministerial support.

As part of our IHCA preview in this issue, Minister for Health Simon Harris stresses his support for the recommendations, while acknowledging the implications for consultants. Although the report admits the difficulty of removing private practice from hospitals, Mr Donal de Buitléir writes in his forward that the review group believes it can be achieved over the lifetime of the Sláintecare programme of reform. The report says that if private practice was removed overnight, the result would actually be an increase in waiting lists. A phased approach is therefore recommended and access to public hospitals for public patients would be expected to improve over time.

The Sláintecare Report highlighted the inequity of treating patients privately in public hospitals. Ultimately, the Government’s commitment to the strategy will be seen based on whether this report will be implemented or sit on the shelf.