Lessons show how difficult it will be to dismantle two-tier health system here

IT WAS described as “Sláintecare on steroids” where a one-tier hospital system was created overnight. But the takeover by the State of private hospitals created a whole new unfairness and risks to private patients. An agreement was reached on March 30 as the country was braced for a potential tsunami of patients severely ill with the coronavirus needing to be hospitalised or placed in intensive care.

The 19 private hospitals said in “an unprecedented step in the national interest” and in a “critical contribution in the overall strategic management of the pandemic in Ireland” they would be put in the hands of the State until the end of June.

At the time, public hospitals had around 250 intensive care beds and the HSE needed to know that access to private hospitals was available if the surge of coronavirus admissions could not be managed.

Private hospitals have in excess of 2,500 inpatient and day beds with 8,000 staff.

The plan was that all patients would be public and private hospitals could not charge any fees to insurance companies such as the VHI.

Wearing the green jersey at this point was what mattered. Around 600 full-time private hospital consultants were asked to sign a temporary HSE contract in return for a salary.

However, it soon became clear the arrangement – costing €115m a month – was full of tangles, not least the impact it was having on insured patients who were attending these consultants before the deal.

Doctors warned of patients with heart complications, patients referred for cancer investigations and people with deteriorating eyesight whose care was put on hold.

Cases emerged of a young patient in Cork whose spinal fusion surgery was cancelled and a man in Offaly who had no date set for his urgently needed stents.

Private consultants were treating patients on a pro-bono basis and also paying out up to €20,000 a month for private rooms.

Only around 260 consultants signed the HSE contract. The HSE indicated earlier this week it wanted to extend the current arrangement when it expired at the end of June and the signals were that it would be continued until the end of July.

The hope was that many of the backlog of patients on public waiting lists would be treated in the private hospitals but just 50pc of inpatient beds in the private hospitals were occupied.

The decision to end the current deal and opt instead for a system where the State can take control in the future if required has been welcomed by doctors and private patients. The takeover was necessary in the crisis but the lesson learned is just how difficult it will be to dismantle the two-tier health system here.