Mark Regan: 'There's huge health inequality between Northern Ireland and England'
Lisa Smyth talks to the CEO of south Belfast's Kingsbridge Private Hospital and the development director of its parent company, the 3fivetwo Group
Q. How did 3fivetwo and Kingsbridge Private Hospital start out and how has the company developed?
A. Well, 3fivetwo started out 12 years ago in its first permanent address at 352 Lisburn Road - hence the name. I still meet people who think it's because we offer healthcare 352 days a year - not sure where the other 13 days went in their assumption!
Anyhow, for the first few years the company offered predominantly antenatal or maternity packages. This was delivered with a background of NHS waiting lists in Northern Ireland being two, three and even four years in some specialities.
When the fledgling Stormont administration recognised it wasn't acceptable to have such delays within a society emerging from conflict, they invited the private, or independent sector as it's correctly termed, to help them reduce the waiting lists. They did this via open and competitive tendering, and our ability to deliver quality results meant 3fivetwo was very successful.
In parallel to the independent sector work, we recognised the need to diversify and expand the core private business, and thus in the next eight years we expanded through the acquisition and creation of numerous innovative health companies including H3, DotComDr, The Training Academy, Optique, Origin, Cosmetech and, of course, Kingsbridge, where we are now.
Kingsbridge is now four years old and continuing to expand both here in Belfast and Sligo, with both hospitals experiencing a steady and healthy growth of private patients coming through.
Q. You are a radiographer, but how did you come to work in Kingsbridge Private Hospital?
A. I qualified from the University of Ulster in the late '90s with an Honours degree in radiography, before spending several years working in various hospital X-ray departments in the HSE in the Republic of Ireland and the NHS in Northern Ireland. While I'm now working in the corporate aspect of healthcare, I still draw on that invaluable clinical experience on an almost daily basis. This has been a huge advantage for me.
I left the NHS in 2001 and joined an Italian pharmaceutical company, Bracco, where I worked for three years before moving to Philips Medical systems. In my last few months at Philips, I convinced the medical directors of Kingsbridge's parent company, 3fivetwo Healthcare, to purchase a cutting-edge CT scanner for the Lisburn Road site.
We went to see the scanner in Holland, and on the flight over, one of the 3fivetwo medical directors tried to convince me that I had a role in play in the growth plans of 3fivetwo. I met the other two directors when we returned home, and it wasn't long before I was sharing the vision they had in expanding to become the largest private healthcare group in the country. That vision is now reality eight years later.
Q. You're now the CEO of one of the biggest independent healthcare providers in Northern Ireland, which must be a very demanding role. Do you have any spare time? How is it spent?
A. I do play some golf, but I have four young children so time isn't really what I would call 'spare'. Actually one of those children, Charlotte, is part of the reason why I am so passionate about waiting lists. I understand the impact. Charlotte was born back in 2003 with Down's syndrome and Tetralogy of Fallot - a hole in her heart.
For the first year of her life, she would turn blue and pass out. The challenge was to get to her first birthday, when she could have surgery to correct this. When she was 11 months old, we saw the consultant who agreed to proceed, but the waiting time was a year. She would have been two before she got the surgery, and there were questions if she would survive.
Thankfully, I had health insurance, and Charlotte had her surgery two weeks later, leaving intensive care on her first birthday. Unfortunately, not everyone is as fortunate as me and Charlotte, hence thousands must wait, and they have my full genuine empathy.
Q. What did you want to be when you grew up? Does your current role resemble your childhood aspirations?
A. As a child I was fascinated by maps and all things geographical. In fact, when I left school I was accepted into to Queen's University to study geography. I only changed my mind the week that the course was due to start and transferred over to radiography.
Anyone who has ever been in my office will see this fascination still exists, with the numerous globes and a giant world map covering a full wall.
Other than the growing number of global locations that the 3fivetwo group now reaches - including our Telehealth partners in Philadelphia, United States - there is probably not that big of a link to those early aspirations of working in the meteorological office.
Q. The health service is currently struggling to deliver services in a timely manner, and waiting times for appointments are on the increase. Were the current problems with waiting lists inevitable? Could anything more have been done to prevent the lists growing by so much?
A. Yes, and I've said it many times before. The independent sector companies were working in partnership to manage the gap between the NHS capacity and demand. We were, in effect, an overflow valve. When that overflow capacity was removed, it didn't take a health economist to foresee the problems ahead.
That said, I understand that the NHS had little choice in the decision because the funding it used to maintain the independent sector was removed. The consequence was inevitable, but it has taken the last year for the public to see the impact and realise that waiting times of one, two or three years are now the norm.
Q. Are there any particular medical specialities you have noticed that are experiencing issues?
A. I am not privy to each NHS department's waiting lists above and beyond the publicly available reports that the Department of Health publishes quarterly, and I'd rather not speculate on where the trusts' problems lie. That would be wrong. What I can tell you is that we are seeing increasing numbers of patients with orthopaedic problems contact us about prices for surgery. In particular, some of the most common questions are around spinal surgery, pain injections, and hip and knee replacements.
Q. There have been some high-profile examples of people paying for their own treatment because they can no longer wait in pain and discomfort. Are you aware of this happening, and has Kingsbridge seen a rise in the number of people coming for treatments?
A. Yes, absolutely. The number of patients who don't have health insurance but are willing to pay cash or take out a low-interest repayment plan via Kingsbridge has increased considerably in recent months.
What is also interesting is that it's not just the more affluent people who are doing this. Patients from every walk of life are turning to us to have their treatment rather than waiting. Patients are going private - not because they want to - but because they have been forced to.
Q. A few years ago, the then head of the BMA GPs' committee in England said patients there would never accept the wait for outpatient and inpatient appointments that are commonplace here. Is it fair to say that patients in Northern Ireland are worse off compared to patients in the rest of the UK?
A. There is a serious inequality in terms of elective healthcare here in Northern Ireland versus that in England. However, we must remember how fortunate we are to have an NHS that offers life-saving emergency surgery immediately. When it comes to non-emergency or elective surgery - that is things such as hip replacements, spinal surgery, cataracts and so forth - we are way off the pace in terms of the time you wait.
Did you know that, in England, the target which is achieved in the most part is for you to have surgery within 18 weeks from the day the hospital gets your GP referral letter? In Northern Ireland, that same composite target is around 50 weeks, and we failed to meet any of the targets in the most recent Department of Health's report in relation to waiting times.
Q. The latest figures relating to waiting times for outpatient and inpatient treatment are due out soon. Do you believe they will show any improvement in the situation for patients?
A. No, absolutely not. In each of the last four quarterly reports from the Department of Health, the figures have been getting worse. There has been little or no change in the plan, and the NHS is not able to rapidly increase capacity the same way the private sector can. The problem is, the report will show numbers and graphs, not the faces of the hundreds of thousands who are affected by this. Real people.
Q. Emergency departments have also been experiencing problems meeting waiting time targets. Given the well-documented trolley waits, has there been a big demand for the minor injury clinic at Kingsbridge?
A. It's been increasing month-on-month but I think that people don't yet understand how accessible it is. For only £25, they get the initial triage - usually within two or three minutes of arriving. If they have a broken wrist or ankle, another £200 or so will see them through X-ray, pain relief and plaster casts. Of course, £200 isn't to be sneezed at, but you will be in and out within 30 to 40 minutes. You will wait many hours in the crowded public system, and as a result we are seeing normal everyday folk use the service.
(This can be) people bringing elderly relatives from nursing homes, or even just a mother who has two other young children and can see the value of being in and out of the casualty ward within a few minutes, rather than hours.
Q. Is Stormont doing enough to ensure the future of the health service in Northern Ireland? Is there anything more our politicians could do?
A. This is a difficult question to answer in a short time. Personally for me, I think Stormont has greater issues to solve than the issues of the individual departments, be that health, education or justice. Stormont is on a virtual pause - as we all know - and until it emerges from that I can't see how they can devote time or effort to any individual department's needs. In that respect, and to answer your question, yes, the system is failing health.
Q. What role can independent healthcare providers play in addressing the current waiting list crisis?
A. In 2006, the Government acknowledged that reducing waiting lists had to be a key target indicator, and to do so the NHS would have to engage the independent sector hospitals to help, given that there was no additional capacity in the NHS.
Back then, at its worst, more than 180,000 people were on waiting lists to see an NHS consultant. We have worked in partnership with the NHS over the past nine years to reduce waiting times. Last year, however, this partnership was paused as the impasse at Stormont meant funding was withdrawn.
I know that there are those with an ideological difficulty with the private sector delivering healthcare, but, if it is able to do it in a more efficient and cost-effective way, we need to give it serious consideration as a society. Not only would it bring the waiting lists under control, but it would save the public purse money.
So long as the NHS offers the service free at the point of delivery, I don't see the relevance of who delivers it.
Q. There is a perception that hospital doctors work in private hospitals to the detriment of the NHS. Is this really the case?
A. This is a frustrating claim to hear. Like any person in employment, consultants are duty-bound to work a set number of sessions or hours within their NHS contracts. I would argue that there is not a single consultant in Northern Ireland that does not work by far in excess of those contracted hours and regularly does so without any payment at all. So what they do in their free time is up to them.
If they chose to play golf, read a book or use the skills that they have to better the health of a patient in a private capacity, that is their choice alone. Juxtaposed to the conventional thinking of the question I've been asked, if they do decide to see a patient privately, that's one less patient on the NHS list, so rather than it being to the detriment of the NHS, it's actually to its benefit.
Did you know that around 10% of healthcare activity in Northern Ireland is private? Can you imagine the burden and subsequent collapse of the NHS if every one of those private patients opted to have that via the NHS instead?
Q. You have said in the past that 3fivetwo can carry out procedures and clinics for less money than the health service. Can you explain this?
A. When the NHS invites us to deliver work for them, they do so via an open and competitive tender. This means that for the majority of surgery types we offer, we must charge the NHS its own price. This is called the NHS tariff.
In effect, this is the cost the NHS claims it costs to do the surgery during a normal working day - Monday through Friday. We know that there are waiting lists and that demand is outstripping capacity, so if the NHS is full during the week, when can it operate on the waiting list patients?
Of course it's the evenings and weekends, but the NHS tariff doesn't allow for overtime payments to nurses, receptionists, radiographers, porters or surgeons, and thus the cost of tackling the waiting lists is always going to be at a premium above NHS tariff.
In Kingsbridge, however, we largely deliver the surgery at the NHS tariff 24/7. We therefore save the public the expense and also allow the NHS to deal with the complex and urgent cases that it does so well. Meanwhile, the elective surgery waiting list begins to reduce.
This is my frustration with the process and with the perception that it is expensive to use the independent sector - it simply is not.
Q. Is there anything the health service can learn from the way the independent sector is run?
A. I was asked this yesterday and gave five points.
Maintain quality, increase efficiency and reduce waste. The NHS is the largest organisation in terms of employees after Walmart and the Indian railway company. It must be run with the mindset of modern business today.
Recruit talented managers, including those with business experience, and invest heavily in them - they are the core of your organisation.
Give those mangers independence and accountability. Allow them to make decisions and avoid management by committee.
The service is an integrated team, and only when there is a symbiotic relationship between both the management and clinical staff will the efficiencies start to emerge.
Respect and reward staff. It doesn't always need to be financial. The power of a thank you can't be underestimated.