It is now nearly nine years since the publication of the Sláintecare reform plans which included proposals that State-funded hospitals should be for public patients only. Private medicine, the report urged, should be phased out.
From the beginning of January the operation of public-only hospitals will take a considerable step forward with the ending of transition arrangements for medical consultants who are covered by a Sláintecare contract introduced in 2023. In return for a higher salary of about €250,000, this deal stipulated that the doctors concerned could only treat public patients in State hospitals, but it allowed them until the end of December to wind down their existing private practices.
About 1,500 hospital consultants who continue to work under older contracts will still have rights to treat private patients in public facilities. However, as all new appointments since 2023 are based on Sláintecare terms and conditions, over time, private medicine will disappear.
However, doctors are warning that the move will have implications particularly for patients requiring care in areas not covered by the private sector.
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The most notable of these will be obstetrics. Maternity services are concentrated exclusively in the public system, as the speciality is considered uninsurable on a commercial basis in the private sector.
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Jim Daly, the former Fine Gael minister, who became chief executive of the Irish Hospital Consultants Association (IHCA) almost a year ago, said that, for example, if a patient wants to have a knee operation, they can go to a private hospital.
“But there are no private alternatives for obstetrics. So as I see it, from the 1st of January, a woman who wants to deliver her baby and wants to go private and have a private consultant manage her pregnancy, will be very limited in the options available for the in-hospital part of that care and for the delivery in hospital, because it will depend on the contract status of the consultant.”
He said the new restrictions could also affect other specialities such as cardiology for children.
Mr Daly said there is provision for local hospital management to allow a continuation of private practice by consultants operating under the Sláintecare contract.
However, he said health insurers have made clear they will not pay claims in respect of subscribers treated by a doctor covered by public-only contract.
Mr Daly said the masters of the three Dublin maternity hospitals have said previously they would like to see the option of private care continue.
However, he maintained that Minister for Health Jennifer Carroll MacNeill “seemed to be quite adamant that there will be no exceptions to this”.
Mr Daly does not believe the elimination of private medicine will free up large numbers of beds for public patients.
“From January 1st there will be no different patients or no new patients treated in the public hospital. What will happen is all of the patients who are in the public hospital will continue to be in the public hospital. They will just all be paid for out of the public purse.
“If you think that there will be additional beds created in the public system as a result of Sláintecare, no, there won’t. The same patients, because of the complexity of their care, will be in those beds.”
In his first interview since his appointment, the IHCA chief described Sláintecare as being “politician-led”. He suggested clinicians should be more involved in drawing up policy, as well as having a greater role in management.
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The IHCA will in February hold a conference featuring doctors who run prestigious hospitals in the United States. The body will also devise leadership courses to equip members with skills to take up top-level roles in hospitals.
He said up to now there has not been a culture in Ireland where clinicians were motivated and encouraged to apply to become chief executives, while there was also the issue of salary differentials to be addressed.
During the year, Ms Carroll MacNeill has highlighted the need for greater weekend discharge rates by consultants to tackle emergency department overcrowding.
He said his members “feel it is a very simplistic view of the world to suggest that the ills of the system can be cured by bringing more consultants on duty at the weekend”.
“At the end of the day we have a finite number of consultants. So you bring in more doctors on Saturday, that is fine, but your service on Monday will not be the same because there is a finite number of consultants on a finite contract.”
The IHCA itself described a meeting with the Minister earlier this year as “constructive and robust”, while others maintained it was tense.
Asked about relations with the Minister, he said: “There’s always going to be, you know, a healthy tension between any given Minister on any given day. I think people regard that the Minister’s motivation and intentions are good. I do think that the Minister would benefit from increased engagement with the people who have responsibility for the delivery of care for patients. When it becomes a one-way communication system, it’s not always the best.”
