Founder member of Doctors Alliance for Better Public Healthcare, Christine O'Malley, tells Theresa Judgethat the co-location debate is not over
The debate on co-located private hospitals is not over but in some respects is only beginning, according to a founder member of a group of doctors campaigning for a better public healthcare system.
The group, Doctors Alliance for Better Public Healthcare, was formed early in January and comprises consultants and GPs from around the State. It says its primary aim is to advocate on behalf of patients and help ensure a better service.
Points stressed by the group include the need to acknowledge the very good work being done by public hospitals and to protect the public health system. Concerns have been raised about privatisation, excessive bureaucracy and a growing lack of trust between patients and staff and between frontline staff and HSE administrators.
The group is concerned at misunderstandings about the potential of private healthcare.
A founder member of the alliance and former president of the Irish Medical Organisation (IMO), Christine O'Malley, says she does not believe the debate on co-located hospitals is over.
"Our aim is to inform the debate. Some may feel that the debate on co-location is over but that is not our view. These hospitals won't be built for another three years and that gives us three years to examine in detail what is going on and where the pitfalls might be. We have to make sure it does not act to the detriment of patient care," she says.
O'Malley says one problem is that the public is not being fully informed of the agreements between the HSE and the private companies that are going to build the co-located private hospitals on the grounds of public hospitals.
"We are not allowed to know what is in these tenders for commercial reasons," she says.
One of the concerns she raises is the expected loss of income to public hospitals. "It appears the public hospital will lose the right to charge health insurers for insured patients who are admitted to the public hospital rather than the private hospital."
O'Malley stresses that people need to be aware that the role of private hospitals is "limited to elective care, to planned operations, the bits that have predictable costs". For example, while a person can get a planned heart bypass operation in a private hospital, all emergency bypass operations are carried out in public hospitals."
All emergency work, which makes up the vast bulk of the work of public hospitals, is not done by the private hospitals. The majority of patients on public hospital wards are patients who came through A&E," she says.
While the HSE and Minister for Health Mary Harney have argued that the new co-located hospitals will have the same case mix as public hospitals, O'Malley doesn't see how a co-located hospital, which will be much smaller than its adjoining public hospital, could afford to duplicate the very expensive emergency teams that are available in public hospitals without massive increases in health insurance charges. This would require charges equivalent to those in the US, she says.
O'Malley raises a number of questions about how the co-located hospitals will work - at what point will they take over the care of private patients who enter through the A&E unit of the public hospital; will they take care of elderly patients who have a range of complex problems; and if there are two elderly patients - one in the public hospital and one in the co-located hospital - who both need a nursing home bed or a home care package and one becomes available, which patient will get it first.
O'Malley says details like these have not been clearly worked out and that there has been "a gross overestimate" of the numbers who can be treated in private hospitals.
While the issue of privatisation and co-located hospitals dominated the alliance's agenda before the general election, there are many other issues which O'Malley and her colleagues want to raise.
In March the group issued two very detailed documents which give its analysis of "myths" about the public healthcare system and outlines measures that should be taken to improve services for all patients.
Ironically for a former president of the IMO, O'Malley says she is disheartened by the fact that "doctors have been relegated to trade union members", that they are seen only as protecting their vested interests.
She points out that the IMO has a dual role of representing doctors and advocating for patients. "The IMO is constantly being labelled as a trade union voice but I think it has fought against that by bringing out policy papers and speaking out on a range of issues."
In negotiations on a new consultant contract, she says "the most shocking thing" for her was that "civil servants and the HSE appear to believe what they are saying - that doctors are only in it for the money, for private practice, that their role is to protect privilege, that doctors are the problem and if only we could sort out the doctors everything would be solved".
The documents put forward by the Doctors Alliance for Better Public Healthcare give a much more complex analysis of what is needed for our health service. In many respects they also make depressing reading because of the problems highlighted. Examples include the fact that "doctors feel disconnected from administration staff", that trust has broken down at a number of levels, that channels of communication between doctors and managers are totally inadequate.
O'Malley explains the tension between "those who are clinically accountable and those who are financially accountable". Doctors and nurses feel they are in the firing line because they are responsible for patient care and patients take out their frustrations on them. Meanwhile managers who are financially accountable "feel doctors don't care about the money".
The planning of services is being done entirely by the people who are financially accountable, she says. Health policy now, she adds, is not the health strategy but "an implicit health policy of providing the best possible care that can be delivered with the money available and within a headcount - the ceiling on recruitment". Therefore health policy is being dictated by general public policy to limit the number of public service pensions.
O'Malley says we should learn from Britain before following the route it has taken in health reform. The alliance, she says, is determined to continue informing the debate.
In the short term it wants investment in bed capacity, additional diagnostic capacity, recruitment of more frontline staff and streamlining of administration structures. We should learn from Britain before following the route it has taken in health reform