The standard mantra of proponents of State-regulated, State-funded and State-delivered healthcare is that our health needs are so fundamental a right that nobody other than the State should be entrusted to provide this service.
What a heavy price we pay for such an ideal: outdated facilities, out-moded work practices, unacceptably long waiting lists and A&E shortcomings.
Fifty years on, our public health sector remains characterised by an acceptance of mediocrity, a burgeoning bureaucracy and lack of accountability. This, despite unprecedented healthcare budgets.
To deliver on our future needs, healthcare systems need to be flexible, rapidly responsive to change, service-oriented, efficient and provide value for money. Our current structures are not well adapted to meet these needs.
Most accept that the independent or private sector has always been at the forefront of Irish healthcare. For some time now independent facilities have demonstrated their capacity to accommodate change in medical practice.
Public sector supporters therefore recourse to accusing the independent sector of perpetuating the two-tier system of healthcare access, of cherry-picking, frowning upon profit in healthcare as some grotesque or perverse incentive. They accuse the sector of shirking its obligations in teaching and research and project the image of independent healthcare as haphazard and unregulated.
The recent growth of independent hospitals has provided the Department of Health and the HSE with a unique opportunity in several ways. Firstly, it can now purchase healthcare from this sector without the huge capital investment which would otherwise be required; this enables the HSE to be more responsive to our changing needs; the HSE can now tender among many independent providers, achieving greater value for money.
By altering patterns of reimbursement, the HSE can create capacity in areas of healthcare that have traditionally been avoided by the old independent sector.
Secondly, the HSE can draw on the unrivalled expertise in the independent sector to build new facilities rapidly, efficiently and within budget. New public facilities generally take almost two decades to plan and construct. Recently opened independent hospitals, such as the Beacon Hospital in Sandyford, have been completed in a fraction of that time.
What do we learn from this? We learn that the public sector, left to its own devices, is incapable of providing a healthcare system to meet the needs of Ireland in 2006.
Given that Ireland has an ageing and rapidly expanding population that will grow from four million to five million within the next 15 years, what hope do we have that the public sector can rise to the challenge of meeting current healthcare needs, let alone future proofing for the ever-increasing requirements over the coming years?
The private sector can provide a necessary, cost-effective service and then allow the State to choose between being a 100 per cent provider of healthcare to being both a provider and a purchaser of healthcare for its citizens.
Ireland requires over 1,000 new hospital beds, our teaching hospitals need huge investment and the HSE must continue to purchase healthcare capacity from the independent sector for the foreseeable future.
In this context, Mary Harney's hospital co-location plan makes sense. It represents the quickest and most efficient way to create the requisite increase in bed capacity; the Department of Health and the HSE can pass on the risk of such an enormous capital investment, granting contracts only to those consortiums that have a track record in designing, building and commissioning hospitals, in addition to running them.
The HSE can purchase services from the co-located hospital rather than from a more remote location. Economies of scale on the one site will enable development of IT systems as well as diagnostic and treatment modalities, heretofore unavailable in the public sector.
By developing emergency rooms in the new co-located hospitals, our A&E crisis will be alleviated more rapidly. The potential for shared governance structures and streamlining of administrations will undoubtedly benefit both the co-located independent and the public hospital.
For many hospital consultants, co-location of public and private patients allows more efficient use of the working day, avoiding the need to travel between different sites.
The opportunity to marry the best features of the independent sector together with the many outstanding qualities of our public system will surely promote healthcare development in a well regulated environment.
The 2006 Euro Health Consumer Index published last June reports Ireland as having one of the worst health services in Europe, with a ranking of 24 out of 25 countries studied. Simply pouring money into our health system as currently structured will not yield significant improvement. Until there is separation between the healthcare regulator and funder and the healthcare providers, we are destined to have a substandard health system.
Let us spend less time arguing philosophically about the relative merits of private versus public healthcare, and concentrate on treating all patients in a clean and safe environment.
Prof J Mark Redmond is a cardio-thoracis surgeon, co-founder of the Beacon Medical Group and medical director of the Beacon Hospital, Sandyford.