Special Delivery Units - Today FM
Irish Medical Organisation

Special Delivery Units - Today FM

Special Delivery Units: The Last Word with Matt Cooper, Today FM 1st June 2011

Prof Seán Tierney, Past President of the IMO spoke to Matt about the Minister for Health, Dr James Reilly’s plans to replace the National Treatment Purchase Fund.

Matt Cooper – Presenter:

Something else that the government is cutting is the national, what is it, the national treatment purchase fund.  This was a system by which if you were a public patient and you didn’t get treatment within a set period of time the State would pay for you to have it purchased privately, be it in this country or overseas.  Now it had been one of the boasts of Mary Harney that this worked particularly well and it made sure that people got their treatment and yet it is to go now.  We’re joined by Professor Sean Tierney consultant surgeon in Tallaght hospital, what you make of this decision professor Tierney.

Sean Tierney – Professor:


Good after noon Matt, well I think the treatment purchase fund, the referrals are going to be stopped and some of the money is going to be diverted into a new agency which is the special delivery unit which was part of the election platform of Fine Gael and is now part of the program of government and its going to bring a focus on using public services more efficiently to try and get more patients treated more promptly in the public service side and that’s probably a very good idea. 

Matt Cooper – Presenter:

If it doesn’t work well then do you not need the safety valve of this scheme where you’ll be able to push people off to the private sector to get the medical treatment they need.

Sean Tierney – Professor:

Well I think the problem is Matt if you look over the last 7 or 8 years the national treatment purchase fund has spent €500 million buying services for patients in the private sector and the difficulty is that it doesn’t address the shortage of capacity in public hospitals.  I mean it would be better to invest the money in sorting out what needs to be sorted out to allow public hospitals provide all the services that are needed.

Matt Cooper – Presenter:

Yeah but will that happen or will the money just be used as a saving?

Sean Tierney – Professor:


Well I think it probably will be used to drive efficiencies, I mean there’s a lot of work going on in fairness already within the HSE and the clinical programs that doctor Barry White has led, have already done a lot of work at looking at how could patients who are brought into hospital get their treatment more efficiently and more effectively and spend less time in hospitals than they currently do because we do keep people in hospital in Ireland for longer than the European norm would be.  So I think there is an opportunity to gain efficiencies. The special delivery unit will bring a focus on that but it will require investment in extra capacity in our hospitals, we will need operating theatres, CT scanners and so on available over longer periods of time.

Matt Cooper – Presenter:

We’ve also got Tom O’Connor with us who is a lecturer in health economy at Cork Institute of Technology, hello to you Tom.

Tom O’Connor – Lecturer:

Hi Matt.

Matt Cooper – Presenter:

Tom are you celebrating the fact that we won’t have all this money being siphoned off to be spent in the private sector now that it will be spent in the public sector instead.

Tom O’Connor – Lecturer:

I don’t think all this money, it’s not a very big amount of money, they’re talking about siphoning off €29 million of the budget in the national treatment purchase fund which to be honest about it is very insignificant in the context of the overall health budget.  More generally I think this, I can see where this is coming from, it really is, to use a medical metaphor a sticking plaster solution to the health service.

Matt Cooper – Presenter:

Why?

Tom O’Connor – Lecturer:

The problem with the Irish health service are structural.  There are problems around private patients occupying public beds, that has risen in the last 12 months because a lot of people have actually, there’s a greater pressure on the public health service at the moment because a lot of people have actually packed up using their, paying for their VHI, there’s about 3% reduction in the people in VHI.  Then the people who are still in VHI have access to private beds in public hospitals and so the waiting list grows in the public sector whilst there’s preferential treatment in the private sector.  Also I think that squeezing the budgets of the hospitals which is what this program, this special delivery program is about, it’s just about trying to squeeze more productivity out of the hospitals.  And the reality is that the hospitals, there are inefficiencies all over the health service in terms of the management structures, there’s poor configuration of services in one part of the country, in certain parts of the east of the country, there’s a high proportion of senior managers, too many senior managers and there’s far less public services.  The whole system of public health in Ireland is actually in a complete and utter, a complete mess and this little measure is not going to solve anything.  And I think where it’s coming from is actually, it’s a presage to Fine Gael’s policy on the universal privatisation of the health service.  What they’re going to do is they’re going to, according to their recent document before the election they’re going to try and squeeze another billion Euro out of the health service, force people to start buying private health insurance, increase the number of people with private health insurance.

Matt Cooper – Presenter:

Tom I’m going to throw a text message at you that came in from a listener.  I pay a fortune to the VHI and I’d be really irked if a medical card patient was in a private bed beside me, as usual they get everything for nothing.

Tom O’Connor – Lecturer:

Well you see that fails to understand the system because if the medical part patient is in a bed beside him, then it’s the medical card patient has the right to be in that bed, he has the right not to necessarily be in that bed he should be in a private hospital if he’s paying for private health insurance, he shouldn’t be occupying a public hospital bed.  What's happening in this country is that public patients have only one bite at the cherry in terms of getting into hospital.  There are 2 waiting lists, there’s a private waiting list and a public waiting list.  The private patients can jump the queue because they have private health insurance and access public beds, they can also access private beds whereas the public patient only has to make do with the residual amount of beds that are left over after between 25 and 40% of their beds are taken away by private patients.

Matt Cooper – Presenter:

Ok we’ll go back to Profession Sean Tierney to finish off, now you see the practical end of  this as a consultant surgeon in Tallaght hospital, how confident are you that this new system will actually make things better.

Sean Tierney – Professor.

Tom is right, this is a small part of a very big picture and you know we have inefficiencies within the system and I think we probably could get more done with what we have.  But I mean a very good example of why we have inefficiencies is the recent decision in relation to the fair care deal, the fair deal for patients moving into nursing homes and we now are accumulating patients in all our hospitals who are entitled to long term care, but there simply is no funds for them.  So they’re sitting in hospital waiting for someone to solve this problem for them so that they can go to where they need to be in a long term care facility that’s suitable for their needs.  That creates huge inefficiencies, we have thousands and thousands and thousands of bed days lost in our system because of that.  Now fixing that alone isn’t a solution, I do think we need to look at using what we have more efficiently, I think that focus is good but that focus was already there before today, it hasn’t been delivered and as Tom says it will require investment in order to use what we have more effectively and unfortunately despite the new taxes that you’ve just been talking about Matt, there’s precious little money for investment at the moment.

Matt Cooper – Presenter:


Thank you very much Professor Sean Tierney from Tallaght hospital and Tom O’Connor health economists…

IMO Membership

Start reaping the benefits of membership.

If you were previously a member of the IMO you can rejoin here.

Join nowRejoin here ›

Enquiries

Have a question?
Please get in touch with us and we will be happy to answer.

MAKE AN ENQUIRY