Rules limiting private practice in hospitals not robust enough says department

Rules governing private practice limits for consultants in public hospitals and their enforcement are not sufficiently robust to deliver compliance in all circumstances, the Department of Health has said.

In a presentation to the Oireachtas health committee the department said as a result, some consultants had engaged in private practice at levels that significantly exceeded those provided for in their contracts.

“This may arise in relation to the level of private activity undertaken on-site, or they engage in significant levels of off-site private practice, although their contract does not provide for this,” the Department of Health said in advance of a committee hearing on Wednesday.

The hearing follows a recent RTÉ investigation which maintained some doctors were seeing excessive numbers of fee-paying patients.

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However medical organisations contended the vast bulk of doctors were working in excess of their contractual hours. They said it was unreasonable to blame doctors or hospitals when private practice limits were exceeded given rising demands for healthcare and changes in legislation.

Working closely with the HSE

The Department of Health said it was working closely with the HSE to ensure compliance with private practice limits was monitored more effectively and that breaches were dealt with appropriately.

It said it would shortly be engaging with the HSE in response to some broader issues which the health authority has raised, including the need for hospitals to collect private patient income.

“However, the HSE has already been advised that those issues do not affect the implementation of measures required to ensure robust governance and monitoring of compliance with the contractual provisions applicable to consultants engaging in private practice, with remedial action pursued where required.”

The HSE said official data showed that, with a small number of exceptions, individual hospitals were compliant with public-private mix requirements and the proportion of public patients treated was higher than the required level.

“This would suggest that the issues raised in the programme are about individual practice rather than whole system non-compliance issues.”

“The activity data at hospital and national level does not suggest that private patients treated in public hospitals are seen out of sequence or ahead of a public patient that had greater clinical need.”

Co-location policy abandoned

The Irish Hospital Consultants Association (IHCA) and the Irish Medical Organisation (IMO) maintained the public/private ratios were developed at a time when the then government planned to co-locate private hospitals on public hospital sites. However, in 2011 the co-location policy was abandoned.

The IHCA argued the methods used to measure public to private ratios were also “both inaccurate and unreliable”.

It maintained public hospitals could not operate without the €600 million in revenue generated by private patients.

The IMO said hospital managers were “in the invidious position of simultaneously having to advise consultants if they exceed their allowed private public ratio, whilst at the same time needing to maximize funding for the hospital received from private patients and their insurers”.

“In excess of 44 percent of the population hold private health insurance and as such can opt to be treated as a private patient in hospital. Consultants cannot deny a patient an emergency admission to hospital because they hold private insurance and so their ability to control their public/private mix is challenged by the number of patients they admit on call as emergencies who elect to use their private health insurance for that admission.”