Access to public hospitals must in future be based only on a person's medical need and not their status as a public or a private patient, writes Mary Harney
The forum on the health sector is an important initiative aimed at assisting the parties within the sector to be bold and expansive in their approach to innovation and change. It's about people engaging together to solve practical problems.
The forum will meet shortly and I want in advance to underline some of my basic values and commitments for the health service.
Our pledge to patients should be threefold: You will be safe; you will get the best quality care for the best possible outcome; and you will be seen and treated on the basis of medical need.
The value that sick people should be treated in order of medical need should permeate all publicly-funded hospitals and health services. Moreover, it should be seen to do so by the public.
Since the early 1990s we have had "universal cover" for public hospital care. Every patient is entitled to public hospital services, with some limited charges, except for people with medical cards.
It was never intended that this public entitlement should come second to the continuation of private care in public hospitals or private insurance in general.
All beds in public hospitals are funded by taxpayers and should be available routinely to all patients, and especially for medical reasons as well as infection control.
We simply cannot allow our public hospitals even to be open to the suspicion or accusation that they do not abide by the value of treatment by order of medical need.
Certain events and practices, such as a very high level of private admissions at public hospitals, have called into doubt if this primary commitment has been implemented in practice. I want administration, employment contracts and policies on the public-private mix to change to support this fundamental ethical commitment.
The Government is committed to ensuring greater equality in access and care between public and private patients in the system and to measure progress in that regard.
Two key features of the new consultants' contract will support equity of access for public patients.
First, outpatient diagnostic investigations, tests and procedures will be managed in a new way. This is a key access point to the health service. The booking of all patients' appointments will be done by the hospital on the basis of clinical priority, and will be subject to clinical validation. What this means is that, irrespective of having insurance or not, people will be admitted in order of medical need.
Second, the mix of public and private patients will be balanced in favour of public patients. For every four public patients treated, one private patient can be treated. In addition, there will one A&E service for all, and no private fees will be earned for any patient in A&E.These measures will underpin our commitment to equity in hospital care. Equity of access is a different issue to having a diversity of hospitals. The existence of privately-managed, independent hospitals does not undermine the commitment to equity for public patients. Rather, private healthcare can be used to improve services for all. If a private service offers quality care and value for money, let's use it to supplement, not to supplant, public service provision.
We should continue to purchase services from private providers for public patients, as the National Treatment Purchase Fund has done for nearly 70,000 people. What we are doing is purchasing treatment for patients, rather than insurance for patients.
Effectively, we are saying to people who do not have health insurance: in our public hospitals, you will be seen in order of medical need. And, in addition, we will also purchase treatment from private hospitals for you.
Of course, the Government will continue to support private health insurance, by keeping it affordable through community rating. But it has never been policy to delay building up public health services, for fear that fewer people would purchase private health insurance.
In fact, we have increased public health funding at the second highest rate among developed countries for 10 years. Some 78 per cent of overall health spending in our country is public funding - higher than the Organisation for Economic Co-operation and Development average. Our policies are supportive of sustained high levels of public investment in public healthcare. A very high proportion of health services will be provided by public servants.
This is where the forum on the health sector comes in. Some 130,000 public servants are providing the bulk of health services in the country.
Some people dismiss statistics in health discussions; but there is no dismissing the facts. We are getting more treatments, faster, and are living longer. Out of hours GP services exist now, while A&E waiting times are down. We have made major improvements in heartcare.
The number of people with medical cards is rising. Breastcheck is now starting the national roll-out. Our survival rates for breast cancer care are fast improving.
Thousands of older people now receive regular, professional care at home. There are more services for people with disabilities. Objective standards for hospital hygiene are now being set and implemented.
The role of nurses has been expanded and degree-level training introduced. We are doubling the number of medical college places.
We have set in train the building of one of the best paediatric hospitals in Europe.
All the parties at the forum are agreed that healthcare is a matter of major public interest, which deserves a focus and commitment at national level similar to that which was applied to the broader economy when social partnership was embarked upon in 1987. Just as then, we should not succumb to defeatism and cynicism.
The Irish Congress of Trade Unions first put forward the idea of the health forum and the Government backs it fully.
If patients, staff and taxpayers see demonstrable changes delivered over short time frames, this will build confidence in our health services, create a strong sense of pride among staff and lay the best foundation for sustained high levels of public investment in health.
Mary Harney is Minister for Health and acting leader of the Progressive Democrats