Free Marketeering in Health

Dressing the Government's privatisation agenda in the robes of centralisation

Privatisation is at the heart of the Government's so-called 'reform programme' in health. Now cloaked by the current economic crisis, the present 'slash and burn' approach to public health services, has been in preparation since the mid-90s. 'Transformation' is a code for marketisation.

The closures recently announced by the Health Service Executive (HSE) in the Mid-West belong to a script first written by a firm of Bolton accountants for the North-East in 2006.

Trapped in its own language, HSE continues to parrot the same worn-out clichés of 'patient safety', 'clinical risk', 'unsustainable' and 'key stakeholders'. Teamwork, which has, according to itself, masterminded a number of PPPs in the British NHS, is apparently being paid millions to regurgitate itself in Ireland. Author of a report on the North-East that recommended the closure of all five public hospitals in the region, Teamwork co-authored the recent report on the Mid-West, and is shortly expected to unveil its blueprint for the South.

A small army of public relations strategists has been employed to sell the Government's privatisation programme. PA, for example, a company that has also laid the ground for extensive bed cutting in public hospitals in Ireland, has been represented by MRPA Kinman (now MKC) whose Chairman, Brian Geoghegan, is married to the Minister for Health.

Strategies, too, are similar. Surgeons have been chosen to 'lead' the HSE's Decimation Programme in both the North-East and the Mid-West.

HSE is preparing to close five publicly-funded hospital in the Mid-West, three general hospitals (Ennis, Nenagh and St John's) and two 'stand alone' specialty hospitals (orthopaedics in Croom and maternity in Limerick City).

The writing has been on the wall for a long time. These closures were overtly recommended by the Hanly Report in 2003. These were the very regions selected as pilots for the Government's new 'burn and slash' approach. Fully implementing Hanly will close around 40 of our public hospitals, as well as countless inpatient psychiatric hospitals.

Last January the PA Report spelt out the monstrous scale of the Government's bed cutting ambitions: 40 per cent of Ireland's public patient beds are set to close by 2014. These closures, the Government hopes, will ensure the viability of those private for profit hospitals that have been sprouting up around the country, like ragwort, in recent years.

Public hospital closures are central to the Government's privatisation policy. As the cancer strategy––in preparation since 1995–– shows, centralisation is a proxy for cutting the public health service. Looking to the for profit sector is at the core of Government health policy. This policy has been embedded in health policy documents for over a decade.

US models of 'disease management' have now been adopted in Ireland, as part of HSE's Decimation Programme. Services for Ireland's
leading diseases are being outsourced in the name of 'excellence'.

Public hospitals are being hollowed out from within: taxpayers' money, until now earmarked for cancer, will soon be available to American
health care giants, some with a background in fraud, such as UPMC (described by Bertie as 'our friends' when he opened their Whitworth Clinic in Waterford).

Many of these for profit entities are far smaller than the public hospitals whose services have been stripped from them on so-called 'quality of care' grounds. Beacon Hospital, for example, opened with just 26 beds. Today, Monaghan General, with 50 beds–– a hospital with one of the best coronary care services in the country––is on the point of closing. Only last week, HSE's 'reform' programme reportedly endangered the lives of two patients there.

The 'critical mass' requirement appears to be little more than a neat device designed to shut public services. Public hospital cancer service
that do not have high volumes of patients are being closed by the HSE, while private for profit hospitals with equally low, or lower, patient
numbers are given fat contracts by the same Executive.

Ireland's health services are being restructured to facilitate privatisation. Services that are known to be profitable are being moved out of the public system into the for profit sector. These giant money spinners include elective or planned care, radiology, pathology, and chronic
diseases.

Their funding is being removed from public hospitals and given to new HSE 'business units' to control and manage. Services for heart disease, stroke and diabetes are among those scheduled for commercialisation under the banner of 'centres of excellence'.

Cancer, that most high-profile of all chronic diseases, has long been selected to lead the way, and breast cancer, that most publicised of all cancers, has been chosen to spearhead the mass closures. Centralising cancer surgery serves corporate interests, as it facilitates the collection of patient tissue for company R&D. Those shouting loudest for public cancer service closures in Ireland include the Irish Cancer Society (ICS) and Europa Donna. As much as 87 per cent of Europa Donna's funding comes from the pharmaceutical sector. ICS's pharma funding as a proportion of its overall income remains unknown.

These disease 'networks' or business units will operate from cradle to grave, across community, hospital, continuing care and even hospice settings. With power being transferred to these new unaccountable entities, public hospitals will over time lose their ability to control the key services they currently provide.

The effect of this radical restructuring of the country's health system is likely to be disastrous, as the recent closure of public hospital cytology services shows. Radiologists have reported that the laboratory tender was rigged to favour Quest, another American company with a background in fraud in the US. Laboratory specialists say HSE bureaucracy prevented some public hospitals from 'competing'.

Public hospitals are unlikely to be able to compete with for profit entities on price for disease contracts. Unlike most private hospitals, which rely on public sector poaching to run their consultant-led services, public hospitals employ 24/7 medical staff. Hospitals need patients. If these institutions lose their core business, their survival as public hospitals is likely to be threatened in the longer term. This has already happened in other health care systems.

These Government policies place patients, particularly the less well off, at risk: hospital A&E and maternity services that used to be accessible will become two hours' drive for some, while many outpatient services that used to be free, such as physio, are likely to become fee-paying. (If the new centre in Ranelagh is any indication, the much-vaunted primary care centres are likely to charge all but medical card holders.) Meanwhile, a new bill is preparation which, like the 'Unfair Deal' for the elderly, is widely expected to cut people's entitlements to free medical care. Quality of patient care is also likely to be compromised: American research shows that care in for profit hospitals is of inferior quality, despite costing government substantially more, than care in not for profit settings.

Discussions have already been held with health unions on 'flexibility'. Nurses, for example, will be expected to rotate across the full spectrum of community, hospital, nursing home and hospice settings. The nursing shortage in Ireland, already acute, will intensify if many choose to leave
rather than work under agency-style conditions.

Not a scintilla of evidence has been produced by the Government, the HSE or the Department of Health in support of the new privatisation
programme. There is no good evidence for centralising the common cancers, for example, nor for centralising routine surgery. But as the Quest contract for women's smear tests shows, commercial interests, not quality of care, has become the driver.