OMBUDSMAN EMILY O’Reilly has warned against the health service becoming just another service that can be farmed out to the most competitive bidder.
Speaking on Saturday, she said health services made available on the basis of the exercise of consumer choice within a purely commercial private market “do nothing to promote social solidarity or good citizenship”.
She maintained that, in certain areas of health provision, particularly nursing home care for the elderly, the role of the public health sector was “being rapidly eroded”.
She said this trend emerged in the Celtic Tiger era but was not grounded in any major health policy or strategy document published over the past 20 years.
Delivering the Irish Medical Organisation’s annual Doolin lecture, Ms O’Reilly said that in the provision of health services there was a danger “we may head, unheedingly, too far down this road of choice, competition, consumerism and commodification”.
If the health service was to reflect social solidarity, “we need to look carefully at any developments which removed healthcare from the communal public arena and relocated it in the private arena of the marketplace”.
She said a state’s public health service should amount to far more than arrangements to ensure services were provided. “The context in which services are provided, the institutions providing them, the financing of the services, the governance arrangements for those services, the extent to which one is entitled to services – these are all factors which both reflect and support the maintenance of the kind of society we want to be.”
However, Ms O’Reilly warned that services provided through State agencies which were dysfunctional were not the answer either.
The ombudsman said places in private commercial nursing homes had surged from 6,932 in 1997 to more than 20,500 in 2010. She said this trend had been facilitated by the provision of generous tax breaks based on a policy that had emanated from the minister for finance rather than the minister for health.
She said over the same period there had been a significant drop in the number of public nursing home beds – down from more than 10,000 in 2001 to just over 6,000.
Ms O’Reilly said that, in setting out the real cost differences between provision of care in public and private nursing homes, the substantial subsidies – in taxes foregone by the State and arising from the tax incentives availed of by investors in nursing homes – should be borne in mind.
The ombudsman maintained – as she has in a number of recent speeches – that there were inadequacies in the main legislation governing health services, the 40-year-old Health Act 1970. “A peculiarity of our system of public health service is that it operates half in and half out of a legislative framework.”
She said the Act was an inadequate expression of what health policy sought to achieve.