Perhaps there would be less skepticism about #Sláintecare if we had a good plan for the current ‘private’ infrastructure, which is much bigger than just a few private hospitals, and more complex than is appreciated. Also, it serves a lot of patients. So here’s a plan...1

The ‘private’ infrastructure includes private hospitals, including two that are co-located with big public hospitals. It also includes consultants offices or ‘rooms’, which can be off-site or located within the campus of a public hospital or a private hospital...2

Those private offices or ‘rooms’ have clinical rooms, waiting rooms, consultation rooms, reception staff, nurses, midwives, sonographers, etc. For #Slaintecare to work, much of that infrastructure will have to be integrated into the public system early on. 3.

That can be done on a fee-per-item basis, available to all patients and not just insured patients. An amalgamated Vhi and the National Treatment Purchase Fund (NTPF) could negotiate the fees on behalf of Sláintecare. Both have the necessary experience and knowledge. 4.

The consultants who do ‘private’ work in public hospitals do it on a fee-per-item basis, outside their salary. They couldn’t care less if the fee-per-item payment is from a private insurer or from Sláintecare. That resource (their hours of ‘private’ work) can be acquired by...5.

Slaintecare in the same fee-per-item basis and used to facilitate 7-day hospital operation. Some will want to work more, others will want fewer hours. This will give great flexibility. A variety of contracts can be offered. But all patients would have the same access...6.

Which leaves the question of what to do about (1) private hospitals (2) the private for-profit insurers and (3) the extra money that wealthier citizens contribute to paying for care in the form of private health insurance, which will have to find its way into State coffers. 7.

(1) The simplest thing is to nationalise some private hospitals to add necessary plant to the State’s infrastructure, starting with the obvious two that are co-located - Mater Private and St Vincent’s Private. Otherwise, you have a messy situation that’s fully fee-per-item. 8.

(2) In the bold new Slaintecare world, the for-profits insurers will have no role. They play an entirely middle-man role (they are classic ‘entrepreneurs’) and add nothing to the system. They will have to close up shop. 9.

(3) The revenue in the private insurance system will be the most contentious and will need great political courage @SimonHarrisTD. That revenue has to be turned into tax and the people who having being paying it will have to pay it as tax instead. Feathers/hissing. 10.

Those people will not have the same fast-track to care that they have now. They won’t be happy. So #Slaintecare will have to improve access to good care rapidly, as well as equalising it. Needs cross-party support. #SocialSolidarity @labour. End.