As few as 20 per cent of consultants in some hospitals adhered strictly to the restrictions set out in their new contract, writes MARTIN WALL
IN A LETTER sent before Christmas to the chairman of the Health Service Executive (HSE) setting out her priorities for 2010, the Minister for Health, Mary Harney, made it clear that she wants to see careful monitoring of the private practice rates of public hospital consultants to ensure compliance with new restrictions introduced last year.
The terms of the new contract agreed in 2008 set strict limits on the numbers of private patients permitted to be treated by consultants working in public hospitals. It stipulates that the ratio of public to private patients treated by doctors in public hospitals should range between 70:30 and 80:20 depending on the type of contract held by each doctor.
However, an assessment carried out by the HSE, and given to the Department of Health in November, suggested that as few as 20 per cent of consultants in some hospitals had been adhering strictly to these restrictions.
The report on consultants’ private practice drawn up by the HSE, which covered the period March to May 2009, found the largest levels of non-compliance with the private practice ceilings for inpatient admissions were in St John’s Hospital and Croom Orthopaedic Hospital, both in Limerick.
There was full compliance with the limits at Connolly Hospital in Dublin and Bantry general hospital in Cork.
The report stated that at the Mid-Western Regional Hospital in Limerick just over a quarter of consultants were adhering strictly to their private practice limits for inpatient admissions. For day cases at the hospital, the figure stood at more than 36 per cent for the period. The report says more than 45 per cent of consultants were within 10 per cent of their official ceiling for both private inpatient admissions and day cases
In November, senior health service officials told the Dáil Public Accounts Committee that hundreds of hospital consultants around the country were flouting the conditions of their new contracts by treating too many private patients.
The committee also heard that up to that time, 85 doctors had been sent warning letters about their private practice levels.
In her letter to the HSE chairman, Liam Downey, Harney said the safeguarding of public patient access to acute hospital services was a key objective of the Government.
“In this context it is essential that the HSE and individual hospitals maintain a sharp focus on ensuring compliance with the terms of the consultants’ contract, especially in relation to the level of private activity permitted.
“I would emphasise, in particular, the need for the necessary balance to be achieved where elective work is concerned, since the public/private mix in this area should be entirely within the control of the hospitals and the clinicians concerned. This is an area where I wish consultant performance to be tracked and reported upon,” she said.
The report, published by the HSE, effectively provided a snapshot of the figures for compliance with the official public/ private ratios for the period March to May without any commentary.
However, a briefing paper prepared by the HSE for the secretary general of the Department of Health, Michael Scanlan, for his appearance before the Public Accounts Committee in November provides more detail. The paper, which has been seen by The Irish Times, said, for example, that at Our Lady’s Children’s Hospital in Crumlin (OLCHC) there were 45 consultants in breach of the contract.
“There are ongoing discussions being held at the hospital’s contract implementation group, which includes members of the OLCHC medical board. OLCHC has stated it is important to recognise the unique feature of paediatric acute care, and the central issue for the hospital and the consultants remains that the absence of any significant private hospital facilities for children means that the public-private mix, especially in national services, will inevitably reflect the insured status of the population at large,” the briefing note stated.
The note said that at Tallaght Hospital there were 20 consultants in breach of the terms of the contract’s private practice stipulations. It said letters were being sent out to medical, surgical and paediatric directorates.
In the midlands, the note said, there were eight consultants at the regional hospital in Tullamore in breach of the contract, four in Portlaoise and one in Mullingar.
In the midwest, the note describes inpatient and day cases as being “particularly high” with fewer than half of consultants complying with contract limits.
“Consultants have been contacted individually and meetings arranged to discuss the arrangements to remedy this with the hospital manager and clinical director. Private and semi-private bed designations in Limerick have been traditionally high due to the absence of a private inpatient facility in the city, [for example] the bed designation for St John’s Hospital is 55 per cent public and 45 per cent private. The take-up of the 2008 consultants’ contract in the Mid West has also been low in comparison with the rest of the country,” it said.
In relation to Cork University Hospital, the note said that inpatient and day-case activity rates were more than 30 per cent and that the proportion of consultants within the contract was 55 per cent and 57 per cent respectively.
It said that at the Mercy Hospital in Cork both inpatient and day-case private activity was exceeding 40 per cent and the proportion of consultants within contract ratio was low at less than 50 per cent.
However, the note also stated that there were no consultants in breach of the contract at Naas General Hospital or at the Coombe Women’s Hospital.
It said that overall compliance among consultants in the Dublin North East group of hospitals was positive, with the majority coming within their contract limits.
Under the terms of the contract, if private practice rates persist at levels above the official thresholds, there is provision for consultants to face financial penalties.
“The new contract, agreed in 2008, stipulates that the ratio of public to private patients treated by doctors in public hospitals should range between 70:30 and 80:20 depending on the type of contract held