Concerns raised over private patients' continuity of care

In April, the State took over Ireland's private hospitals, in order to increase bed capacity before the predicted increase in Covid-19 cases.

Private consultants were encouraged to sign a Type A public practice only contract.

The current deal is costing an estimated €115 million per month.

Private consultants claim bed occupancy in the private hospitals has remained relatively low since the deal was brokered, with the Minister for Health disputing these claims.

According to data on 17 of Ireland's private hospitals, compiled by Dr Fergal McGoldrick of the Hermitage Clinic in Dublin, there has been less than 40% bed occupancy overall since the deal was brokered.

However, Simon Harris, the Minister for Health, said last Thursday that it was "a bit of a myth... that these [private] hospitals are empty. For example, in April 2020, the Bon Secours Hospital in Cork had 82% inpatient occupancy and now it may even be greater.

"UPMC Whitfield in Waterford has 55% occupancy, the Mater Private Hospital Cork has 57% occupancy and the Mater Private Hospital in Dublin has 60% occupancy."

Meanwhile, full-time private practice consultants say the Type A contract does not allow them to retain their existing private patients, with many refusing to sign.

The HSE has said it will use the private hospitals and the National Treatment Purchase Fund to alleviate the public waiting lists.

However, concerns have been raised that this adds private patients to the already-long public waiting lists, as well as disconnecting them from their consultants.

Dr Fergal McGoldrick, a private consultant orthopaedic surgeon who works in the Hermitage Medical Clinic, says the Department of Health seems "inflexible" when it comes to changing the contract.

"The reason why the private consultants have not signed has been clarified. It is to do with continuity of care. If you sign up, you cannot take care of your own patients."

Dr McGoldrick says it is unclear who will take over responsibility for the private patients.

"There is no plan for 2.2 million people."

"The only hope is that in a semi-urgent case, you could phone a doctor who has signed the Type A contract and ask them if they would take the patient. But this is not applicable to all patients."

Dr McGoldrick says he cannot understand why other contracts, such as Type B, C or service level agreements, were not offered.

"The state would have had to pay significantly less. It would have allowed us to continue treating our private patients independently, as well as treating public patients."

He also says the plan to carry out surgeries using the National Treatment Purchase Fund, while still paying for the use of private hospitals, is "not logical".

Firstly, he is concerned that not enough private consultants have signed the contract to allow procedures to proceed, with roughly 300 consultants still refusing to sign.

He also does not believe it represents value for money.

"Last year it was estimated that treating 25,000 patients using the National Treatment Purchase Fund would cost €75 million.

"Now, they are talking about carrying out a few thousand procedures over three months at a cost of €115 million per month. Why do a few thousand procedures at that cost?"

In terms of continuity of care, Dr McGoldrick says after the Type A contracts came about, it was up to the CEO of the private hospitals to permit private patients access, and some consultants were seeing their patients pro-bono.

This practice was temporarily halted due to issues surrounding indemnity insurance.

Previously, the State Claims Agency advised that full time private practice consultants who had not signed the Type A contract were still covered under the Clinical Indemnity Scheme, as long as they did not charge the patient, insurer, hospital or the HSE for the treatment.

However, on Sunday May 3, the State Claims Agency said they were no longer offering clinical indemnity to private consultants who have not signed the Type A contract.

Fianna Fáil TD Stephen Donnelly raised the issue, and Deputy Donnelly also said the State Claims Agency instructed that samples and specimens from biopsies should not be tested if they had been sent by private consultants who had not signed the Type A contract.

This decision was reversed on Friday May 15 after public outcry, and it means that some private consultants can still carry out pro-bono work.

However, private patients who cannot access their consultant and require urgent medical care say their only pathway is their local accident and emergency department.

A cardiac patient, who wishes to remain anonymous, has spoken to the Irish Examiner about how she struggled to get care within the private health system.

Mary, not her real name, was diagnosed with a cardiac condition on March 9. She has private health insurance and her consultant works in a private hospital.

"I was told I needed to go in on April 9 to get a test done, and possibly a cardiac procedure depending on the outcome of the test."

In the weeks leading up to the procedure, Mary became very unwell. She contacted the hospital where her consultant worked on March 30.

"They told me all procedures were going to be cancelled for private patients. I explained to my consultant's secretary that I had been unwell.

"The secretary spoke to the consultant and he said that I had to get my procedure done urgently."

Mary was told her procedure would be done on April 1.

"They said if I didn't get it done on April 1 it would probably be three to six months before I could get it done again."

Mary's procedure went ahead on April 1 but unfortunately it did not go to plan.

It resulted in me having to get emergency cardiac surgery, I had to get four procedures done in total. It was a huge shock. I had to get a pacemaker inserted.

Mary was discharged from the private hospital on April 4. However, her condition did not improve and she was extremely unwell at home.

On April 5, she went into her local public hospital through A&E, as this was the advice being given to private patients who needed urgent care.

She was kept in for a day of observation.

"They [public hospital] told me I needed to go back to the hospital that I got the procedures done in, because they couldn't help me. They didn't have the specialised doctors or equipment to look after me."

On April 6, a cardiac nurse from the private hospital Mary attended rang to see how she was doing. She told them that she had been in her local A&E.

"I was unwell all that week, and rang the [private] cardiac unit again on April 8, but they advised they couldn't see me, and to go to my own GP or to A&E."

Mary's GP was becoming increasingly concerned for her welfare and prescribed her pain medication.

"The following week, I rang the private cardiac unit again on my GP's advice, once again they said to just go to my own GP."

Things were not improving for Mary, and on April 24 her GP saw her in person for a consultation.

"She rang the cardiac unit and advised them my blood pressure was dangerously low and my heart rate was erratic and I needed an urgent review.

"They told her there was nothing they could do as they were not permitted to see private patients under the agreement. They told her I had to go to my local A&E.

"My GP explained to them there was nothing the A&E could do, they didn't have an electrophysiologist in the hospital, nor did they have the equipment to check or reset people's pacemakers."

The GP then rang Mary's private consultant's secretary, to see if she could get an appointment that way.

"They said they could now only take cases sent from public hospitals, who are public patients. But they said they would see what they could do."

That afternoon, the cardiac unit rang Mary and reiterated the same message: she could not be seen because she was a private patient.

If she was unwell, she had to go to her GP or to A&E.

On Monday 27 April, Mary rang the cardiac unit and said she was seriously unwell.

"Something had to be done, I couldn't continue on the way I was. My GP was concerned because it was cardiac, and my symptoms were getting worse.

"I told them I was being driven up to the unit and needed to be seen."

A cardiac technician saw Mary that day and they reprogrammed her pacemaker.

"But they said they shouldn't have seen me. They said their hands were completely tied."

Mary was told that if she disimproved, to ring the private cardiac unit, and they would try their best to help her.

"I rang the following week and spoke to the electrophysiologist. He said he was sorry but he couldn't see me.

"He sent out a home monitor on April 30, and I recieved it Wednesday May 6 in the post."

Mary received a letter yesterday which gave her a face-to-face appointment with her consultant for November 10.

"This will be the first time since my surgery that I will be able to see my consultant. I underwent a few cardiac procedures within 48 hours, and I have not had a follow up review in person.

"If I need to get the pacemaker adjusted I have to ring the private hospital first to see if there has been any change and if they can see me, but first stop is my GP, even though she can't do anything."

Mary says she recognises that public patients are waiting years to get treatment and she has the privilege of private health insurance, but is worried about the continuity of care for private patients.

"We are not getting the tests and treatments we need. The only pathway was my local A&E, but it wasn't the care that I needed. I am here in limbo.

"You are afraid to go to A&E because of Covid-19, and then when you do go, they don't have the care and services you need.

"There are people who are going to become seriously ill and die because of this."

When contacted for comment, the HSE said: "As discussions are ongoing in this matter it would not be appropriate for the HSE to comment at this time."