Sláintecare – are we willing to pay for it?


Sir, – The Government has indicated that from the summer of 2020, all new medical consultants will be appointed under a new Sláintecare public-only contract – which will also be made available to existing consultants (“Public hospitals: consultants to be offered €250,000 a year”, News, December 20th).

In principle, this is a big step forward in the transformation of our public healthcare services.

One thing, however, we have learned from pay differentials in any job is that it is not an attractive proposition to work next to someone doing similar work for substantially less money; call it human nature.

Perhaps this was one of the reasons why public-only “Type A” consultant contracts failed to take off in the recent past.

To attract newcomers to take up public-only Sláintecare contracts, existing consultants will also need to be convinced of their value.

One way to do this is to focus less on basic pay and give more thought to incentivising productivity.

This works in the private sector.

Put simply, the harder you work, the more you get paid.

As all consultants work on multidisciplinary teams, there is no reason why this could not apply to other healthcare workers as well.

As must be the case in any healthcare transformation, the rationale to do this must be to improve patient care – and not just to pay healthcare workers more money.

Another way to encourage existing consultants to take up new public-only contracts would be to stop providing prospective medical indemnity cover for private practice in public hospitals through the State Claims Agency.

Instead, this would have to be purchased from private indemnity organisations by existing consultants who wish to continue private practice in public hospitals for as long as this is permitted.

If the Government is serious about Sláintecare, then needless to say there should be no facilities for private patients in the two new public hospitals it is building – the National Children’s Hospital and the new National Maternity Hospital.

A key issue in relation to consultant recruitment and retention is job quality.

One thousand new consultant posts will not transform the public heath service if office space is the boot of a car, and there is no room to hold a clinic in, or no space in theatre to operate in, or if the equipment is out of date.

Few, if any will return from Toronto, New York, London or Sydney to take up jobs in these conditions.

In the end, the most difficult pieces of the Sláintecare jigsaw puzzle to put into place will be how to deal with capacity if significant numbers of private patients choose to become public patients and how to replace the loss of the private income which currently subsidises public hospitals.

As with all public services, the success of the Sláintecare project will depend largely on how much we are willing to pay for it.

It will, however, also depend on consultants being prepared to take up leadership roles in backing it and in working to implement it – in the interests of their patients.

One thing is for certain: we cannot continue ploughing in the same furrow. It has turned into a rut.

The time for change has come. – Yours, etc,



Consultant Obstetrician and Gynaecologist,

Coombe Women & Infants University Hospital,

Dublin 8.