Madam, - The Government's view is that public-private partnerships are the way to go. There will be eight private hospitals built on co-located grounds with public hospitals in order to remove private patients from beds in public hospitals to private beds in these co-located hospitals thus freeing up beds.
Superficially, that sounds like a good idea because they are creating beds in the public sector and they are increasing accessibility of beds to public patients. However, if the new co-located hospitals are going to decant out private patients from the public hospitals, are they going to select out those who have relatively non-serious illnesses that do not require particularly high levels of medical care or will they replicate intensive care units, coronary care units etc?
If the new consultant contract has a percentage of consultants working entirely in the public sector, then those consultants, by definition, will not be able to care for patients in the co-located private hospital. This is because the new contract they have signed will only allow them to treat public patients.
This means, in turn, that if they cannot be called to treat a private patient in the co-located hospital, who is going to be called? Is it going to be a consultant who has a variation of that contract which allows him or her to see 20 per cent of patients privately? Will we have hospital managers counting every consultation, every operation and every visit in order to determine if a consultant is exceeding the 20 per cent cap on private practice. Or is it going to be a purely private consultant working only in the co-located hospital and filling its beds with elective private patients to keep it financially solvent? Where, in turn, will these consultants come from?
Theoretically, you can see merits in this form of private/ public partnership but in practical terms you can also see a huge apartheid situation developing where there is a common Accident and Emergency (A E) in the public hospital and once you have passed through the A E department, you are pointed left for private treatment in the co-located hospital or right for public treatment and each has its own queue of trolleys!
Let us also look at the situation where cataract surgery performed in private practice clinics is becoming more popular through the National Treatment Purchase Fund (NTPF).
The NTPF allows patients who are on a waiting list in the public hospital service for between three and six months to have their cataract surgery performed in a private setting. Treatment under the NTPF is paid for by the Government on a case-by-case basis so an individual private or public surgeon can perform that operation in private time in a private institution and be paid a fee for the surgery.
There are advantages for the health providers in that the overall cost per unit cataract operation is lower than in the public hospital system for a whole host of reasons. They are also having the surgery provided by a surgeon and ancillary nursing and diagnostic staff who are being paid on a fee per item basis.
The Government can save money through the NTPF as it does not have to pay pensions and social insurance and all of the other ancillary costs that go with employing staff in a public hospital.
The disadvantage of the NTPF scheme is that the public hospital services can be progressively run down for elective and more routine types of surgery because the patients are being whisked off under the NTPF relatively quickly.
There is a real worry among Irish ophthalmic surgeons that public hospital services will be progressively run down because it can be argued that the same need is not there because the need is being satisfied elsewhere in a private setting. Is this universal health insurance by stealth? - Yours, etc,
PETER BARRY, FRCS,
Consultant Ophthalmic Surgeon,
Merrion Road,
Dublin 4.