OPINION:The Government is putting an end to a system that favours private patients and fee-earning consultants, writes Mary Harney.
SOCIAL PARTNERSHIP works with respectful, intelligent dialogue. So, if I, or the Government, were to use prejudicial language about the motivations or policies of trade unions, employers or farmers, they would cry foul. And rightly so.
Yet, David Begg, leader of the Irish Congress of Trade Unions (Ictu), has chosen loaded, prejudicial words to attack my initiative and Government policy on hospitals co-location in The Irish Times(Opinon & Analysis, July 23rd).
If we conducted dialogue on that basis, your position could be described - prejudicially - as ideological and driven by a vested, sectional interest. But I would rather debate facts and state my position, in the hope that at least the leadership of social partner organisations would accept in good faith my position and that of the Government as we state it.
Let me restate some basics.
The co-location initiative is designed to free up public beds for public patients. It is not right that beds and staff that have been fully paid for by the exchequer to deliver services for all patients should be taken up, on a subsidised basis, for those who can afford private insurance. David Begg writes about the "delicate hybrid that is the public/private mix in Ireland" as if I and the Government were about to bulldoze over a flower of great beauty and fragrance.
David Begg surely knows part of that "delicate hybrid" has been that public hospitals provide extraordinary levels of private activity, even in beds allocated for public patients, resulting in more fees going to hospital consultants but to no other staff. I am surprised this seems to be accepted without any qualms, notwithstanding that many members of trade unions have private health insurance, and benefit from the subsidised use of public beds in private hospitals.
The current situation favours private patients and fee-earning consultants. It disfavours public patients. The Government and I are putting an end to that, through the new consultants' contract and the co-location initiative. This won't end all private work, but it will end hidden subsidies and uncontrolled private work in public hospitals. The Government is simply determined to get a much better deal for public patients.
Since well before I became Minister for Health, it has been Government policy to end the hidden subsidies for private patients within public hospitals. We believe private activity should be charged at the full economic cost. By having the private sector manage private activity - as opposed to using public facilities for excessive private work - this will become more transparent.
I suspect that if I happened to be a member of another political party, it would be described as a very different kind of ideology. It might even be described as renationalising public beds. As regards the financing of co-location facilities, developers and banks are now working with the Health Service Executive (HSE) on the contracts involved.
Let me state this clearly: there will be no underwriting of private sector risk. If, after all efforts are made to solve issues, the private sector fails, the State will not be contractually bound to buy out the equity or debt finance. This has been the policy from the start. Begg or anyone else has no grounds to insinuate otherwise.
Begg goes on to say it would be a no-brainer for Ireland to emulate the Nordic model of healthcare. Well, let's take Sweden, for example. Health services are tax-funded (as in Ireland), not based on universal insurance. Acute hospital beds have been reduced rapidly in Stockholm. The private sector has been invited in to run public hospitals. Perhaps we should have some dialogue in social partnership about that. I haven't started that debate. But would there be any takers?
We do indeed have much to learn from Nordic countries and other countries in the best organisation of services, which is why I spent time visiting Sweden, Norway and Denmark last year. From Denmark, we have learned that reducing lengths of stay in hospitals and moving services out of acute hospitals and into community settings is critical for best outcomes and a sustainable health service. And this is at the heart of the HSE's reform programme.
The suggestion that universal health insurance is fundamental to solving all health issues needs close scrutiny. Much of the debate concentrates on acute hospital services and, to a lesser extent, access to GP services. There has been little analysis of, and debate about, non-acute and social services such as services for children, older people, people with a disability or mental illness, and population-based services such as health promotion, screening and immunisation. I am not convinced insurance-based funding rather than tax-based funding has much new to offer for these services.
Let us be clear, however. There is no unlimited source of new health funding. There is no simple answer to sustainable health funding for the future. There is no easy answer to what benefits should be provided within what limits. Unlimited funding and unlimited benefits are not realistic features of any healthcare system.
Since the second World War, no EU country that is tax-funded has moved to universal insurance, but the opposite has happened, for example, in Spain.
And short of banning people from paying for private medicine directly, or through health insurance, and banning doctors and hospitals from providing such services, there is no way to stop some people from purchasing top-up health insurance over and above public services. Indeed, top-up insurance is purchased by middle- and higher-income people in countries such as Germany, which have social insurance models.
These are facts. I can't understand why Begg would want to dismiss such complexities of policy, even to the point of claiming baldly that no planning is happening in Government and the Civil Service on the long-term effects of ageing in our society.
This is so clearly not the case. For example, we are fully engaged across Government in issues around pensions and the new fair deal arrangements for long-term care have been developed over the last three years with precisely an ageing population in mind.
So, David, we are meant to be partners. And that requires some mutual respect, above all, for each other's motivation as being the public interest. Let us then have our dialogue based on facts, in all their complexity, and reach agreement based on realistic, balanced compromise in the best interests of the whole country.
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Mary Harney is Minister for Health and Children