Health spending all wrong, says consultant

Funding goes not to patients but to keep people in jobs. We need to reverse our cost system, a consultant argues

Using our healthcare system as “a sanctuary for underachievers” needs to be stopped, a Galway-based consultant has advised the Taoiseach and Minister for Health. Sherif Sultan believes that a healthcare system which offers permanent and pensionable jobs breeds complacency.

The consultant vascular and endovascular surgeon argues that to remain competitive and productive, Health Service Executive employees must be answerable and subject to performance-related targets. Those who do not consistently reach their targets should not be employed, in his opinion.

“Recruitment bans will not address the inefficiencies of the HSE, they only serve to make those already in employment all the more secure. We have an excess number of employees in the HSE with a substantial portion of these wrong for the job. Lifting the ban on firing people will do more to address this fundamental issue than initiating a ban on recruitment,” Sultan asserts.

In a hard-hitting letter to the Taoiseach and the Minister for Health, Sultan explains that he feels it is incumbent upon him, as “an ethical and dedicated practising physician”, to air his views on the misappropriation of funding.

Within days of sending the letter on September 9th of this year, Sultan received a reply from the Taoiseach saying he had passed it on to the Minister for Health who would be in touch.

Dr James Reilly sent the consultant a letter in which he assured him he would discuss it with his colleagues. Sultan does not expect the issue to go further.

In his letter, Sultan points out that an unprecedented proportion of Ireland’s health budget of €16 billion per year is spent on salaries. He notes that Ireland has the highest number of administrators and nurses per 100,000 population in Europe, with the lowest number of acute beds and less than the average number of doctors.

Job security

Sultan says the Croke Park agreement protects a wage bill that accounts for 70 per cent of healthcare expenditure and says we can no longer afford this. He says the HSE is in effect closing beds to pay for salaries.

“Our health service is not in place to provide employment. Our healthcare system exists to treat patients and, somewhere along the line, this fundamental concept has been forgotten. Drastic reform is necessary but readily achievable with a change in mindset and a shift of focus back to where it should lie, ie on the patient.

“Our aim should be to redress the imbalance in appropriation of funds and work on achieving a healthcare system in which the majority of money is spent directly on the patients and the minority is spent on administration and salaries.”

The only realistic way to ensure that the money follows the patient, according to Sultan, is to outsource treatments and procedures letting the contracted service providers take the burden of overheads and running costs, while the taxpayer pays only for the procedure.

Sultan compared the cost to the taxpayer of vascular index procedures performed in two Irish teaching hospitals – one a public sector HSE-run hospital and the other a linear management hospital system (LHMS)/centre of excellence.

Both serve the same population of patients. For any index procedure, the cost was €22,850 in the HSE-run hospital versus €6,570 at the LHMS clinic.

The price of minor surgery such as varicose vein procedures was €18,900 when performed at HSE-run hospitals versus €2,000 at a private clinic.

The disparity was explained by administration costs and wage bills within the public sector – as long as the Croke Park agreement remains, the price gap cannot be bridged, according to Sultan. “The only solution is to cease performing these minor procedures within the mainstream hospital setting . . . Provisions must be made for these procedures to be performed within ambulatory clinics, primary medical centres or the office setting.

“The most efficient way to reach the €1,000 mark for such procedures is for office practice to be nurtured and this also requires support from the insurance companies to truly make this a commonplace solution. Conversely all complex major index procedures must be contracted to any health sector that can provide an all-inclusive package that includes two years of follow-up for every patient for €23,000.”

To sustain such a system will require expansion of health insurance coverage to the uninsured, says Sultan, but it will guarantee that the money follows the patients and is not consumed by indirect costs.

He believes this will increase the net economic wellbeing by roughly €2.2 billion per year.