Sláintecare and need for investment


Sir, – I read with interest Cliff Taylor’s generally balanced piece on Sláintecare (“Sláintecare must not be sacrificed at the altar of Irish politics”, Opinion & Analysis, SaturdaySeptember 18th). However, he notes that resistance to the elimination of private patients from public hospitals will come from consultants, by inference protecting their income. However, a much more compelling argument is that such a change would be very poor value for money. The 2017 Sláintecare report predicted a funding requirement of €3 billion over six years to establish the reforms proposed and €380 million to €465 million annually during this period and thereafter to deliver universal healthcare. Based on the 2016 figures, the elimination of treating private patients in public hospitals would result in a further requirement for €645 million annually to offset the loss of associated income. This is in addition to current annual funding which is in excess of €15 billion for 2018 and likely subject to the usual annual increase of approximately 4 per cent to 5 per cent.

Although currently 20 per cent of beds in public hospitals are available for private patients, the expectation that the eradication of private patients from public hospitals would free up the elective treatment of public patients is naive. The percentage breakdown between elective and emergency private admissions to public hospitals has not been documented.

However, it is likely that essentially all of the private admissions to acute hospitals in locations where there is readily available alternative elective accommodation in private hospitals is for emergency treatment or necessary complex treatment which is not available in some private hospitals.

Since all citizens have access to public hospitals and there is very limited emergency treatment available in private hospitals, usually 8am to 6pm, these same patients will continue to be admitted to public hospitals. Therefore, there would be only a small increase in the availability of beds for the elective admission of public patients. To achieve this end it will require at today’s costings €0.6 billion of the € 1.5 billion total extra required to establish and deliver Sláintecare for the first six years and subsequently €0.6 billion of the €1 billion required annually to deliver the reforms. Clearly this does not represent value for money, a declared principal of Sláintecare, but rather it represents an extraordinary extravagance to achieve an ideological endpoint.

In October 2017 the Department of Health established a working group to examine the impact of separating private practice from the public hospital system chaired by Dr Donal de Buitléir, which has yet to report. The options appear limited. These include raising taxes to pay the full cost, restricting admission of private patients to those requiring emergency treatment and deferring elimination of private patients indefinitely.

Sláintecare reforms will bring a greatly more efficient and effective service but it will be more expensive. Where cost savings are possible, such as a pragmatic approach to the elimination of private patients from public hospitals, they should be availed of. If we want a much-improved health service it would require considerable ongoing investment, which would require general acceptance by the public and our politicians. – Yours, etc,


Retired Consultant


Dún Laoghaire, Co Dublin.