Madam, - The Government's invitation for tenders to build independently financed hospitals on 11 publicly funded hospital sites is likely to be the most important health service initiative for many years.
The concept, however, needs to be understood in the context of its political and philosophical evolution and the far-reaching effects it is likely to have on the present public system.
To some extent at least, the strategy of such co-located facilities evolved out of the concerns of the medical board of Waterford Regional Hospital at the putative development of at least three private hospitals in Waterford city. Board members, who collectively have experience of working in almost all the health systems of the English-speaking world, felt that consolidation rather than fragmentation of the collective healthcare facilities would be in the best interests of all patients. It would also avoid unnecessary duplication of services, which in the end must be funded from one source or another.
The board's concerns were brought to the attention of the Tánaiste and Minister for Health and the current strategy has been developed by the Government through the Health Service Executive.
The Waterford medical board's understanding of the initiative is that the Government is not simply engaged in the sale of the sites for private hospitals for their monetary market value. The "price" to the developers at Waterford, for instance, will be the provision of a much-needed public haematology/oncology ward, as well as a public daycare unit.
The building of the private wing itself will enable private beds to be freed for public use in Waterford Regional Hospital.
As the independent sector will be able to undertake this project in a fraction of the time and more cost-effectively than the State, the net benefit to WRH will therefore be an increase in its public beds of about 25 per cent at no outlay cost to the taxpayer and with greatest expediency.
The benefits do not just end there for the public health system. A developer who is on site will be well placed to be the provider for future expansion of the public hospital, possibly on a lease-back basis. More importantly, two independently owned and managed hospital systems will sit side by side on the same campus and will be able to establish mutually beneficial service developments. At times of pressure, the public facility will be able to lease beds or purchase procedures from the independent sector and vice versa.
Had the co-location strategy been developed some years ago, we could, for example, have seen the placement of the Blackrock Clinic on St Vincent's Hospital campus and St Vincent's Hospital might now have on-site access to cardiac surgery.
This is not a laissez-faire policy, slipping the private health care system's leash; it is in fact the first effort aimed at curbing unfocused and untrammelled private hospital development in this State as, with the offering to the private sector of very attractive sites for their activities comes a micromanaged contract and rapid benefit to the public system.
The opponents of the policy will come either from the ranks of those who want to see uncontrolled development of private hospitals or from the ideologically blinkered. Both groups must, however, appreciate that they are saying no to the most effective and rapid answer to our current public health service difficulties.
This co-location strategy is not only the antithesis of privatisation but is a sophisticated political mechanism to get the independent sector to fund improvement of the Irish health service and to do it rapidly. - Yours, etc,
J. B. O'CONNOR, FRCS,
Surgeon,
Waterford Regional Hospital,
Dunmore Road,
Waterford.