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Co-located Hospitals and the Health Service

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As is evident from your letters' page, opposition to co-locating private with public hospitals refuses to go away.

It was clear before the general election that key ministers had no idea about the cost of co-location. Furthermore, the Minister for Finance, who should know better, seemed to equate its cost with the the level of tax foregone. Conveniently, he ignored the ongoing costs that will arise due to duplication of activities and resources, the operation of two separate management systems on the same site and, most critically the premium needed to cover future profits of the developers of the co-located hospitals.

In the long run, these items will be far more significant than the initial tax breaks. In addition, private health insurance subscribers will face substantial additional premiums and, at the same time, public hospitals will encounter substantial reductions in revenue to be funded by taxpayers. This is classic "lose-lose" rather than "win-win".

The Government's mandate has been to fix the health service - not to break it by allowing the private sector to selectively cherry-pick profitable niches. Valuable time and MANY LIVES have been lost as a consequence of the single-minded pursuit of this ideologically-driven approach and the opportunity to develop a single-tier, public system could be lost for at least a generation.

Instead of pursuing privatisation by stealth and hiding behind task forces and reports, the Government should, even at this late stage, ditch this warped PD ideology and start tackling the very real and obvious issues linked to management, staffing and resources. If this had been done much earlier in the ten-year life of this government, we could have reached, by now, a situation where the end of waiting lists would be in sight and the need for private heath insurance as a method of queue jumping would have diminished.

Letter published in the Irish Times on 24th November 2007.

Privatisation of Hospitals

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It is patently clear that co-locating private and public hospitals is like trying to mix oil and water. It will give rise to fragmentation, duplication and staffing and operational problems on a massive scale and, most critically, it will drive an even deeper wedge into our inequitable health service. The major political parties should pledge to unwind them and the Dail must ensure that no binding commitments are entered into ahead of the next election and a comprehensive review. Failing that, politicians should give notice that they will progressively introduce terms and conditions that make this "mad cap" scheme unprofitable to the developers.

Instead, what should be done is to retain these "hospital loving" developers to design and build units with step down beds on the proposed sites to be managed by the public hospital. This could be started next spring and done within two years.  Simple !

Broadcast on RTE's Today with Pat Kenny on 21st December 2006.

Privatisation of Hospitals

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Following Susan Mitchells' article (11th June) about plans for eleven co-located private hospitals, it is clear, but not surprising, that the Government has learnt nothing from the ongoing decentalisation debacle. While decentalisation could be disruptive to thousands of public servants and families and to the operation of relocated departments, the roll-out of these private hospitals is potentially far more serious.

At a time when inequitable property tax breaks are being closed off, a new break for hospitals is being ramped up. This will result in the State losing taxes equivalent to 48% of the cost of developments. In addition, it will have to give away prime sites, be obliged to pay full commercial fees to use the facilities and have no ownership or managerial rights notwithstanding having contributed almost half the total capital cost. How can this be remotely described as either progress or value for money? It is patently clear that co-locating private and public hospitals is like trying to mix oil and water. It will give rise to fragmentation, duplication and staffing and operational problems on a huge scale and, most critically, drive an even deeper wedge into our inequitable health service.

Based on your report, many key bodies have reservations or are outrightly opposed to the proposals and the only people in favour seem to be the Tanaiste, consultants, builders and investors.  As the proposals seem to driven by ideology and profit and are being pursued without any popular mandate or genuine debate, the major political parties should pledge to unwind them and the Dail should ensure that no binding commitments are entered into ahead of the next election and a comprehensive review. If, in the meantime, the Minister and HSE have the luxury of surplus resources and energy to pursue these risky and unproven ideas, they should be immediately redeployed to provide more public hospital beds, improve services and develop a more unified health service.

Letter published in the Sunday Business Post on 19th June 2006.

Privatising Healthcare

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Why is the State offering extraordinary returns to investors in the health sector when it can easily raise the finance at less than 3% per annum? How can the Government justify subsidies of up to 47% by way of tax breaks to investors in hospitals *AND* then, on top of that, having to make annual payments to these investors to cover rents, fees, dividends, interest and profits? It is nonsense for investors to suggest that the State would gain from the resultant PAYE and VAT as it would be getting these if it financed the hospitals in the first instance.

In relation to the proposed replacement of Crumlin children's hospital, you quoted the Minister for Health (Wednesday 7th September) as saying that she would investigate innovative ways to get the hospital in place quickly and that there is a lot of interest in the provision of healthcare facilities. Is this Harneyspeak for the provision of tax incentives to investors to build and operate the new hospital with all its implications for costs, prices, standards, ethics and access?

It is time for our socially-conscious Taoiseach and opposition parties to put a stop to this creeping privatisation which is unwanted and unnecessary. If replacement of Crumlin is so urgent, why were public funds not released years ago as sought by the Pollack Report, New Crumlin Hospital Group and many others.

Co-located Hospitals

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May I add my voice to concerns about evolving health sector strategies.

Why is the State offering extraordinary returns to investors in the health sector when it can easily raise the finance at less than 3% per annum? How can the Government justify subsidies of up to 47% by way of tax breaks to investors in hospitals and, on top, having to make annual payments to these investors to cover rents, fees, dividends, interest and profits? It is nonsense for investors to suggest that the State would gain from the resultant PAYE and VAT as it would be getting these if it financed the hospitals in the first instance.

By any standards, Ireland already have an inequitable two-tier health system and the Minister of Health's current policies will result in a fragmented and highly discriminatory three-tier system. What is really needed is an uncomplicated single-tier system where care is based on need rather than capacity to pay. The Government has no mandate to develop a "for profit"  health service and opposition parties should, ahead of the next election, pledge to roll back all measures aimed at  privatising key health services. They could also usefully address the need to convert the VHI into the a form of compulsory health insurance for all and let a much diminished private insurance industry concentrate on the private healthcare sector.

The Minister's plan to transfer beds from public to private hospitals is akin to re-arranging deck chairs on the Titanic except that in this case they are being moved from steerage up to first-class. This measure is being presented as progress but it is, in reality, privatising and cherry-picking by the side door.

Instead of pursuing this zero-sum game, the Minister of Health, her department and HSE should review why  Ireland's health spend (as a % of Gross National Income) has risen above the EU average notwithstanding that the proportion of our population aged 65+ is only two-thirds the EU average. Is this because we are more prone to sickness and accidents than our EU counterparts (e.g. drink- and traffic-related), or because we get bad value from existing services (overpayment and underperformance), or because resources are mismanaged (too many administrators and offices and too few doctors and beds)? Findings and needs, not ideologies, should govern strategies aimed increasing rather than reducing equity.

This letter was published in the Irish Times on 24th August 2005.

Investment Double-Speak

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The Tanaiste wants to give tax cuts to Irish investors to encourage investment in local hospitals rather than in overseas property. If investment in hospitals and other infrastructual projects is so urgently needed that tax breaks and tolls are required to support it, what is the justification for the State investing over a billion euro a year of tax revenues in overseas businesses via the National Pension Reserve Fund?
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