Plans to remove private healthcare from public hospitals, a cornerstone of the Sláintecare reform plan, are likely to take considerably longer and be more expensive than originally envisaged, according to people briefed on the issue.
Publication of a report which laid out the steps necessary to separate public and private care, expected in recent months, has been shelved until the autumn.
Sources say the report, furnished by public policy expert Donal de Buitléir to Minister for Health Simon Harris some months ago, contains a detailed roadmap for removing private patients from public hospitals. However, many of the measures may prove unpopular with doctors, and patients who hold private health insurance.
Senior government insiders are sceptical about the Sláintecare project, and point to continuing budget overruns in the health system. They say the extra funding required for its projects is being taken up instead by the overspending of existing budgets.
One senior source familiar with the issue said removing private care would take longer and be more expensive than anyone expected when the Sláintecare report was adopted as Government policy.
Waiting times
Revelations this week that health spending in May was running one-third above the anticipated annual growth for the year, along with figures published on Friday showing record waiting lists, will do nothing to allay the sceptics’ concerns.
The figures, labelled a "scandal" and a "disgrace" by Fianna Fáil, show 556,411 people were waiting for outpatient appointment at the end of May, up almost 5,000 in a month. More than 106,000 of these have been waiting for more than 18 months.
The number of patients waiting for inpatient or daycase treatment fell slightly, to 68,765, due to a €75 million outsourcing initiative by the National Treatment Purchase Fund.
The Irish Patients’ Association called on the Government to carry out a gender analysis of the figures, after a breakdown it received showed there are about 78,000 more women on the outpatient list than men.
Removing private care from public facilities, as envisaged in Sláintecare, would free up capacity in the public health system, reducing waiting lists and congestion at emergency units. However, it would also deprive public hospitals of the fees received from private patients and make private health insurance more expensive.
Frustration
The Government would have to fund the loss to public hospitals of private patient income of about €600 million per annum, while consultants would have to be compensated for loss or earnings or have their contracts renegotiated.
Separating the public and private healthcare systems is at the heart of the plan, drawn up by an all-party committee of TDs and published two years ago. There has been frustration among its supporters at the slow pace of reform.
One senior figure familiar with the plans said that the public-private separation was likely to take longer than the 10 years envisaged in Sláintecare.
A Sláintecare implementation office has been set up in the Department of Health under programme director Laura Magahy. Opposition TDs, including the Social Democrats co-leader Roisin Shortall who chaired the original committee that agreed the report, have been frequently critical of the pace of reform.
Meanwhile, proposals to regionalise the management of the health service, marking a return to a decentralised system abandoned when the old health boards were abolished in the early 2000s, are likely to be brought to Cabinet in the coming weeks by Mr Harris.
The new structure for the health system – organised around a small number of “regional integrated care organisations” – would see existing hospital groups enlarged to include other care organisations.
It is expected that each regional organisation would have a high degree of autonomy from central HSE structures, would have its own board and would be responsible for its own budget. The new structure will require legislation to be passed by the Oireachtas.
