The recent RTÉ Prime Time programme – The Battle for Care – claimed to "examine the widespread failure to implement the 2008 Consultant contract and the impact this is having on Ireland's healthcare system".
It did no such thing.
The programme examined the behaviour of a few consultants, three out of 115 waiting lists, and some hospitals. And it painted a grossly unfair picture of services provided by acute public hospitals to public patients.
The truth is more reassuring: the 2016 annual report on acute hospital activity from the Healthcare Pricing Office shows that public hospitals delivered five times more procedures to public patients than private patients. The report was based on comprehensive data collected by the Hospital In-Patient Enquiry (HIPE) scheme which operates in 55 public and voluntary hospitals.
The HIPE scheme, established in 1971 and continually updated in line with best international practice, is a health information system designed to collect clinical and administrative data on discharges from acute public hospitals in Ireland. It gathers information on, among other things, age, public/private status, length of stay, and whether the patient was admitted as an emergency or for an elective procedure.
The principal diagnosis and principal procedure is also recorded for every patient. Public/private status refers to whether the patient saw the consultant on a private or public basis and does not relate to the type of bed occupied nor is it an indicator of private health insurance.
The 2016 report shows that 1,704,452 discharges were reported by the hospitals. Over 83 per cent of discharges were treated on a public basis, an 11 per cent increase since 2012. Private discharges accounted for just 16.4 per cent of total discharges.
More than half (53.6 per cent) of all discharges had medical card status so they are getting their fair share of hospital services.
In addition, in 2016, hospitals provided more than three million out-patient appointments to 1,342,195 people. Four-fifths of these were seen within 12 months. The sheer volume of work carried out in acute hospitals, including diagnostic investigations, tests, and procedures, suggests that consultants and other health professionals work very hard.
Yes, there are problems with access to many hospital services. Waiting times for elective procedures are too long. Some consultants behave badly and do not always fulfil the terms of their contract. Hospital managers can easily solve this problem. The 2008 contract (updated in 2014) explicitly states that “the implementation of the 80:20 ratio of public to private practice shall be the subject of audit, including audit by the Department of Health” and “the employer has full authority to take all necessary steps to ensure that for each element of a consultant’s practice, s/he shall not exceed the agreed ratio”.
Managers can also ensure private patients do not jump the queue for out-patient appointments and hospital procedures. The contract states that: “A common waiting list operated by the public hospital will apply to both public and private patients. Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director.”
Waiting times could be shortened by removing from the list those who do not turn up for appointments. Implementing this simple step could mean about 250,000 extra patients could be treated annually.
Apart from waiting times, Irish hospitals have other serious problems.
A 2017 EU report on the state of health services in Ireland found that there are too many “avoidable hospitalisations” for chronic health problems, such as asthma and diabetes, which are better treated by primary care teams.
“High hospital admissions for chronic conditions suggest problems with co-ordination and continuity.” The report also recommends a “stronger focus on prevention and primary care”.
This recommendation is not new. Since the World Health Organisation’s Ottawa Charter on health promotion was published in 1986, policy makers and health practitioners have been advised to “reorient health services” from a sickness to a prevention model.
Thirty one years later, Irish hospitals have 622,179 citizens queuing up for sickness treatment. Huge numbers have chronic health problems and are overweight or obese. Health inequalities are worse than ever. Most of the procedures carried out in acute hospitals are for conditions related to health behaviour, such as smoking and lack of exercise.
Government policy is to promote health and prevent disease through the implementation of Healthy Ireland: A Framework for Improved Health and Wellbeing 2013–2023.
Unfortunately, Irish people love their acute hospitals and would prefer to take pills or undergo surgery rather than change their unhealthy lifestyles.