Sir, – Sam Coulter-Smith, in his excellent article "We risk throwing the voluntary hospital baby out with the Sláintecare bathwater" (Opinion & Analysis, February 17th), confuses two separate and critical issues.
The first is the undeniable need for far more rapid and focussed change in our health services, changes in which voluntary bodies, like the Rotunda Hospital, and St Michael’s House, led the way during the height of the ongoing pandemic.
He does, I think, understate the responsiveness and effectiveness of HSE staff on the ground.
He correctly identifies the immense failures of governance in the HSE, where not making a decision is too often the default.
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The second is the continuation of costly, inefficient, and largely unregulated private healthcare, very heavily subsidised by the Irish taxpayers. This provides a very substantial increment to the salaries of a minority of our consultants, and high rates of return to investors.
More seriously, it drives a set of perverse incentives to admit people and do procedures, and pushes public patients even further down our ever-lengthening waiting lists. It’s likely that if we stopped subsidising this peculiar system, the money released would more than make up the gap in the incomes of certain acute hospitals.
The quote from Paul Reid with which he finishes his article is on point. “Maybe we need to give them [the voluntary hospitals] the means to get on and do what they do well and not try to control them quite so much”.
However, this needs to extend far beyond the acute hospitals, to include other health and social care delivery. HSE needs a working model of governance, reporting and accountability, not micro-management. – Yours, etc,
ANTHONY STAINES,
Professor of Health Systems,
Dublin City University,
Dublin 9.
Sir, – There is a fundamental flaw in the argument of Sam Coulter-Smith that Sláintecare will adversely affect patient choice. To exercise choice you need to have the financial means to do so.
Absent that, the operation for which you are on a public waiting list for six months, but which can be obtained privately in six weeks, is not available to you.
His assertion that depriving the rich from accessing private healthcare will throw a burden on the public sector is akin to saying banning Rolls-Royces would drive up the cost of a Ford Fiesta. Enough of this nonsense. – Yours, etc,
KENNETH HARPER,
Burtonport,
Co Donegal.
Sir, – Sam Coulter-Smith, in his opinion piece on voluntary hospitals whose existence is threatened by Sláintecare, mentioned the Erinville hospital, a maternity hospital in Cork City. The Erinville, or “the Ville” as it was popularly known, will always have a fond place in my heart as my first two children were born there. The standard of care there was wonderful. It was founded in 1799 and moved to a new site in 1898.
It was seen as Cork’s premier maternity hospital for many years.
Its existence however is not threatened at all by Sláintecare as, sadly, it closed with the amalgamation of Cork’s maternity hospitals in 2007. – Yours, etc,
MARY MORRISSEY,
Castletownbere,
Co Cork.
Sir, – Dr Coulter-Smith rightly draws attention to the important role the voluntary hospitals might have in the provision of contemporary healthcare in Sláintecare.
We should also acknowledge the historical contribution of the voluntary hospitals. The Charitable Infirmary (more often referred to as Jervis Street Hospital), which was founded in 1718, gained the historical distinction of being the first voluntary hospital in the then United Kingdom of Great Britain and Ireland; the Westminster Hospital, the first voluntary hospital in Britain, opened two years later in London.
The founding of the Charitable Infirmary marked the beginning of what may be described as the “voluntary hospital movement”.
Dr Steevens’s Hospital opened in 1733, Mercer’s Hospital in 1734, the Hospital for the Incurables in 1753, the Rotunda Lying-In Hospital in 1745, the Meath Hospital in 1753, St Patrick’s Hospital in 1757, the Cork Street Fever Hospital and House of Recovery in 1804, Sir Patrick Dun’s Hospital in 1818, the Coombe Lying-In Hospital in 1823 and the City of Dublin Skin & Cancer Hospital in 1911. Most of these hospitals were founded by doctors, or their family executors.
Some of these hospitals, in addition to having provided healthcare to the citizens of Dublin for nearly three centuries, continue to make substantial contributions to healthcare in the city.
Having been associated with The Charitable Infirmary and the City of Dublin Skin and Cancer Hospital for many years, I have seen the benefits of substantial funding provided by the Charitable Infirmary Charitable Trust for research to Beaumont Hospital, and by the City of Dublin Skin and Cancer Hospital Charity to enable foundation of the Charles Institute of Dermatology at UCD, and the establishment of the Irish Skin Foundation, among other initiatives to support dermatology in Ireland.
I am aware that the proceeds from the sale of other hospitals have been used similarly to assist research and the development of our health services.
It would seem timely, therefore, to consider the beneficial role that bodies overseeing the legacy of the voluntary hospitals might have in the future development of our health services. – Yours, etc,
EOIN O’BRIEN,
Dún Laoghaire,
Co Dublin.