Nothing was so telling about the likely fate of the recently published report examining private activity in public hospitals as the date on the cover. The report of the independent review group chaired by Donal de Buitléir is dated February 2019, yet the Government only saw fit to publish it in late August, at least six months on from its completion. Noteworthy, too, was the absence of the Minister for Health, or any other Government minister, at the launch of the document.
If all of this suggests the report will join so many others in health that are gathering dust, that would be a pity. The review group has built on the good work done in 2017, when the Sláintecare blueprint for the future of the health service was published, with its own road-map for progress.
Just as with Sláintecare, the latest report lacks details when it comes to the costs involved
Sláintecare, for all the cross-party agreement it enjoyed, suffered from two defects – a lack of proper costings and a failure to specify just how one of its main goals, the disentanglement of public and private medicine, was to be achieved. The de Buitléir report remedies the latter defect, though only partially. It proposes a 10-year journey towards the elimination of private medicine in the public system, and with it an end to the unfairness that allows those of greater means to be treated more quickly in public hospitals than those who have to rely entirely on the public system.
However, just as with Sláintecare, the latest report lacks details when it comes to the costs involved. It suggests doctors with contractual rights to see private patients in public hospitals could be offered a once-off payment to encourage them to opt out of these arrangements. But how would this payment be calculated, and how much would it cost overall?
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The report suggests future consultants move to a public-only contract as part of the creation of a one-tier system. Yet the number of consultants on the existing Type A contract, which limits them to public work only, has fallen over the past decade; only 169 consultants out of 2,800 are on this contract. The trend suggests the profession will have to be handsomely incentivised to leave private pastures for good. Would the suggested salary of €182,000 be enough?
The proposed abolition of pay caps for some posts will further add to the cost of implementing the report, as will the recommendation that the existing lower-pay arrangement for post-2012 consultants be ended. The latter two-tier arrangement will be the subject of talks between the Government and the medical unions next month. The Irish Medical Organisation has said it wants this pay inequity ended before it talks about other changes. The question for the Government, given its delay in implementing Sláintecare and the palpable distaste among some Ministers for the de Buitléir proposals is: what exactly does it want for the future of the Irish health service?