Hospitals 1970-2010

Health Act 1970

The Health Act 1970 modernised the eligibility criteria. The dispensary system was replaced by the General Medical Services system. It provided for a choice of doctor system for those eligible for free GP services. GPs are self-employed and provide services to patients either on a paid basis or under the General Medical Services medical card system.

The legislation provided new criteria in relation to eligibility. Full eligibility entitled patients to free GP hospital care and prescription medicines. Those with limited eligibility did not qualify for free GP care, paid nominal fees for hospital and specialist care, and were entitled to a refund in respect to expenditure on drugs above certain criteria.

Persons with certain illnesses were covered for costs irrespective of income. The legislation provided for the amendment of the eligibility criteria by ministerial order.

The FitzGerald Report had recommended the centralisation of hospitals into four regional hospitals, supported by 12  300 bed general hospitals. The remaining hospitals would become community hospitals and health centres. However, this was not reflected in the Health Act,1970.

Hospitals Council

Comhairle na Oispideal was established in 1971 and was responsible for public hospitals. Comhairle na nOspidéal is a statutory body established under the Health Act of 1970 to regulate the number and type of consultant posts and to advise the Minister for Health and Children on matters relating to the organisation and operation of hospital services.

The appointment of members to Comhairle na nOspidéal is a statutory function of the Minister for Health whereby “not less than half of the persons appointed shall be registered medical practitioners engaged in a public capacity in the provision of hospital services”. The current Comhairle board comprises 18 hospital consultants, three health board CEOs, two Department of Health officials, one nurse, one GP, one trade union official and one senior health manager.

1970s

Public hospitals were permitted to provide public, private and semi-private accommodation for those with limited and no eligibility in an attempt to standardise conditions for consultants in public and private hospitals.

The contribution from rates was phased out in the 1970s, and the health budget became entirely financed by the central government.

Free hospital care was extended to 83% of the population in 1979. A health levy was introduced at 4% of income.

Consultants’ contracts enabled them to charge fees for those who did not qualify. The contract agreed in 1979/80 allowed consolidated positions with a right to private practice inside and outside public hospitals. Consultants were obliged to work 32 hours a week in the public hospital system.

1980s

The 1980s was an era of cost cutting due to low growth and high public sector debt. Between 1987 and 1989, the number of hospital beds was cut by 20%. There were cuts in health service staffing, and charges were introduced for outpatient and inpatient care.

The first private hospitals were built in the 1980s.

The strain on the health system’s waiting lists incentivised many people who could afford it to take out private health insurance. By the early 1990s, one-third of the population had private health coverage, and a fifth of public beds were being used for private purposes funded principally by the insurer, the VHI.

Under the General Medical Services contract, GPs were paid a flat rate fee per year for patients.

The Commission on Health   Funding Report 1989 criticised the two-tier system and recommended a fixed contract for consultants with monitoring of consultant’s public work. It recommended the establishment of a single health service executive to replace the Health Boards.

1990s

The Health Act 1991 required that public hospitals designate a proportion of the beds to private. This was 20%.

The common waiting list proposed by the Commission was not introduced. In effect, the guarantee of private beds meant that those with insurance could obtain speedier treatment than those on public waiting lists.

A new contract was negotiated for consultants. It was contemplated that a public-only contract would be introduced, but this was removed in the late 1990s to supplement hospital income.

The First Irish Health Strategy was published in 1994 for Shaping the Health Care Future.

At the end of the 1990s, the voluntary health insurance sector was opened up to competition. Charges for private patients in public hospitals were increased.

The Eastern Regional Health Authority was established in 1999 to coordinate health and social care services in the eastern part of the country. The  voluntary hospitals were brought under State control to provide coherence in care between community and hospital service,

The cutbacks of the 1980s continued to place a strain on the hospital system. Throughout the 1990s, hospitals were at capacity and beyond.

2000s

The new health strategy Quality and Fairness A Health System for You was launched in at the end of 2001. It proposed a large expansion in bed capacity with 3,000 new beds for public patients in the next decade.

It promised waiting times would be reduced to 12 months at most for adults and six months for children. By 2004, it was proposed that no public patient would be waiting more than three months. Services for persons with disabilities, older persons and children were to be improved with commitments to additional days centre places for assessment and rehabilitation services.

In the period  1997 and 2002, healthcare expenditure doubled from €3.6 billion to €8 billion, and by 2008, it had doubled again to €16 billion annually.

The Brennan  Prospectus Report in the early years of the millennium proposed a single executive to replace the Health Boards. The Minister appoints the Board. The Board appoints Chief Executive and HSE managers in financial health and social services. Over 40 organisations were amalgamated into the HSE.. The Department of Health was to be responsible for health policy and legislation.

HSE Established

The HSE was established in 2005. The emphasis on private commercial health and social care services increased. Initiatives were taken to transfer care from hospitals to community services. A proposal for co-location of private hospitals on the grounds of public hospitals was made in 2005.

Health remained an important political issue in the 1990s and 2000s. A number of TDs were elected to the Dail on the platform of maintaining local hospital services. Each lost his or her seats in 2007. The health system seemed to be expensive while failing to deliver the requisite desired standard.

The three so-called pillars are the National Hospitals Office, the Primary Community and Continuing Care Office and the Shared Services Office. The Shared Services Office was amalgamated with the other pillars in 2007.

In 2008, a further reorganisation was planned, including the establishment of the newly integrated National Hospitals Office and the Primary and Community Care Office into a single integrated service under a national Directorate with the establishment of the regional area.

The HSE prepares its service and plans and raises them before the Minister. The Minister, in turn, laid them before the Oireachtas. The CEO is accountable to the Health Committee.

The HSE has been criticised for failing to clarify roles and responsibilities. The budget HSE budget was €14.7 billion in 2009. The HSE provides an annual 2009 expenditure of 16.3 billion.