Health Minister Simon Harris’ vision for the future of the Irish health service has much to commend it. Laying out his own perspective for the future of health care in Ireland in a wide-ranging presentation, to the Oireachtas Health Committee – which is to make recommendations shortly on a long-term vision for health care and the future direction of health policy in Ireland. He said he wanted to tackle health inequality and improve access for people to health and social care.
The Minister’s view is that this can best be done by dismantling the HSE, delivering integrated care locally by regional units, increasing health service capacity, removing any incentives for hospitals to treat more private patients and moving from hospital centric to primary and community care. There has been serious concerns for some time about the size and bureaucracy of the HSE, which the Minister said has resulted in the over-centralisation of decision making and accountability, which impeded service responsiveness. He plans to slim it down to a leaner organisation which could deal with commissioning and other national matters.
It makes sound sense, as the Minister said to retain a national “capability” in the new system (whether provided by a slimmed down HSE or the Department of Health), as not only will it be necessary to have an organisation to commission services, but it is also extremely important to have national standards to which delivery units must adhere. The lack of these common national standards was one of the major drawbacks of the previous health board structure. There will also be a general welcome for the Minister’s view that the Hospital Groups and the Community Health Organisations should be geographically aligned, established on a statutory basis and take over responsibility for the delivery of integrated care within defined geographic areas.
However, there are other areas of the Minister’s vision which would appear to pose major problems. The Minister devoted little of his 16-page speech to the need to increase capacity, including staff in the re-structured service. His views on capacity, included under the heading “Untapped potential in the system,” stated that the level of capacity required into the future is being worked on by the Department and unlike previous reviews; it will extend beyond acute hospital beds, to look at issues like the provision of additional capacity in primary and community care.
Since capacity in primary, community and hospital services, including staff and in the case of hospitals general beds and ICU beds, is the underlying cause of patients being unable to access timely and appropriate services, it is concerning to see this dismissed in a few paragraphs.
It is also extremely worrying that it appears as if this all important capacity review may be conducted by the Department without the input of stakeholders. In view of the critical nature of this review, it would seem vital that it would consult as widely as possible with all those who have detailed knowledge and expertise on the implications of the current capacity shortages and how they can best be met. However, truly the strangest part of the Minister’s vision for the future is his view that private patients should pay the same fees in public hospitals as public patients (the full economic cost) and consultants should be paid from the public purse for treating private patients in these hospitals.
I am not sure what the full economic cost of various procedures would be, but since it is likely the Department and the HSE have pared them to the bone under Activity Based Funding, I imagine this would result in a major income loss to public hospitals, which are expected to generate over €1 billion in income this year.
The Minister’s idea that consultants in public hospitals should no longer be entitled to charge fees to their private patients, but instead be remunerated by the State under a new contract which would cover their public work and their permitted private work in the hospital sounds even more peculiar.
With about 400 permanent hospital consultant vacancies at present because consultants can’t be recruited, one would expect that any further curtailment of their private work would act as a further disincentive to consultants taking up posts in public hospitals. On the other hand one wonders where the State is to find this increased funding to pay consultants for treating private patients, especially since it is now facing large bills for non payment to many consultants of fees under the current contract.