Wednesday 26 October 2016

Private hospitals key to curing waiting-list crisis

Recurrent ideological barriers at the root of unacceptable public system problems

Brian Fitzgerald

Published 11/09/2016 | 02:30

Critical: Brian Fitzgerald says the system is creaking Photo: Steve Humphreys
Critical: Brian Fitzgerald says the system is creaking Photo: Steve Humphreys

Waiting lists in public hospitals are at an all-time high. We now have 530,000 people waiting, often unacceptable lengths of time, for critical diagnostics and treatments. The system is creaking - and that's before winter has even begun.

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The challenges facing our public hospital system are compounded by many issues. Not least the obstacles to recruiting and retaining consultants, and the underuse of available capacity in private hospitals.

As a former CEO of one of Ireland's largest and leading acute adult hospitals, St James's, and the current Deputy CEO in Beacon Hospital, I have seen the system from both sides.

Public and private should not work in isolation from each other, and any ideological notion that they should is misplaced and at the root of many of our current, systematic failings.

The best example of this is the new consultant contract which was introduced in 2008. Under this new contract, consultants are prohibited from taking up private-practice work outside of their hospital of employment - even after they have completed their 37-hour public commitment.

This severely limits their earning capacity and is the reason why most new consultants are leaving these shores, with no plans to return. And why would they, when countries like the UK, USA, Australia and many in mainland Europe have no such restrictions in place.

A decade ago, we routinely saw up to 10 top-class candidates for a consultant position - now, too often, there are none. Some of those who have moved abroad are looking to return, but the question of contract reform is foremost to their mind. This is an illogical restriction, based on miscounted ideology. And meanwhile, waiting lists grow.

Dated hospital infrastructure and severe hikes in medical indemnity do not help matters either, with medical indemnity costs for surgeons having increased from approximately €20,000 per annum five years ago to €70,000 per annum now, for example. These hikes are a result of the legal cost structure, increased insurance claims and insurers leaving the market. Again, a system-wide approach is what's required to address this - a clinical indemnity insurance scheme that's utilised by those in the public and private system.

Private hospitals have the capacity - and the desire - to work in tandem with the public hospitals in addressing the mounting waiting lists. The National Treatment Purchase Fund was one of the most successful approaches for facilitating this collaboration and its reintroduction from next year by Minister Harris is to be welcomed.

Just this week, Minister Harris visited Beacon Hospital to officially open our newly expanded endoscopy facility. We have invested €7m in this unit, which enables us to conduct 12,000 scopes in the next year - double what we did in 2015.

Endoscopy, cardiology, orthopaedics, vascular, neurology - these are just some of the areas that we are currently collaborating with public hospitals in, but not to the degree that we can because of the recurrent ideological barriers.

At Beacon Hospital, we have just invested almost €35m in new diagnostic equipment and the expansion of our oncology, urology and endoscopy facilities. Contrast this with the HSE capital budget of €344m this year, of which 75pc is ring-fenced for specific projects. Therefore, only €86m is available for infrastructure replacement for the whole public health system.

There are 19 private hospitals in Ireland. We have the facilities, equipment, expertise and capacity to work with our counterparts in the public system in the best interests of patients.

We must bring down the ideology barriers and let the best management and healthcare professionals collaborate in a more streamlined and transparent way to guarantee our citizens access to the services they deserve.

Brian Fitzgerald is Deputy CEO, Beacon Hospital

Sunday Independent

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