2nd Annual Private Healthcare Conference, Dublin, 21 March 2007 - Closing Remarks by Mary Harney, T.D., Minister for Health and Children

21 March 2007

Health care is complex. Medicine is complex. Health economics are complex. Health legislation is also detailed and complex. There are no easy answers in any area.

But there is one thing is very clear to me: the vast majority of patients don’t care whether their care is provided by the public sector, the private sector, the voluntary or not-for-profit sectors: they simply want the best quality care and the best outcomes.

That is the over-riding interest of patients, and their well being is the over-riding public interest.

Of course, patients and the public interest demand that health care should also be provided on economic terms. No-one wants to feel they are paying more than they ought to. They also demand that health care is provided in an ethical framework that accords with their basic values about fairness, dignity and respect.

They also want health care to be available when they need it.

They want to feel confidence in their doctors and nursing staff. They want to be treated with dignity and respect, and communicated with as equals and as adults. They want standards to be set and enforced.

They want their health care to be carried out efficiently. They want health care administration to meet the highest standards of customer-focus we see in the best companies and services.

Looking at all these real priorities of patients, we can see how little relevance are issues about public and private finance and institutional governance.

Patients priorities can be – and are – met and fulfilled in public service institutions in Ireland. They are also well met and fulfilled in privately-owned institutions. There are instances where each of the public and private have failed to meet patients’ needs and priorities.

As far as I am concerned, my job, as Minister for Health is to make sure that patients’ priorities are met in all health care settings in our country.

My agenda for now and for the future is therefore focused on standards – setting and enforcing standards in all healthcare settings, whether public, private, voluntary or not-for-profit.

This is the core issue.

I am determined that we will move to a licensing regime for all hospitals, for example. We are providing now for the first time for a registration and inspection regime for all nursing homes, both public and private, equally. This is just the start.

All providers will be treated equally. The same minimum standards will be demanded of all providers even-handedly, because the patients’ interest demands it too.

In that context, arguments about the public sector or the private sector being inherently better – or worse – at providing health care are irrelevant. These arguments must be put to bed for good. They are, and will soon be seen to be, the remnants of ideological hang-ups on both sides.

Health care is not better or worse because it is publicly or privately funded and managed. It is better or worse because of standards, management, professional competence and appropriate and efficient use of resources.

This is the challenge for all health care providers – from a single GP working alone to a complex tertiary hospital, to nursing homes and palliative care providers.

For these reasons, I simply don’t accept the ideological argument that it is impossible to operate any health care service on a for-profit basis and at the same time provide quality health care.

Most of the focus is on hospitals in this respect – but the same ideology frowns on, and would prohibit, any profit in GP practices, in nursing homes and in minor injury clinics.

With the over-riding priority being standards for patient safety and quality care, I want to see both public and private sectors working together in Ireland to deliver better patient services for the whole population.

The key task is to set the right standards and to challenge all providers to meet, and even, exceed them.

So I say to people here today from all sectors: if you want to work in an environment where standards of patient care really count, then there is a wide and warm welcome for you in healthcare in Ireland.

I will not put artificial barriers in the way of any of you – whether you are public or private sector, Irish or non-Irish, for profit or not-for-profit.

I want to see innovation, efficiency and investment in Irish health care, from both public and private sectors.

There are some who would put up a ‘No Entry’ sign on the Irish health care system to Irish and international health care providers, just because they are privately-financed organisations.

This is not the policy of this Government. Ours is to work with both public and private sectors to best effect, as we set out in our Health Strategy in 2001.

It is the now the modern European approach to use both public and private providers of hospital care to best effect for patients.

As you at this Conference know well, in Sweden, Germany, France, Spain, the UK and elsewhere in Europe, State authorities at different levels are making innovative use of private sector providers. That is what we are doing in Ireland too.

To avoid using the private sector would be completely out of line with European developments.

The National Treatment Purchase Fund now systematically uses private hospitals for public patients. Up to now, public patients had no systematic access to private hospitals. It is an entirely appropriate use of public funds to use all hospitals in the State that meet quality standards for the treatment of public patients. No hospital should be excluded on the basis of its ownership. Private hospitals can supplement public hospitals.

It is also increasingly common for the HSE to contract with private providers to ensure that patient services are delivered faster and closer to home.

Is there any difference for patients between an MRI scan, a CT scan, radiotherapy or a dialysis treatment contracted by the HSE and one provided directly by the HSE? Of course not, because the HSE will only contract, as the NTPF does, where quality standards for patients are met.

In my view, these developments break down, rather than build up, two tier systems. The key thing is that all capacity in the country should be available for use for patients whose care is paid for and entrusted to the public sector.

To refuse to use private capacity would definitely drive us towards a two tier system.

In that context, I would like to briefly address some specific points that were made in the course of your Conference.

Universal insurance not necessary

Calls for universal insurance – which is compulsory insurance – ignore important developments in recent years.

Every person in Ireland is fully entitled to hospital care. Ireland has universal cover already. The United States does not. Ireland pays for these health services from compulsory taxation, not compulsory health insurance. In this respect, our model – universal cover funded by taxation – is, in fact, closest not to the US, nor to Germany, but to Sweden and Denmark. In our context to introduce universal compulsory insurance on top of universal compulsory taxation would be simply additional taxation, and double taxation at that.

One effect would be to pay a fee per item for all procedures – presumably, with little or no salary. Perhaps this makes it attractive to some. But I could not stand over a situation where one person, and one only, on the medical team in a hospital was paid a fee – the consultant – while others, non-consultant doctors, nurses, technicians, porters and cleaners, were paid flat salaries.

There is no barrier to using the public and private sectors together in a tax-based finance model. There is also no barrier to introducing new methods of payments to hospitals in this model. Universal compulsory insurance is, in my view, a red herring and an unattractive one at that.

Co-location projects and viability of private hospitals

I am very clear of the benefits of the co-location initiative to patients and to our health care system. Politics will not stand in the way of the initiative.

I do not believe that the private sector has anything to fear from the co-location initiative. It is odd that I am being criticised on the one hand for facilitating the private sector and on the other for putting private hospitals in jeopardy.

Let me put it simply: it can’t make sense that private hospitals that are five or fifty miles away from a public hospital are a good thing, but private hospitals five or fifty yards away from a public hospital are bad.

And for those who are running private hospitals currently I would say, first, we did introduce capital allowances for building private hospitals, but we did not, and we will not, take away business risk. It is not the job of the State to make decisions as to where and how people invest their money.

Business wants as much certainty as possible for the future and in respect of public policy. I understand that.

The changes we are introducing in the consultants’ contract and in the arrangements governing public and private work are long overdue. We could not continue with the present system, either in respect of consultants’ contracts or in respect of the absence of management of the extent of private work in public hospitals. It has become unsustainable and unfair.

However, these changes will take some time. The co-location hospitals will be up and running not tomorrow but in three years. That’s a fast building time, and also a reasonable time for business planning.

Similarly, the arrangements for new consultants will have effect over time.

I would also point out that we have said we will be open to contracting-in consultants who are working in private hospitals primarily. So instead of public sector employees working out there, we will contract with private providers to bring them in on a sessional basis.

This is all part of the flexibility and pragmatic co-operation I want to see between public and private providers in Ireland.

Health insurance costs

It is a matter of long standing government policy that the full economic rate should be charged for private beds in public hospitals.

We can expect the private sector to charge the full economic rate too.

I do not believe that, in the context of approximately €1 billion in health insurance premia now being paid in Ireland, the additional cost, over some years, of fully charged beds in public or private hospitals, or in co-located facilities, will provide an insuperable challenge to the private health insurance market or will make insurance unaffordable.

Health care costs are rising. Health insurance costs are rising. We have a policy, which we will maintain and support, of community rating in order to keep health insurance affordable for older and sicker people.

But it is not the answer to hide real costs, to provide complex, hidden subsidies or artificial supports, for example, by pricing private beds in public hospitals wrongly.

We will get efficiency by transparency in finance and costs at all levels of health care provision, including in the health insurance field.

Conclusion

There are many other parts of the agenda of today’s Conference that I would like to discuss if time permitted. I do want to congratulate you on another successful conference and I re-state my commitment, and that of the Government, to get the best health care for the people in our country by having all providers work together in a framework of high standards.