Concern at level of private practice in hospitals

Stronger enforcement of the rules limiting private practice in public hospitals is needed, an official from the Department of Health told the Oireachtas health committee.

Concern at level of private practice in hospitals

The department’s assistant secretary Teresa Cody said some consultants had engaged in private practice at levels that “significantly exceeded” the levels provided for in their contracts.

“This may arise in relation to the level of private activity undertaken on-site, or they engage in significant levels of off-site private practice although their contract does not provide for this,” said Ms Cody.

While the HSE was responsible for ensuring consultant compliance with their contracts, hospital groups are responsible for reporting individual consultant compliance.

The committee met to discuss the oversight and monitoring of hospital consultant contracts highlighted by RTÉ’s Primetime Investigates.

Committee chairman Michael Harty said members were very concerned by the revelations that some consultants were consistently in breach of their contracts.

Many consultants are allowed, under their contract, to do extra paid private work within public hospitals, with the breakdown mainly 80% public patient and 20% private patient.

Ms Cody said the department was working closely with the HSE to find a solution to ensure compliance is monitored more effectively and, more importantly, breaches were dealt with appropriately.

Health Minister Simon Harris has established an independent expert review group to examine the impact of separating private practice from the public hospital system, one of the key recommendations of the Sláintecare report. Ms Cody said the group would conclude its work by the end of next summer.

The national director of the HSE’s acute hospitals division, Liam Woods, said the health authority fully accepted that it must have measures in place to ensure “robust oversight” of contract compliance.

Mr Woods said the HSE was taking a number of additional steps in conjunction with the department to strengthen existing controls in this area.

He added that activity data at hospital and national levels did not suggest private patients treated in public hospitals were seen out of sequence or ahead of a public patient with a greater clinical need.

Mr Woods said the public hospital system sought to charge and collect €620m in private income every year but this was proving difficult to achieve. “The HSE will be short in its income collection by about €90m in the current year,” he pointed out.

However, he insisted the HSE was neither targeting private patients nor urging hospitals to take measures to manage cost because of the income shortfall.

He pointed out that nearly 80% of hospitals’ private income came from patients arriving in the emergency department or maternity services, with the balance coming from inpatient elective work.

The vice-president of the Irish Medical Organisation, Dr Peadar Gilligan, said the RTÉ investigation, in focussing on the alleged actions of a tiny number of unidentified doctors, was missing a much larger point.

“We do not have sufficient medical specialists to deliver the type of care that is taken for granted by patients in most other comparable countries,” he said.

The president of the Irish Hospital Consultants Association, Dr Tom Ryan, said most consultants worked well over their contracted hours to care for patients who relied on an under-resourced and understaffed healthcare system.

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