No accountability until public health system disentangled from private medicine

November 9, 2017

Accountability at both administrative and clinical levels in our hospitals will not happen until the public health system is disentangled from private medicine, Róisín Shortall TD told a major health conference this morning.

In a keynote address at the second National Health Summit in Dublin, Deputy Shortall said the mixing of private incentive and public interest at the heart of our health system creates “an ungovernable twilight zone”.

Deputy Shortall chaired the cross-party Committee on the Future of Healthcare which recently produced a 10-year blueprint for reform of the health service, called Sláintecare.

Ireland’s health system has failed people and the Sláintecare reform plan is “the only game in town,” she said.

Deputy Shortall, who is a former Minister of State for Primary Care, outlined the work of the Committee, the first to reach a political consensus on policy relating to an area of major public importance.

“The need for more accountability in our health system, and particularly in our state-funded hospitals, was behind the most radical, but also the most urgent, recommendation of our Committee,” she said.

“This was the clear and pressing need to disentangle our public health system from private medicine.  Our hybrid system, unique in the western world, permits senior doctors to use publicly-funded hospitals and diagnostics to treat their private patients.

“There is a huge lack of transparency about the level of cross-subsidisation from public funds to doctors and senior managers in publicly-funded hospitals, to the health insurance firms that place their clients in those hospitals, and to the supposedly separate private clinics which many voluntary hospitals operate alongside their state-sponsored operations.

“It is impossible to establish whether we are getting value for money from our public hospital beds, for example, or from our publicly funded equipment, our consultants or other healthcare staff.  And without a clear line of sight of resources, transparent data and effective information systems, it is not possible to establish accountability at either administrative or clinical level.”

Deputy Shortall added:

“Absurdly, public hospitals are given annual targets, rising year on year, for income generation from private patients. Meanwhile hospital consultants who are already paid generous public salaries are permitted to see private patients on the side, to top up their earnings.

“This blurring of lines between public interest and private gain creates a classic perverse incentive, paying publicly-funded hospitals and consultants to treat private patients ahead of those in the public system whose needs may well be greater.  Is it any wonder that we have 660,000 people on waiting lists for hospital services? The mixing of private incentive and public interest at the heart of our health system creates an ungovernable twilight zone.

“All we know for sure about them is that public money flows into them, and private money comes out, in the form of “top ups” and special payments for senior doctors and executives. How this alchemy comes about is, we are told, none of our business. Until this nettle is grasped, there can be no real reform of the Irish health service.”

Deputy Shortall said the committee proposed strong legislation for accountability. This would make the Minister for Health ultimately responsible for delivering health system change and for the delivery of care to the population.

“Staff at all levels within the health system would also be accountable for their delivery of relevant aspects of the health service to the population through specific, known performance measures. Additionally, support for the development of needed skills to promote improvement would be provided.  Equally we proposed to legislate for national standards in clinical governance, national and local accountability structures right down to community and hospital levels, so that clinical governance covers all clinical staff including consultants.”


9 November 2017

Deputy Shortall’s full speech is available here.