Difficulties in adhering to 'private' stipulation

THE HSE has indicated to the Department of Health that it could be “challenging” to get the required level of compliance with new official limits on consultants’ private practice levels in some hospitals.

The HSE said the problem particularly affected hospitals where large numbers of fee-paying patients have traditionally been seen. It also signalled that difficulties were being experienced in areas where no alternative private facilities were available.

The HSE has told the Department of Health, for example, that for the period March to May 2009 – the first period for which a full assessment was available – 45 consultants at Our Lady’s Children’s Hospital in Crumlin (OLCHC) were in breach of the terms of the new contractual private practice limits.

The Minister for Health, Mary Harney, has told the HSE in recent weeks that she wants to see monitoring of the consultants’ private practice levels in the year ahead. She said that safeguarding public access to acute hospital services was a key Government objective.

Under the terms of the new contract, introduced in 2008, tight restrictions were placed on the number of private patients permitted to be treated by consultants working in public hospitals. It stipulates that the ratio of public to private patients treated by doctors in public hospitals should range between 70:30 and 80:20 depending on the type of contract held by each doctor.

However, the assessment for March-May 2009 carried out by the HSE, and given to the Department of Health in November, suggested that as few as 20 per cent of consultants in some hospitals had been adhering strictly to these restrictions.

In a briefing note prepared for the appearance of its secretary general Michael Scanlan before the Dáil Public Accounts Committee in November, the Department of Health said the HSE had signalled “that it may be particularly challenging to achieve the required level of compliance in certain hospitals which have historically had quite high levels of private practice”.

A separate HSE briefing note, which reveals that 45 consultants at Our Lady’s Children’s Hospital in Crumlin, were in breach of the contract, states: “OLCHC have stated that it is important to recognise the unique feature of paediatric acute care and the central issue for the hospital and the consultants remains that the absence of any significant private hospital facilities for children means that the public private mix, especially in national services, will inevitably reflect the insured status of the population at large”.

The note also says that private and semi-private bed designations in Limerick had always been traditionally high due to the absence of a private inpatient facility in the city.

Ms Harney told the HSE just before Christmas that it was essential it and individual hospitals maintained a sharp focus on ensuring compliance with the terms of the consultants’ contract.

Ms Harney also told the HSE that for the avoidance of doubt she wanted guidance to the health system to make clear that even though they were generally classified as day procedures, endoscopies, including colonoscopies, came within the scope of the new contract agreement on procedures for which a common waiting list (involving both public and private patients) for outpatient services would apply.