MEDICAL MATTERS: If one issue is set to dominate the health agenda for 2006 it is the planned extension of the health sector by encouraging the construction of private hospitals on the grounds of public hospitals.
While the move, as announced by Mary Harney last year, will "decant" the private beds that currently exist in public hospitals into the adjacent private hospital, it can hardly be labelled an out and out privatisation of the health service.
The former private beds will become public ones and will add some 1,000 beds to the public bed stock.
And yet the plan has evoked significant opposition from within the health service and the trade union movement. The use of public- private partnerships to fund the initiative is a significant change in Government policy and it has set alarm bells ringing.
The Health Service Action Group (HSAG) invited Prof Allyson Pollock, professor of health policy at Edinburgh University, to address a conference on the topic late last year.
She said the use of public-private partnerships (PPPs) had led to the "disintegration and fragmentation" of Britain's National Health Service (NHS).
She claimed cost overruns on PPP hospitals in the UK had been of the order of 200-300 per cent.
"Every public-private partnership is associated with hospital closure programmes, with major bed and staff reductions," she told the conference.
Pollock claimed the NHS now leases back buildings and services to private enterprise at a cost "far greater" than the cost of money the State could borrow to design, build and operate these hospitals itself.
The chairman of the HSAG, Dr John Barton, said: "American research consistently shows that investor-owned for-profit hospitals, not alone offer more costly healthcare but also inferior healthcare."
Can privatisation via PPP be that bad? Even Maev-Ann Wren and Dale Tussing, authors of an ICTU report, An Agenda for Irish Hospital Care Reform, who were overall critics of the Harney plan, acknowledged it had some good points: it ends the practice of private care in public hospitals; it yields more acute hospital beds, including more public ones; and by tying private operators into strict governance and service delivery targets, it gives the Department of Health some control over the operation of the new private hospitals.
Prof Mark Redmond, cardiac surgeon and medical director of the Beacon Hospital in Sandyford, is in favour of developing private facilities on public sites.
"There could be a sharing of certain services, some financed by the private facility and others by the public hospital," he says.
Redmond emphasises the flexibility and efficiency of private hospitals and their capacity to accommodate rapid changes in medical practice.
Surprisingly, some of those with extensive experience of the private sector are not enamoured by Ms Harney's initiative.
James Sheehan, who developed both the Blackrock and the Galway clinics, says the plan will propagate a two-tier level of healthcare.
He questions whether the VHI and other insurers will be able to adequately fund the newly decanted private beds.
And, in his view, people with private health insurance also contribute to the public hospital system through their taxes and should be entitled to be treated in public hospitals as private patients.
Wren and Tussing question whether building private beds will generate public beds on a one-for-one basis . "[ Private hospitals] will not offer multidisciplinary care . . . and will not have high-cost specialised services such as stroke units."
In other words, will the new private hospitals concentrate on elective surgery, leaving those with complicated (and more costly) medical problems to be treated by the adjacent public hospitals?
There are a number of fundamental questions raised by the introduction of public-private partnerships.
For example, will implementing the Harney initiative mean the end of aspirations to introduce a single hospital waiting list?
Will it also make it difficult to introduce a system of universal health insurance in the future?
Might a strengthened primary care sector - as announced by the Tánaiste in the Budget Estimates - be empowered to purchase services from hospitals, including the new private ones? This would allow an element of competition which might sharpen up both the quality and the value-for-money parameters of the entire health sector.
We need a vigorous debate on the issues surrounding public-private partnerships in the Republic.
The Minister for Health could start this debate by telling us in detail how she sees the new private hospitals integrating with the existing system at both primary and secondary care level.
Dr Muiris Houston is pleased to hear from readers but regrets he cannot answer individual queries.