The controversial plan to co-locate private hospitals on the grounds of eight public hospitals is ahead of schedule, although issues over consultants' contracts remain, Theresa Judgereports.
The HSE has insisted that legally binding agreements for the co-location of private hospitals on the grounds of eight public hospitals will be signed on April 16th. If this deadline is met - and a senior HSE official says the procurement process is "actually ahead of schedule" - then the controversial plan will go ahead even if there is a change of Government at the election.
However, concern has grown among the private companies vying for contracts to build and operate these hospitals, that have already invested millions of euro in preparatory work, that the process could be delayed beyond an election.
There is also the unresolved issue of how the negotiation of a new contract for consultants will affect how co-located hospitals are staffed.
A source close to one of the bidders says there was "consternation" when it was confirmed by HSE chief executive Brendan Drumm last week that some 70 per cent of consultants - those on "category one" contracts - would not be able to work in the co-located hospitals under their existing contracts.
This means that Mary Harney's plan to free up 1,000 beds by moving private patients out of public hospitals and into the co-located private hospitals depends upon consultants agreeing new contracts that would see them switch their private work from public hospitals to the co-located ones, as the new hospitals could not operate without public consultants.
The issue arose last Thursday at a meeting of the Joint Oireachtas Committee on Health and Children attended by Harney and Drumm.
While Harney told the committee that she expected a new contract to be agreed with consultants by the end of March, consultants' representatives have said they believe that this timeframe is too short.
For as long as these discussions are ongoing there will be a degree of uncertainty for private developers.
Fine Gael spokesman Liam Twomey who, along with Liz MacManus of Labour, has called on Harney not to sign any legally binding agreements before the election, says he believes the HSE will not be able to force consultants to give up their right to continue doing 20 per cent private work in public hospitals.
He believes a situation could then arise where publicly paid consultants would be doing private work in public hospitals and also in the co-located private hospitals. He argues that both consultants and developers will benefit but patients - both private and public - will lose out.
Harney told the Oireachtas committee last week that the current category one contract "does not guarantee access to private practice".
However, Irish Hospital Consultants Association (IHCA) general secretary Finbarr Fitzpatrick says this is not consistent with what Harney has said in the past when she indicated that she could not force existing consultants to give up doing private work in public hospitals and that any attempt to do so could result in the State having to pay them compensation.
Fitzpatrick says, however, that in the new contract negotiations starting today, the IHCA will be prepared to discuss this issue.
McManus says she believes Harney has now changed the type of contracts on offer to consultants, where private work is allowed, to suit the needs of private hospital developers but Harney has denied discussing the issue of consultants' contracts with developers.
It appears that Mary Harney is determined to push the plan through even in the last weeks of the current Government.
The five companies bidding for the eight hospitals have been reassured that it will not be possible to "unravel" the agreements once they are signed.
In a statement issued at the weekend, Beacon Medical Group, which is bidding for six of the hospitals, said: "Beacon Medical Group welcomes the confirmation that the co-location process is on schedule for completion and we are confident of meeting all the deadlines required in the process."
Tom Finn, the assistant national director of the HSE's national hospitals office, says the benefits of the plan for public patients have not been fully recognised and he stresses that it is "a public initiative, for the benefit of public patients, not a private initiative".
Opposition to the co-location plan has centred on the argument that it further consolidates our two-tier health system and represents further subsidisation of the private system by the public system.
Those in favour of the plan argue that private companies can provide urgently needed new beds quicker than the public system.
Finn says the procurement process is "100 per cent on target" and that it is "actually ahead of schedule".
"On April 16th, we will be awarding sites to successful bidders at which point it will be legally binding."
He says there have been about 120 face-to-face meetings between the public hospitals, the HSE and the bidders.
The hospitals concerned are the Mid-Western Hospital in Limerick, Waterford Regional Hospital, Cork University Hospital, Sligo General Hospital, St James's Hospital, Beaumont Hospital, Connolly Hospital and Tallaght Hospital in Dublin.
The five companies - Beacon Medical Group, Bon Secours Group, Capio, Mater Private and Mount Carmel (formerly Harlequin) - have all put in bids for at least two sites, while Beacon is bidding for six.
The bidders are currently drawing up detailed plans for each site and they will be invited to tender on March 2nd. The evaluation of bids is due to conclude on March 23rd.
If agreements with successful bidders are signed on April 16th, the companies will then have to go through the planning process and, given the level of opposition to the proposals, it is likely that objections will be lodged.
Finn says the debate over the plan to date has not recognised that the contracts include "a lot of significant minimum requirements which are there to protect the public interest".
For example, they will be required to take emergency admissions 24 hours a day, seven days a week.
He says the co-located hospitals will be providing a full range of care to private patients and once they open, the only private patients remaining in public hospitals will be those availing of a very small number of national specialist services, such as lung transplants and spinal injuries, which are based at specific public hospitals.
The co-located private hospitals are also required to make available 20 per cent of their beds to public patients to avail of Government tax incentives and to provide services to these patients at a fee of 10 per cent less than that charged to private insurers.
Finn says that while it is not expected that these beds will be required for public patients once public beds have been freed up with the removal of private patients, mechanisms will be included in the service level agreements to ensure they will be available in the event of a backlog in the public hospital.
However, the Beacon Clinic in Sandyford in Dublin, which opened in October, is also subject to this requirement but the HSE has never made use of these beds for public patients despite problems over the winter in Dublin's public hospitals.
Finn maintains the plan is "incredibly good value" for the public system, saying no opponents have been able to show otherwise.
Fine Gael's Twomey accuses Mary Harney of "copperfastening the two-tier health service". He says both private and public patients will suffer.
Private patients will be paying much higher insurance premiums but may not have access to consultants in the co-located hospitals.
Whereas public patients will also have less access to consultants who instead of working in the same public hospital will be doing private work "off-site", in the co-located private hospital.
He says he is amazed that the HSE would consider signing legally binding agreements with private hospital developers before agreeing a contract with consultants.