Oireachtas Joint and Select Committees

Wednesday, 18 January 2017

Select Committee on the Future of Healthcare

Health Service Reform: Private Hospitals Association

9:00 am

Mr. Brian Fitzgerald:

As an example, if a consultant in the public system does one day a week in the private system, and has the right contract, that consultant will receive professional fees from the insurance companies.

The consultant will also bill patients directly in an outpatient setting. Many consultants will have private outpatient settings within public hospitals. They do not have to come to the Beacon Hospital to do that.

I will try to paint a picture of what I was referring to when I discussed management. The management team produces a management plan for the hospital. We submit it to the board every year. The board scrutinises it and makes amendments as it sees fit. That is the plan and we are held to task for it. We are measured every month under a ream of performance indicators. At an earlier stage in my career I worked with great governance groups but we did not go down to that level of scrutiny. Earlier I referred to accountability. The reality is that if we do not perform, there will be inevitable consequences. In that sense it is no different to any private business.

Recruitment has been mentioned several times. When I referred to doctors I was referring to consultants.

There are two sides to information and communications technology; corporate ICT and clinical ICT. In a previous life, the hospital I worked in was in the public system. It had fantastic clinical ICT and excellent corporate ICT. In fact it was better on the clinical side than the ICT I am working with currently. It is mixed. We have seen the adoption of clinical ICT in the Galway clinic. I know the Hermitage Medical Clinic has a roll-out at the moment. Our hospital is just behind that stage. We are going to catch up and we are planning to invest in that area.

Theatre time is an interesting area. The set-up is typical of all the private hospitals – I have discussed this with people from Blackrock Clinic and the Mater Private Hospital. Typically, staff come in at 7 a.m. and knife-to-skin time is 7.30 a.m. The first patient is prepared, on the table and the surgeon is in at 7.30 a.m. If that does not happen, a big red flag is raised. We have eight theatres in use from Monday to Friday from 7.30 a.m. to 7 p.m. and they go through lunch. Typically, we have two teams on the nursing side. I am unsure what specialty was referred to earlier, but four times seems like a lot. I know of surgeons who could do six joint replacements in a theatre session in one day. They have put it to me that they would be lucky to undertake one or two per week in the public system. I do not know the full reason, I am simply saying that is what they have said to me. That is the process. We offer those slots across the week to a range of surgeons.