Wednesday, 26 April 2006
Question 49: To ask the Tánaiste and Minister for Health and Children her views on the strong criticisms made at the recent IMO annual meeting of her proposal for private hospitals on public hospital grounds and the fact these proposals do not represent an evidence-based approach to health policy; if she will review her insistence on pushing through proposals that are likely to have a serious and adverse impact on the health services; and if she will make a statement on the matter. [15686/06]
It is to be expected that diverse views are expressed at a gathering of the Irish Medical Organisation. For example, Professor John Higgins, consultant in obstetrics and gynaecology at Cork University Hospital, stated the following at the organisation's conference: "If dynamic, flexible arrangements are put in place then I think the co-location model recently suggested by the Tánaiste should be an absolute winner [for us all]". Similar views were expressed in the media last week by Dr. Rob Landers, consultant pathologist at Waterford Regional Hospital and chairman of its medical board.
The policy direction I have given to the Health Service Executive is to achieve 1,000 new public beds. If we build a new public bed in the traditional way, the Exchequer bears 100% of the capital cost. If we do it in the new way, that is, by moving the private beds into new co-located facilities and freeing up new public beds, the capital cost to the State is less than 50%. In addition, the running cost of the private beds would no longer be subsidised or managed by the State. The HSE is now taking the necessary steps to implement this policy to achieve a significant increase in the number public beds.
Like very many other countries, we have a mixed system of financing and provision of hospital services and there is no reason we should not continue to build on this. We already have excellent private hospital management dating back to the 18th century when St. Patrick's Hospital in Dublin was founded by Jonathan Swift. The Highfield group has been offering services in the Dublin area for 150 years. There are many other hospital providers which have, more recently, established strong reputations for quality and service among the public.
There is no evidence from Ireland that for-profit hospitals have a lower patient safety record than all others. It is highly relevant that the same body of consultants largely treats patients in both public and private settings. I do not believe those consultants would accept, still less promote, a proposition that their patient care and patient safety be lower in one location than in another. Patient safety is vital in all hospitals, both public and private. I will promote accreditation and clinical auditing for all settings, irrespective of their financing structures. I urge support from medical organisations and practitioners for all measure to assure quality care for all patients in all locations.
The board of governors of St. Patrick's Hospital will be surprised that it is a for-profit organisation. Is the Minister not taking on board the fact that, overall, there was widespread criticism of her proposal, not just from the IMO but also from others? Does she not need to listen to this? Will she indicate what research she has carried out to justify what appears to everybody else to be a top-of-the-head kind of proposal?
Does the Minister not accept that international evidence indicates that for-profit hospitals are more costly and do not have outcomes as good as those in public hospitals? Will she indicate how she can justify the diversion of so much public money into private hands? The hospitals in question are not private, they are publicly funded for-profit hospitals. Does the Minister not accept that by saying the State will have no management role in these hospitals, although it is funding them to a great degree, she is exposing a weakness in her argument? Whatever happens in those hospitals will be determined largely by the desire to make profit rather than anything else.
Does the Minister not feel at this stage that it is important to circulate among the public evidence to back her claims and to agree to take on board and consider carefully the criticisms that have been made, not only those of the medical profession but also those of economists, who reckon the proposal will cause more problems in the health service than exist at present?
There are 2,500 private beds in the public hospitals. The policy pursued by the Deputy's party, when it was in Government, was that 20% of beds in all new hospitals would be private. The taxpayer pays the full cost of these and, furthermore, staffs them and subsidises them to the tune of 40%. The only staff members getting any income from the insurers are the consultants. I recently compared this to pilots getting all business-class air fares.
I want to convert 1,000 of the 2,500 beds into public beds for all patients, not just private patients. The manner in which I suggest doing so is such that these beds would be provided to the taxpayer at less than half the cost, including the capital allowances, of building the beds in the traditional way. Furthermore, these beds are already staffed by nurses who are being paid through the public system, and therefore all that is required is the relocation of the private beds to a different facility that would be totally financed by private investors. Hospitals would have these facilities co-located so the consultant staff could be on-site. We all know that consultants can use their time more effectively if they are on-site as opposed to operating at a number of different sites under a system of bi-location. This is why this policy is being pursued. Before I announced the policy, Prospectus, which has great expertise in this area, did some consultancy work for me.
In the OECD approximately 27% of health care is provided privately and 72% or 73% is provided publicly. In the United States, where the reverse is the case, some 60% of health care is private and 40% is public. I noted recently that the Prime Minister of British Columbia, Gordon Campbell, asked why Canada was so afraid to consider a mixed health care delivery model like those in many European states and others which would deliver results for its patients at a lower cost to taxpayers. That is what I am trying to do.
I am trying to provide 1,000 beds at less than half the cost of doing so in the traditional way, thus avoiding the need for the huge subsidy of 40%. Much private work is carried out in our public hospitals and the rate is increasing very rapidly because of the great numbers with private health care insurance. The taxpayer should not fund the capital provision of the private beds, nor should he or she subsidise them to the tune of 40%.
There will still be private patients in the public hospital system because they can be there as of right. I suggest that the Minister publish every scrap of evidence because she will need to make her case to the public and those working in the health service. She will admit that these are not privately funded hospitals but State-subsidised hospitals over which the State will have no direct control. Those hospitals could care for patients from Asia apart from those earmarked by the Minister. An entirely new business could be created and we will have no control over it. All we will have done is handed over a great deal of money, which could have been used to invest in the health service, to private for-profit organisations interested in making money.
It does not require rocket science to realise that one can provide 1,000 public beds for less than half the cost of building them in the traditional way, yet the Deputy says this does not make sense and suggests we should instead pay €1 million per bed to build the 1,000 beds, which sum we are currently paying.
The public hospitals will either lease or sell the required land and will not invest any money in the beds. At present, the public system is funding the entire cost of the private beds. Patients have to enter a public hospital on the basis of equity and not on the basis of whether one can pay and another cannot. My policy is one of total equity in respect of facilities provided by the taxpayer. We do not have this at present.
Most consultants to whom I have spoken, comprising at least 100 from hospitals around the country, totally support this initiative. They regard it as the most effective way of getting——
Under the Deputy's proposal, the consultants will do all their private work in the public hospitals and the State will continue to subsidise the beds to the tune of 40%. She obviously believes this is a good idea.
What I say is true. The Deputy believes my proposal is stupid although it involves providing the beds at half the cost that would be incurred in the traditional way.
Question 50: To ask the Tánaiste and Minister for Health and Children if the recently established health fora are to be sidetracked by the Health Service Executive in the issuing of protocols, such as occurred recently in the executive's north-east region in respect of its removal of paediatric services from Louth, Navan and Monaghan general hospitals without prior consultation or discussion with the health forum; and if she will make a statement on the matter. [15561/06]
The function of regional health fora is clearly set out in section 42 of the Health Act 2004, which provides for the establishment of the fora to make representations to the Health Service Executive as they consider appropriate on the range and operation of health and personal social services provided within their functional areas. I understand the first meeting of the forum for the north east took place on 27 March 2006 and that a wide range of issues was discussed.
On the specific service referred to by the Deputy, I am advised there has been no change in the provision of paediatric services in the north east region in recent times. A paediatric transfer protocol was developed by a multidisciplinary regional group, established by the North Eastern Health Board in 2003, to establish clear, concise and workable guidelines for the assessment and management of all children under the age of 14 presenting at a non-paediatric facility in the north east. This protocol has been operational as a draft protocol since spring 2005 and was formally implemented on 10 April, with a review date of six months from that date.
In accordance with its terms of reference, it is open to the Dublin and north-east forum to make representations on this matter to the CEO of the Health Service Executive.
I thank the Tánaiste for her response. The major decision to remove paediatric admissions from Dundalk, Navan and Monaghan hospitals, which was implemented on 10 April, should have been discussed at forum level. The forum members should have been given the opportunity to make representations or observations prior to a service being removed. It is any parent's nightmare to be forced to drive past Dundalk, Navan or Monaghan hospital with a critically ill child, suffering from an asthmatic attack, meningitis, an epileptic seizure or choking. The forum members should have been able to discuss the matter and give assurances to people that these children would be looked after if they were taken to the nearest hospital, where they could be stabilised. If necessary, they could subsequently be transferred. There is no point in the next meeting of the forum discussing or making an observation on a decision that has already been taken. From the executive's point of view it would be somewhat like a thunderstorm, something that will pass after an hour or two and the air will clear afterwards. This is why I believe these new fora——
Does the Tánaiste agree that these fora are completely irrelevant if they are not allowed to discuss matters of policy or service delivery to the public and the effects they have on the public? We talked about appropriate observations. Would the Tánaiste agree nothing could be more appropriate than wanting to save the life of a child while being forced to drive past a hospital, which represents the worst nightmare for any parent?
The fora are free to discuss policy issues. However, the fora are prohibited from having a role when it comes to clinical judgment issues and the appointment of staff. This issue falls into the broad area of policy, on the one hand, and patient safety and clinical judgment on the other hand. This is why it was decided this service should not be supplied in four different hospitals covering a relatively small population base. As the Deputy is aware, these services are provided in Cavan and Drogheda.
The protocol came into effect in April and it will be reviewed in six months' time. In the meantime, perhaps the matter could be discussed at the next meeting of the forum.
Obviously, anybody who is critically ill may be brought to a hospital with an accident and emergency unit that is on call for emergencies. Clearly for all patients, the sooner they are brought to the most appropriate place for treatment the better. The sooner a patient can get to the place that can deal with his or her difficulty, the better the outcome. If a patient is brought to a hospital that is not able to provide the kind of service required, the delay in taking him or her to the more appropriate setting, in this case Cavan or Drogheda, could cause serious difficulties for him or her.
A review of what happened to the late Pat Joe Walsh in Monaghan General Hospital is expected to be complete next month. The review of services in the region will also be available in May. As a matter of urgency we need greater clarity as to what should happen in the north east because there have been major difficulties. For almost as long as I have been a Member of this House, the hospital services in that region have been the source of much debate here. Many of the problems stem from having so many hospitals for such a small population base, which causes great confusion and difficulty.