HSE will be abolished over next five years, says Varadkar

The Health Service Executive (HSE) is to be dismantled in the term of the next government, Minister for Health Leo Varadkar said on Saturday.

He also indicated that hospital consultants could receive up to €13,000 in pay restoration over the coming years on a phased basis and salaries for those working exclusively in the public service could be close to €200,000 by 2019.

Mr Varadkar also signalled that he favoured reforms which could see consultants have greater freedom to carry out private practice provided public commitments were met.

Speaking at the annual conference of the Irish Hospital Consultants Association (IHCA) in Tullamore, Co Offaly on Saturday he said he often heard people arguing that the HSE was not fit for purpose and should just be abolished. However he maintained that this was "nonsense".

He said there were a lot of good people in the HSE and they needed to be maintained in important roles. He said replacement organisations also had to be built up.

Mr Varadkar said on foot of reforms being put in place to hospital and community structures, the dismantlement of the HSE could be achieved within a five -year period.

The abolition of the HSE had been a key priority of Mr Varadkar's predecessor as Minister for Health James Reilly.

Mr Varadkar told the conference: “I am very much behind the hospital groups. The chief executives and their senior teams are now in place, and I hope to appoint the remaining boards as soon as possible.”

“Legislation is being prepared to establish the Children’s Hospital Group Trust on a statutory basis, and legislation to establish the other hospital groups can be done within two years. “

“Nine community healthcare organisations have also been established. Together these reforms will enable the creation of a purchaser/provider split, the establishment of a commissioning body, and for the HSE to be dismantled during the term of the next government.”

The establishment of hospital groups, the abolition of the HSE, the putting in place of a healthcare commissioning agency were all elements of the Government’s planned move towards a system of universal health insurance.

In his address to hospital consultants Mr Varadkar did not mention universal health insurance specifically but spoke of achieving “universal healthcare, in steps”.

“I am a strong believer in universal healthcare, by which I mean access to affordable healthcare for everyone in a timely manner. But the foundations have to be put in place first.”

"These include addressing some of the significant capacity constraints that exist in our health service, the full implementation of activity based funding, the establishment of the Healthcare Pricing Office on a statutory basis, a new fairer drug reimbursement scheme, and the further development of the hospital Groups and community healthcare organisations.

“I don’t think it’s something to be rushed, but I do think we can do something every year to significantly improve access to healthcare.”

Mr Varadkar also said that medical consultants who backed the Haddington Road and Lansdowne Road agreements could stand to receive between €12,000 and €13,000 in pay restoration in the years ahead.

He said this pay restoration would be achieved in three phases restored in three phases: April 2017, April 2018 and April 2019.

"This represents pay restoration of about €12,000 to €13,000 per person. For example, this will bring the salary of a Type A (exclusively public service) consultant at the sixth point on the scale appointed prior to September 2012 back up to €192,000 in April 2019. "

“I think this is going to make us much more competitive with other English-speaking countries when it comes to salaries than we are at present.”

The Minister also signalled he favoured many changes to the existing contractual designations for consultants which determine their rights, if any, to carry out private practice.

"It is my own view that the system of Type A, B and C contracts isn't working any more. It creates an inequality among consultants in what's a very unequal health service. I would prefer to move to a single contract, perhaps similar to that of consultants in the NHS with a basic salary and a system of bonuses and excellence awards."

“Being a hospital consultant in a public hospital is a really busy, full-time job. And consultants shouldn’t really have time for private practice outside of the hospital during normal working hours.

“Those who want to do private practice should perhaps have part time or session contracts instead. And those who wish to do private practice in their own time should be allowed to do so, provided they honour the terms of their public contract, and provided we have a means of verifying that they have. But these should all be matters for future negotiation.”

In his address Mr Varadkar also said that as the economy moved into a position of growth he would like to see a target established for achieving a consultant staffing level of about 3,600 within the next 5 - 7 years. This target was originally set out in the Hanly report more than a decade ago.

The Minister also urged doctors “not to be critics of the Irish public health service, but rather to be advocates for it”.

“Doctors, I believe, have a responsibility to advocate on behalf of patients and must continue to do so. There should be and will be no gagging clauses as long as I am Minister. But I know what patient advocacy is, and I also know what it is not, and I think you do too. Patient advocacy should never compromise patient confidentiality, and should never be a tool to be used in industrial relations or inter-personal disputes.”

He also maintained that the public health service was competing both domestically and internationally for the services for administrators and mangers.

He said pay rates for managers in the Republic of Ireland was below those paid in Northern Ireland or Britain.

However he said in the wake of a deep recession telling the public that they would have to pay more to managers was unbelievably politically toxic.