For better and for worse

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So goodbye Leo, hello Simon. One of the most interesting contributions I heard in recent weeks was by outgoing Senator Prof John Crown on <em>The Late Late Show, </em>when he was asked by the host whether he would like to be the Minister for Health. Without missing a beat, Prof Crown said “No” and essentially said that the Minister had no power over budgets and the only job to effect real change was that of the Taoiseach. This column was at times quite critical of the former Minister, which I would wholly stand by, but it must be stated that, particularly in his early days in the job, before the General Election fever took hold, Leo Varadkar made an honest effort to make things better and succeeded in not making things catastrophically worse and that ranks him higher than his immediate predecessors. May he go well.

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That said, I am sort of glad that my appointment papers as a consultant in Dublin will be going across somebody else’s desk. Simon, I think you’re terrific.

I thought of what Prof Crown said when I saw in the Programme for Government, presumably devised before Harris was appointed, that a new performance management unit is being set up and those hospitals who do not meet their targets will have to use their own budgets to ensure their targets are met “with the assistance of private sector providers”. The Programme also says: “We will provide for the temporary transfer of management of hospitals to another provider where there are consistently poor outcomes, patient experiences and financial management.”

Now amidst the truly pressing questions that have dominated public debate in Ireland for the last few weeks including Irish water, Irish water, Irish water, turf cutting, Irish water, Danny Healy-Rae’s intellectual ramblings on climate change, Irish water, and Irish water, this sharp rightward turn in the direction of travel of our public health service has passed largely without comment. It is hard to know what exactly the Government envisages here. I have no ideological beef with the idea of private healthcare. Although I do not have a private practice, most of my colleagues here in the UK do, and contrary to what most people in Ireland seem to think about NHS consultants, private practice is essentially unfettered once your public commitments have been delivered. Private medicine has its place both in the UK and Ireland and many people use it extensively as is their absolute right to do so.

That said, what public hospital systems in both the UK and Ireland find most challenging (to wildly varying degrees) is the demands of safely running, staffing, and funding a fit for purpose 24/7 service with general medical, surgical, paediatric, and obstetric care for acutely unwell patients. This is what makes the headlines. The private healthcare sector, both in the UK and Ireland, has never appreciably shown any interest in running this sort of service. This is not a criticism of such providers. They have a responsibility to turn a profit for their shareholders and 24/7 general medicine is messy, complicated, and costly. Who are these private sector providers who are going to assist our struggling hospitals? Are they the same agencies to whom management of our beleaguered hospitals will be temporarily transferred to should they fail to meet the performance management unit’s targets? If so, why? If they are fit to manage such budgets and services, as the Government seems to believe, then why aren’t they already doing so on behalf of their own shareholders and clients?

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The rhetoric about involving private providers in public hospital management in the Programme for Government though is eerily reminiscent of that of the Tories

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My sojourn abroad in the US and the UK has given me a new perspective on Irish politics. Irish politicians and parties have their faults, many of them grievous, but I’d struggle to think of an active politician in Ireland that was anything other than basically well-intentioned. They could legitimately be accused of lacking vision, foresight, and executive competence. However, even in their darkest moments they do not even approximate the intrinsic badness and venality of the Conservative Party, with the Republican Party of  Trump, Cruz, and Ryan being unfathomably worse again. The rhetoric about involving private providers in public hospital management in the Programme for Government though is eerily reminiscent of that of the Tories. That particular experiment came to a grim outcome in Hinchingbrooke Hospital in Cambridgeshire, a small district hospital with long-standing financial problems, the management of which was signed over to a private provider called Circle Health in 2011. In January 2015 Circle announced that because Hinchingbrooke Hospital was “no longer [financially] viable under current terms”, it wanted to withdraw from operating it under the exit terms of the contract, on foot of a disastrous inspection by the Care Quality Commission. They left behind a £14 million deficit  (they were only liable for £5 million under the terms of the deal) and a hospital rated as the second least efficient in England.

But hey ho. At least they weren’t vested interests.

<p class=”captionwhiteMIstyles”>Over to you Simon.