Vol. 406 No. 3
13 Mr. R. Bruton asked the Minister for Health whether he has satisfied himself that admission to basic hospital treatment is currently decided on the basis of medical need and commonly applied to those waiting for public or private care; and whether his proposals to entirely separate public beds from private beds will alter this.
95 Mr. Bradford asked the Minister for Health whether he has satisfied himself that admission to basic hospital treatment is currently decided on the basis of medical need, commonly applied to those waiting for public or for private care; and whether his proposal to entirely separate public beds from private beds will alter this.
102 Mr. R. Bruton asked the Minister for Health whether he has satisfied himself that admission to basic hospital treatment is currently decided on the basis of medical need, commonly applied to those waiting for public or private care; and whether his proposals to entirely separate public beds from private beds will alter this.
I propose to take Questions Nos. 13, 95 and 102 together.
The principle underlying the availability of public hospital services has, until now, been that admission should be based entirely on the criterion of medical need, irrespective of whether public or private care was required. I am satisfied that this principle has always operated in respect of emergency cases, which must be admitted to whatever bed is available, and this will continue to be the position.
However, there has been a growing concern that the admission arrangements for non-emergency procedures, particularly where there is a significant waiting list, may have been operating to the disadvantage of the public patient. The modifications to these arrangements, which have been agreed by the social partners in the context of the Programme for Economic and Social Progress, are designed to improve equity of access to public hospital services by removing those elements of the present arrangements which may, in practice, be unfair to the public patient. I am glad to have the opportunity to explain in detail why this is the case, and why the concept of a common waiting list for all beds, public and private alike, while attractive in theory, may in practice make it harder rather than easier to achieve equity of access.
At present, every person in the country is entitled to a public bed, but those above a certain income are required to make private arrangements with their consultants. The consultant is, of course, responsible for deciding which patients should be admitted to the available beds. This inevitably gives rise to a perception that a consultant's private patient may be able to jump the queue for a public bed. Deputies will appreciate that it would be very difficult to devise any administrative mechanism to prevent this since the decision as to which patient should be admitted must remain a clinical one.
Under the new arrangements, any person who wishes to be a public patient will be entitled to avail of public consultant care. This will enable us to phase in a requirement that consultants' private patients must use private or semi-private beds if they have been admitted for non-emergency treatment.
The new arrangements will not lead to any reduction in the number of public beds; there will, therefore, be shorter waiting lists for public patients since private non-emergency patients will no longer be treated in these beds. The programme also includes a commitment to monitor the operation of the new arrangements to ensure that they are operating fairly.
The public hospital system will also continue to cater adequately for the private patient. The Government have made it clear that our public hospitals benefit greatly from having a balanced mix of public and private practice, and that the role of private medicine and of voluntary health insurance will not be diminished.
If the new arrangements lead to an increased demand for private and semi-private beds in the public hospitals, this demand can be met on a self-funding basis — it will have no effect on either the number of public beds or the improvements in the position of public patients.
In conclusion, I would ask Deputies to accept that the Government and the other social partners would have had no reason to discuss and agree these new arrangements unless they were specifically designed to increase, rather than reduce the equity of the system. They address the difficulties with the present arrangements which have been highlighted in the analysis of both the Commission on Health Funding and of NESC both of which recommended a change in eligibility on the lines of that now proposed. They arise from the sincere belief that equity and, in particular, the interests of the public patient, will be best served by ensuring that a guaranteed number of beds are available to public patients and by monitoring the operation of the arrangements to make sure that the public patient gets a fair deal.
It is clear to me in the light of the discussions with the social partners and the reports of the Commission on Health Funding and NESC that there is a wide measure of support for the course action which the Government now propose to take.
It is dismaying that, for the first time, the Minister is admitting that the common waiting list concept would not work fairly. However, would it not be very foolish to throw out the common waiting list idea at this stage given that, at section 2.61 of their report, the Commission on Health Funding recommended that the key need in regard to bringing equity into the system is the establishment of a properly working common waiting list? Would the Minister not agree that he is being very selective in citing just one aspect of those recommendations and that his statement that there will be more public beds available for public patients is based entirely on an assumption that people will not take up their entitlements? Is it not the case that that will only happen if the public system is so bad that people will opt not to take up their entitlements?
May I appeal for brevity for the obvious reasons?
I will try to be brief but the Deputy did ask three or four supplementary questions. First, this is not the first time I have made the point relating to what the Commission on Health Funding recommended. They recommended the establishment of a common waiting list but we did not accept it because, as I said, while it looks very good in theory it just would not work in practice. The commission's recommendation was based on admissions being monitored to ensure that private patients would not be admitted to available beds ahead of public patients. As I have stated already, it would be almost impossible to do this administratively because the right to decide on which patients should be admitted to hospital must always remain with the consultant who makes the clinical decision.
That is a cop out. The Minister is afraid to take on the consultants.
Furthermore, if we were to go for the common waiting list it could lead to private practice being taken out of our public hospitals. As I have often stated in this House, the private-public mix has served the nation very well since the foundation of the State. It is not new. It ensures that the very top consultants in their disciplines are available on campus to their public patients when they need them and are not practicing, say, four or five miles away or an hour's drive away, in some private hospital.
They do.
It is my view that there will be more public beds available for public patients as a result of this change and this assumption is well based. As I stated in the House before, less than 1 per cent of those who subscribe to Voluntary Health Insurance subscribe to avail of category II treatment, as it were. I see no reason this should change.
Question No. 14 in the name of the same Deputy.
The Minister is throwing back months of work in the faces of the commission.
I appreciate the work of the commission.
The Minister is ignoring their recommendations.
I have called the next question.
