Harnessing public and private systems to meet demand

The Independent Hospitals Association of Ireland proposes that the principle of taking a “whole system” approach to national service planning where all of the resources, capacity and expertise in the State are made available to meet the gross healthcare requirements of all patients, be adopted with immediate effect, writes Catherine Whelan.

Catherine Whelan
Catherine Whelan

The independent hospital sector plays a vital role in the provision of healthcare nationally, providing high quality, innovative care to over 400,000 patients annually.

Each year, the country’s 20 independent hospitals make available 1,000,000 bed nights, undertake over 250,000 surgical procedures and treat almost one quarter of all mental healthcare admissions.  In certain specialties, for example cardiac and spinal surgery, independent hospitals undertake over half of all procedures.   Over 8,100 people are directly employed by private hospitals across the country, with the obvious knock-on benefit for towns and communities nationwide.

Independent hospitals have pioneered the introduction of many new technologies and innovations, having led the way historically in the introduction of linear accelerators, PET CT, MRI and more recently having made available CyberKnife and Stereotactic Radiosurgery innovations.

Each year, the country’s 20 independent hospitals make available 1,000,000 bed nights, undertake over 250,000 surgical procedures and treat almost one quarter of all mental healthcare admissions.

Each hospital within the Independent Hospitals Association of Ireland (“IHAI”), which is the representative body for the sector, is either accredited by an internationally recognised body or regulated by the Mental Health Commission.

Key National Role

While our health system is frequently described as “two tier”, the interdependencies between both the public and private health system are significant.

A recent survey carried out by RED C for the IHAI, indicated that over three-quarters of people believe private hospitals play a key role in meeting the healthcare needs of patients nationally (79%) and that private hospitals play a key role in reducing the burden on the public hospital system (77%).

Common Challenges

While there are key interdependencies between the independent and public hospital system, there are also many common challenges facing both.

A truly “national” approach to healthcare planning should take account of existing capacity, resources and expertise in all parts of the system.

The financial pressures being managed within the public hospital system are well documented with further budget cuts of over €600m placing strain on the system’s ability to manage occupancy rates of close to 100% and reduce waiting lists for elective surgery (43,015) and outpatient appointments (309,496).

The financial challenges facing the independent sector can be distilled into two main issues.   Firstly, the number of patients that can potentially present for care in an independent hospital is diminishing given the number of people that have cancelled their health insurance (245,000 since 2008) or downgraded to a plan that does not give them full access to an independent hospital. Secondly, the prices negotiated by health insurers with independent hospitals have reduced significantly in recent years.

In addition to the pressure on financial resources, both independent and public hospitals are grappling with the challenge of attracting and retaining healthcare professionals, particularly doctors. The shortage in medical manpower is a key national issue, with the structure of the current consultant contracts which were drafted at a time where the national healthcare strategy envisaged co-located public and private hospitals, now restricting the ability to make optimal use of what is a very scarce resource.

Universal Health Insurance

The Government’s plan for Universal Health Insurance (“UHI”) envisages one integrated healthcare system by 2019, where all of the health resources and capacity across the country, regardless of their origin as “public” or “private”, are made available to all patients.

The independent hospital sector supports this principle and believes that immediate adoption of this concept would address some of the current challenges we face.

A truly “national” approach to healthcare planning should take account of existing capacity, resources and expertise in all parts of the system. This would avoid State investment in facilities that already exist within the independent sector and would enable underutilised capacity within the sector be made available to support the reduction of current public waiting lists. This could be managed by way of alignment of independent hospitals to relevant Hospital Groups.

Similarly, in relation to medical manpower challenges, consideration should be given to how we can deliver maximum benefit to patients nationally from this increasingly scarce resource. If we issued contracts that enabled consultants, once their public service obligations are fully met, to practise in any independent hospital, the State could incentivise the retention of consultants by allowing them the opportunity to work and develop their skillset in the independent sector, while increasing our national capacity to address the country’s healthcare needs.

“Whole System” Approach

The IHAI believes that there are many elements of the UHI ethos which could be applied with immediate effect for the benefit of patients nationally. In particular, the Association proposes that the principle of taking a “whole system” approach to national service planning where all of the resources, capacity and expertise in the State are made available to meet the gross healthcare requirements of all patients, be adopted with immediate effect.


Catherine Whelan is Chief Executive of the Independent Hospitals Association of Ireland, the representative body for Ireland’s 20 independent hospitals.