Public-focused system will have repercussions for private patients

I AM one of the VHI’s 1.57 million subscribers. The cost of my membership is €871.04 this year. Because I pay private health insurance (PHI) I enjoy certain perks.

I have, in the past, had speedier access to specialists than some of my public-patient colleagues. I have had a private hospital room.

I would prefer not to have to pay PHI, but in a country where I have witnessed a sluggish and understaffed hospital system let the public patient down, I have opted to pay for the reassurance of “going private”.

Just over half the population — 51% — pays for this priviledge. So what will the new almost-agreed consultants’ contract mean for us?

Throughout the talks, Health Minister Mary Harney has played up the importance of boosting consultant numbers in the short-staffed public hospital system. To this end, she and health service employers have continually pushed for the introduction of a public-only contract.

This would commit future consultants to working exclusively with public patients. They have succeeded in introducing this category of contract, according to the terms of a draft agreement reached on Thursday night. A second category will allow consultants split their public/private work 80:20, provided the private element is on a public campus and the third category, which the Health Service Executive (HSE) says will only be available “in exceptional circumstances” will allow consultants treat private patients off-site.

The overall tone of Ms Harney’s and the HSE’s welcome for the new agreement is that it will, in particular, involve a commitment to the public service. Following through on this commitment involves a promise of recruiting 2,000 consultants over the next number of years.

The problems posed by this commitment to the public service and a massive recruitment drive are two- fold. The former does not sit nicely with Ms Harney’s co-location plan. Her stated intent in relation to this initiative is that it will free up public beds because private patients will be shipped out to eight co-located hospitals. Who will staff the hospitals I could find myself in if the focus is on staffing the public system? Who will staff these hospitals when we cannot fill existing vacant posts? Where will an additional 2,000 consultants come from?

The shortage cannot be resolved quickly. The turnaround time for recruiting a consultant, from seeking initial approval to filling the post, is approximately two years. We currently have approximately 2,000 consultants and 4,000 junior doctors within the hospital system. Ms Harney’s plan is to reverse this ratio so that consultants outnumber junior doctors by 2:1. Experts within the health service estimate this will take up to 15 years.

Doubtless, there are overseas and homegrown doctors poised to apply immediately for the initial 68-plus consultant posts due to be re-advertised next month, but recruitment in the long term is unlikely to be speedy. The new additional medical students starting in universities this year will not realistically reach consultant level for another 17-18 years. Again, when it comes to offering them a consultant contract, if the focus is on the public system, where will this leave us numerous fee-paying patients?

On the other hand, it is impossible to predict how many consultants on existing contracts will opt to switch over to the new public-only contract. In the short term, the number engaged in private practice is unlikely to change significantly. Moreover, the HSE will need a certain number of future consultants to opt for some private practice to maintain cover for private patients. This is especially relevant in the area of obstetrics where up to 40% of patients have PHI. It is not clear how a cap of 20% on the number of private patients a consultant can treat will work in a maternity hospital. What if I fail to fall within that 20% — where will I go to give birth?

Doubtless, a deal is better than no deal, and it is not in anyone’s interest for the current tentative agreement to break down. However, whether it will transform the health service in the manner Ms Harney envisages is still anyone’s guess.