Hospital bed debate

Many healthcare professionals argue that Minster for Health and Children Mary Harney's plans to offer tax incentives to private investors to develop private hospitals in the grounds of public hospitals throughout Ireland have not been debated sufficiently.

The purpose of her initiative is to free up 1,000 public beds by moving 1,000 of the 2,500 private beds in our public hospital system into new "for-profit" hospitals over the next five years. The following two opinions capture the essence of the arguments for and against this.

FOR: Prof Mark Redmond is a cardiac surgeon in Our Lady's Hospital for Sick Children, Crumlin and medical director of the Beacon Hospital, Sandyford

By developing private facilities on public sites, Minister for Health Mary Harney can shift private beds out [of public hospitals] and generate more public beds at minimal expense. The HSE would then be able to formalise its arrangements with consultants for time spent in the co-located public and private facilities. There could be a sharing of certain services, some financed by the private facility and others by the public hospital.

The State could benefit financially from the long-term lease of the site and avoid much of the capital investment required. The State is not actually funding these independent hospitals no more than it funded all the hotels built in Ireland over the past decade. Rather, by providing capital allowances, it is merely facilitating a development of healthcare facilities which would otherwise be unable to attract private investment. Recent massive investment in our healthcare system has not yielded significant improvement.

Privately funded facilities have the capacity to accommodate changes in medical practice. By their very nature, they are efficient and flexible.

Our current structures are not well adapted to meet our healthcare needs. More money is not the answer. Ms Harney is correct in embracing the independent sector which is much more likely to deliver our future healthcare needs.

Over 50 per cent of our population with private health insurance seems to agree.

AGAINST: Dr Fergus O'Ferrall, director of the Adelaide Hospital Society at the Adelaide & Meath Hospital incorporating the National Children's Hospital, Tallaght

The plan to have new "for-profit" private hospitals on the campuses of public hospitals makes neither health policy sense nor economic sense. There is a fundamental difference between simply building 1,000 new public beds and the plan announced.

Those occupying private beds in the new "for-profit" private hospitals, despite the policy to introduce consultant-provided, team-based working arrangements, will not have the same quality of care, because they will not have the comprehensive care teams and services available to those in private beds in our public hospital systems.

Those occupying public beds will also get poorer care because consultants will not be around as much as they are when public and private beds are in the same hospital.

The not-for-profit governance model of acute hospitals in European countries is based on commitment to patient care rather than profit as the supreme value in running hospitals. Such a model is cheaper for the taxpayer. It allows the state to plan the hospital system more effectively without waiting for proposals from private investors. It will lead to better care for all patients through a single, high-quality standard of care provided by the same healthcare teams within one hospital. It avoids cementing in the rigid two-tier hospital system through public and private "for profit" hospitals and would make ending our current inequitable system more achievable.

Medical journal studies have demonstrated that "for-profit" care is high-cost with health outcomes that compare very unfavourably with those of "not-for-profit" care. Some aspects of life, such as our care for the sick, are too precious to entrust to the market.