Health service reform was a central theme at both the Irish Medical Organisation's (IMO) annual meeting and the annual conference of the Progressive Democrats at the weekend. Minister for Health Mary Harney while promising the annual health budget could rise to €20 billion by 2012, said extra spending is contingent on reform of the health service.
She defended investment in private hospitals, to be co-located on the grounds of existing public hospitals, as a method of freeing up public beds by reducing the number of private beds in public hospitals.
However, IMO chief executive George McNeice told doctors it was invidious for the State to provide tax breaks to private hospitals when forgone taxes could be invested in much-needed public hospital facilities. A number of speakers from significantly diverse backgrounds united in their criticism of the Tánaiste's plans.
Economist Jim Power said they risked causing additional problems for the health sector; hospital developer and consultant surgeon James Sheehan described the plans as a "total non-starter"; and Dr Fergus O Ferrall of the Adelaide Hospital Society decried a lack of evidence to support Ms Harney's initiative.
In the absence of a White Paper on the subject, it would be helpful if the Government published, even at this late stage, the evidence behind the decision to create additional hospital capacity through the private sector. This significant element of health sector reform merits further public debate.
There were also signs of emerging consensus at the conference. Prof John Higgins, head of the obstetrics and gynaecology unit at University College Cork, called on fellow consultants to embrace and lead changes in the hospital sector. He suggested that each hospital should have an overall clinical director to set the strategic direction for the facility and control its budget. In calling for a flexible new consultant contract with a more clearly defined public commitment, Prof Higgins moved consultants closer to the Tánaiste's position.
There is a danger, however, that this early evidence of common ground between hospital consultants and the Minister could founder on the precipitate actions of health service employers.
Reports that the recruitment of consultants is being outsourced by the Health Service Executive, along with recent consultant appointees being told they must work without a team of junior doctors, have angered consultants. Such unilateral decision-making is unnecessarily provocative. And it is unhelpful to the bigger goal of health reform.