Mr. Martin Varley:

Good morning, Chairman and committee members. I will read through the statement as quickly as possible.

I thank the committee for the invitation to join in its discussions on the use of private hospital capacity and the impact of the agreement on the continuity of care and healthcare delivery.

The IHCA is the representative body for more than 3,200 hospital consultants practising in public and independent hospitals. The association represents approximately 95% of all hospital consultants in Ireland. This submission outlines our views at the time of writing on Friday morning, prior to the outcome on the Cabinet discussions on the private hospital agreement, which was scheduled to take place during the day.

The association's members have been front and centre in treating Covid-19 infected patients throughout our acute hospitals since early March, in addition to providing emergency, trauma and urgent care to patients with non-COVID illnesses. This includes consultants in essentially all specialties across the full spectrum of acute hospital care. Whole-time private practice, WTPP, consultants have demonstrated their commitment by continuing to treat patients with urgent care needs on a voluntary basis in private hospitals throughout Ireland in the absence of a suitable contract and in the face of other significant constraints. We have sought agreement on practical and workable contractual arrangements that would properly enable WTPPs in treating Covid-19 and non-Covid-19 patients while also continuing to treat their existing and new patients who rely on them for urgent medical and surgical care.

This includes patients across all ages and demographics from the 46% of the population that has maintained health insurance over the years. For a relatively high proportion it includes older people who have maintained health insurance at all costs, going without in other aspects of their life, so that they could afford timely care when needed. This is driven by the access problems that exist in our public health service, a problem which has been caused by the failure of successive Governments to ensure adequate capacity in our public hospitals. This is not the fault of any patient, but it is patients who are now being penalised because of the failings in our health service.

Independent hospitals carry out 250,000 theatre procedures annually, accounting for approximately 40% of the total number of procedures requiring anaesthesia in acute hospitals. Those figures relate to 2015 and I expect that today the figures are even higher. Consultants in private practice also provide care for medical patients and are responsible for a significant proportion of outpatient consultations.

The IHCA working group engaged with HSE and Department of Health officials in early March and over the past two months on contractual proposals to be offered to WTPPs to enable the provision of care to patients in private hospitals and consultant outpatient clinics.

The proposals of health service management are preventing and restricting whole-time private practice consultants providing continuity of care to their patients. The contract being offered does not provide for the practical workable approach required to facilitate the optimum engagement of the maximum number of WTPPs. This is despite months of constructive efforts and collaborative engagement with officials by the IHCA working group. This has resulted in large numbers of existing and new patients of private practice consultants being deprived of the continuity of care they urgently require. The failure to resolve these matters is seriously impacting on the provision of care to patients across private hospitals and in private consultant outpatient clinics. As a consequence, large numbers of patients requiring urgent care are being added to waiting lists unnecessarily. In addition, it is adversely impacting on the effective use of private hospitals and the clinic capacity of WTPPs.

In March, on a precautionary basis, the State entered into arrangements to have access to the private hospital capacity to cater for the expected steep surge of infected patients requiring acute hospital care along the lines of the experience of Lombardy and Madrid. The steep surge did not occur because of the mitigating actions taken and at this time it appears it is unlikely to occur in the months ahead given the success of the public health measures implemented thus far. The test of time has confirmed that the private hospital agreement, which is costing approximately €115 million per month, represents poor value for money from patient care and taxpayer perspectives. The experience is that of very low private hospital bed capacity occupancy, at approximately one third on average, and low utilisation of theatre and other ancillary facilities. Furthermore, the private hospital contract is prohibiting the provision of urgent care required by patients with non-Covid illnesses. This is leading to the accumulation on waiting lists of a large number of patients who require urgent care. There is now the additional risk that these patients will deteriorate clinically and will increasingly evolve into emergency cases if they are not treated without delay.

I will conclude with one or two final comments. We are basically calling for the contract to be brought to an end. I know decisions to that effect were taken last Friday. The most important thing is to utilise the savings that will be achieved through ending the contract to put in place increased capacity for our public hospitals. The Government and Dáil have already decided that there should be significant investment in additional acute hospital beds and step-down beds. This is provided for in the national development plan. We would certainly welcome these additional beds being put in place in an accelerated manner in the context of the current crisis.