Removing private practice from public hospitals will be costly, says Donohoe

Implementing recommendations from expert group report will pose ‘difficult choices’

Minister for Health Simon Harris. File photograph: Cyril Byrne / The Irish Times

Minister for Health Simon Harris. File photograph: Cyril Byrne / The Irish Times


Minister for Public Expenditure Paschal Donohoe has warned that the cost of removing private medical practice from public hospitals would be “significant”.

The Minster said that given the scale of the costs set out in an expert group report, which was published on Monday, the proposal would be carefully considered “in the context of all competing demands for investment within the health sector and the wider public sector”.

Earlier, Minister for Health Simon Harris said removing private practice from public hospitals would be complex, take time and cost money.

Mr Harris said he would consult Government colleagues and stakeholders on issues relating to how this could be entacted.

Mr Harris said implementing the report’s recommendations would undoubtedly pose “ some difficult choices”.

However, he said it would also represent “a significant step towards achieving single tier healthcare for all public patients envisaged in Sláintecare – the blueprint for health service reform drawn up by an all-party committee in the Oireachtas”. The elimination of private practice in public hospitals was a key element of Sláintecare.

Launching the report, the expert group’s chairman Dr Donal de Buitléir said the current system of private practice in public hospitals was unfair.

He said Ireland was unusual in that those with private health insurance or who could pay out of their own pocket were able to access services in public hospitals quicker than those who did not have insurance cover or who could not afford to pay themselves.

“It is difficult to think of any other public service where people are treated more favourably simply because they can pay more for the service,” he said.

Dr de Buitléir said while his group’s recommendations would give rise to increases in public expenditure, he believed they were affordable.

He said the final additional cost at the end of a 10-year implementation period would be about €650million per annum, mainly from the loss of existing income for public hospitals generated from private patients.


The report also acknowledges there would have to be a financial incentive offered to hospital consultants with contractual rights to see private patients in public facilities to opt into a new public-only system. It did not set out an estimate on how much this would cost.

Dr de Buitléir, who argued this cost would be a one-off, said he was confident the Irish health service would be able to attract consultants to treat public patients only in State-funded hospitals. He said the group had proposed a salary of just over €180,000 for such a contract and this would would compare favourably internationally.

The report says the Government should end the existing lower-pay arrangement for consultants appointed since October 2012 for those medical specialists to be recruited in the future under what would be known as a Sláintecare contract. It says the 2012 pay cuts should also be ended for those recruited in recent years on contracts which already only allow doctors to see public patients.

However, the report says “a more flexible approach to remuneration such as applies in the third-level education sector may be necessary to fill particular highly specialised posts”.

The report says that the vast majority of existing consultants – about 2,500 – have contractual rights to treat private patients in public hospitals. It says it will be necessary to enter into negotiations on the proposed Sláintecare consultant contract. It says some consultants with existing private practice rights in their contracts may opt to retain these for some time in the future.

The review group also says the Department of Health and the HSE should introduce of a once-off contract-change payment to encourage consultants “to move to exclusively public contracts at the earliest opportunity.”

It says it would be a matter for the Department of Health and the Department of Public Expenditure to set the rate for such a contract-change payment, which would be in consideration of any loss of earnings.

The report says the Government should send a clear signal that, at some future date, private activity will no longer be permitted in public hospitals.