Seanad debates

Wednesday, 19 December 2007

Health (Miscellaneous Provisions) Bill 2007: Second Stage

 

4:00 pm

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)

The surgeon wrote to me about the need for consultants, which was acted upon, but the consultant there never wrote to the HSE to say there was something wrong with the false positives. The director of nursing did and that led to the suspension of the mammography service.

The health system over which I preside has been in place for a considerable time. It is a public hospital system in which 20% of the beds, funded 100% by the taxpayer are available only to private patients. It is fundamentally wrong that there are 2,500 beds in our public hospitals which only some people can access. Contracts of employment, however, have been signed with consultants on that basis which I cannot break without generously compensating people. Insurers have been involved in contracts with the hospitals for resources based on that fact. I want to convert those beds and make them available to every citizen on the basis of medical need. I prefer the term patients who access services on the basis of medical need to the terms "public" and "private". That has been the cornerstone of our approach to the consultants' contract. If we were prepared to allow unfettered access to private activity in our public hospitals, we would have had a contract of employment two years ago.

Almost half the elective procedures two years ago in one of the hospitals in this city were for private patients even though that bears no resemblance to the catchment area of the hospital. Only 24% of the accident and emergency activity was regarded as insured patients, yet the elective work was almost 50%. That is wrong and to deal with it we established the National Treatment Purchase Fund to take the patients who could not access these beds to be treated in private hospitals. That is crazy. It costs €300 million a year in salaries to staff these beds of which the insurers pay €74 million, so the State subsidises those beds every year to the tune of €226 million, yet only some people can access them.

The co-location initiative was put forward not because of the book referred to by Senator Donohoe, which I read only last summer, but because several doctors in Waterford, Beaumont, St. James's and other hospitals wanted to build private hospitals on the grounds. Several private hospital projects were being initiated and some private hospitals were being built away from public hospitals. I believe that having the two together, with doctors on site, is preferable to the situation that prevails in the city at the moment that can see doctors working in three, four or five hospitals.

One third of consultants have category 2 contracts; that amounts to about 700 doctors and 650 of them are in Dublin. It is not unusual for many of these consultants to work in three or more hospitals; some work in four or five. The contract allows them to do this, although it is good in terms of time management or patient management. Hospital management has informed me it may receive a call in the afternoon from a consultant saying he or she will do his or her round at 7 p.m. or 8 p.m. This means the patient will be kept in the hospital all day and junior doctors will be paid overtime to carry out the round with the doctor. These are crazy practices that are not in the public interest and not in patients' interests. I want to keep doctors on the site rather than have them driving all over the city, which seems to be the Opposition's policy.

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