HSE warns Sláintecare may require compensation for consultants

Elimination of private practice in public hospitals to pose financial complications

The Health Service Executive has told the Government it may need to compensate medical consultants for loss of earnings or renegotiate existing contracts if proposals under the Sláintecare health reforms to eliminate private practice in public hospitals is implemented.

The HSE also warned that without incentives – including financial ones – it could prove more difficult for the public system to recruit and retain top-quality consultants and that this, in turn, could impact on the quality of patient care.

“Improved recruitment and retention means better access which in turn means better health outcomes,” the HSE said in a submission to the review group established by the Government to examine the proposed removal of private care from public hospitals.

The HSE made its comments in a submission to a review group established by the Government which is examining the implications of removing private care from public hospitals.


A number of other organisations in the health sector have warned of complications arising from the plan.

On Monday, The Irish Times reported that the State-owned health insurer, the VHI, advised the Government that any change to the consultants' contract that prohibited private practice in public hospitals "would be likely to be contentious . . . and could potentially give rise to arguments framed in constitutional terms".

There is a very large and disproportionate growth within certain sectors or specialties in private healthcare which is related to the demands of an increasingly aged population

In a separate submission, the Health Insurance Authority (HIA) highlighted cost implications from the move, saying the Government would have to fund the loss to public hospitals of private patient income of approximately €600 million per annum at current prices.

Salary rates

For its part, the HSE said consultants operated in the internationally competitive market with transferable skills and knowledge. It said that there was “no evidence to suggest that current salary rates which give recognition of private income are attractive”.

The HSE also argued the loss of about €630 million which public hospitals receive from the treatment of private patients as well as other revenue generated at present from the statutory €80 per night charge and €100 emergency department attendance fee would have to be made up by the exchequer.

In a submission to the review group, the HSE said that the elimination of the private care from public hospitals as proposed under the Sláintecare reforms would “effectively vacate” elements of contracts agreed by the State with hospital consultants in 1991 and 2008 which permitted within certain rules to treat fee-paying patients.

The HSE said the Sláintecare proposals would effectively eliminate all private inpatient and day-case work for 1,789 consultants who have contracts which allow them to carry out limited private practice on their public hospital sites. It said it would also reduce the income for a further 748 consultants with types of contracts that provide for both onsite and offsite private practice.

The HSE warned that the proposed changes “may have an impact on both the retention of current consultants and the recruitment” of senior doctors in the future.

‘Financial rewards’

The HSE said that consultants were already opting to work full time within the private healthcare sector.

“There is a very large and disproportionate growth within certain sectors or specialties in private healthcare which is related to the demands of an increasingly aged population. This is creating significant opportunities within specialties to achieve disproportionate financial rewards as compared to other medical specialties, particularly in areas such as joint replacement or cataract surgery.

“General healthcare might be better served across sectors by addressing and balancing these differentials. This could include, not only specialties, but also the public/private and rural/urban divide as is the case in Scandinavian countries without stifling initiative and inventiveness.”

The HSE said that “in order to attract new consultants into the public system there would need to be a new or renegotiated contract which would allow consultants to receive remuneration comparable to the levels in the private sector”.

The HSE also warned that private hospitals did not have the capacity to manage all private patients currently treated in the public system.

It maintained “in the event that all private practice was transferred from public hospitals to private hospitals then the private system could be overwhelmed”.

The HSE said there were a number of medical specialties such as obstetrics and paediatrics for which there were no facilities in private hospitals.

Martin Wall

Martin Wall

Martin Wall is the former Washington Correspondent of The Irish Times. He was previously industry correspondent