Oireachtas Joint and Select Committees

Wednesday, 23 October 2019

Joint Oireachtas Committee on Health

Private Activity in Public Hospitals: Discussion

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I understand why this happens so it is not a criticism, but a lot of the report focuses on the consultants and on what we need to do for them. I would like to bring it back to the patients. Let us put the consultants aside for a minute and ask how things would be affected for patients. The ESRI report is good in the numbers it gives on what is going on in our public hospitals. Those numbers will come as a surprise to many people. For example, three quarters of the beds in public hospitals have people in them who have come through the accident and emergency departments. Most people probably intuitively think the number is much smaller but three of every four beds in our public hospitals are filled with patients who have come in from the accident and emergency departments. Whether we take private practice out of public hospitals or not, three of the four beds will still be filled with those people. We will still have to care for them but we will have a lot less money because we will no longer be taking money from the insurance companies. Three out of four beds will still be full with the same people but we will be behind because we will not be getting paid for any of that, whereas we were getting paid for about one in five of those patients. That leaves one of every four beds. The vast majority of those bed days are for public patients. The ESRI report shows that less than 4% of the bed days in public hospitals are for elective private care. That is the only bit that would change because the people will still come through the accident and emergency departments. Less than one on 30 of the beds would have people in them who may not have been in them if we took elective private care out. On the basis that some of those patients are in the public hospitals because the public hospitals might be able to deal with more complex matters, of those one in 30 beds, a load of them will still be filled. Those patients will have to go through the public system because they will be availing of public facilities. Let us assume that if we remove private practice from public hospitals, in reality it will free up about one bed in 50 in our public system. That is broadly what it will do and that is the actual change we will see. At the same time, we will also remove the money that pays for that one bed in 50. We would not suddenly have one bed in 50 free and have doctors and nurses ready to treat the public patient who would go into that bed. We are not funding that and we have a lot less money available because we are not taking any money in from the patients from the accident and emergency department.

If we just said that in principle it is no longer allowed to have private care in public hospitals, one bed in 50 might be freed up but we would not have the money to pay for that bed or for the doctors or nurses, and we would have significantly less money available to treat the patients in the other 49 beds.

I fundamentally and wholeheartedly agree with the principle of equal care in public hospitals, and I think it is enough that it is a principle. The narrative to date has been that doing this will somehow reduce waiting lists and improve access for public patients. Based on the analysis we have been given, it will do the opposite. It will reduce capacity for public patients, thereby increasing waiting lists. Is this a reasonable analysis of the numbers we have just seen?

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