Madam, - We believe that the Government's proposed mechanism for "co-location" has not been thought through properly and is seriously flawed. The present plan to co-locate a privately funded hospital on the grounds of the Mid-Western Regional Hospital in Limerick will be socially divisive, effectively creating one hospital for the rich and another for the poor. Limerick does not need more social division: it needs less.
However, if a properly structured complementary relationship is put in place between the two co-existing units, then the building of this co-located unit has the potential to benefit all the community.
The present Government proposal will limit access to specialised services for both insured and uninsured patients. For example, were a national expert for a particular clinical condition to opt to work only in the public sector, insured patients would be excluded from accessing his or her services - and vice versa. The ambitious and fair-minded esprit de corps of the Regional Hospital's medical, nursing and managerial staff - the source of its notable efficiency in looking after all the patients in the mid-west - will be damaged by splitting the staff artificially according to the patient's insurance status rather than clinical needs.
We propose a model that would resolve these issues and will achieve the aims of the co-location proposal by using the Mid-Western Regional Hospital (MWRH) and the co-located hospital according to clinical need, rather than insurance status. We propose that the co-located hospital be developed as an elective hospital for both insured and uninsured patients and that the MWRH be further developed as the primary acute hospital for dealing with all emergencies and complex medical and surgical problems. The entire complex would become a single cohesive unit with central governance under the authority of the HSE.
In the Limerick model, using an example of 400 beds in MWRH and 200 beds in the co-located hospital, MWRH would retain 100 (25 per cent) private beds and the co-located hospital would have 100 (50 per cent) public and 100 (50 per cent) private beds. This would mean the creation of 100 extra public beds on the site, thus achieving the primary objective of the Government's co-location plan. The income from private beds in the public hospital would pay for the public beds in the co-located hospital. Patients would be admitted to either facility entirely according to clinical need rather than insurance status. The overall public/private bed-complement would reflect the current level of health insurance uptake in the region and there would be no issues surrounding equity of access or quality of care for either group.
Insured patients who need to avail of the services of consultants wishing to work exclusively for the HSE would have access to private beds within the existing acute facility, and vice versa. Cohesion would be ensured by the rational development of critical services (such as a single intensive care unit) and a single standard of care would apply across the complex, with appropriate governance of clinical performance.
A scaled-down version of this model is already operating successfully at the Mid-Western Regional Hospital where the radiotherapy unit was developed from private funding but provides services to all patients, public and private. The model we are proposing might be applicable nationally. - Yours, etc,
GERRY BURKE,
Consultant Obstetrician,
Steamboat Quay,
Limerick;
PAUL BURKE,
Consultant Surgeon,
Verona Villas,
Limerick;
JOHN DRUMM,
Consultant Surgeon,
Steamboat Quay,
Limerick;
HUGH FLOOD,
Consultant Urologist,
Raheen,
Limerick.