EDITORIAL: Sláintecare reforms must be prioritised

ONE of the big issues discussed at the Cabinet meeting held at University College Cork on Friday 13th last was the Sláintecare plan for health service reform, about which little or nothing was heard over the summer months since its publication on May 31st last. The good thing is that it was the product of a cross-party report by the Oireachtas Committee on the Future of Healthcare, which sets out a 10-year vision for the future of the health service that is badly needed, as the public element of it has been on a continuous loop of lurching from one crisis to the next and people are suffering as a result.

No matter how much ‘spin’ Minister for Health Simon Harris tries to put on them, the measures announced in last week’s Budget will only scratch at the surface of what needs to be done to tackle the crisis in public healthcare. Populist measures like reducing prescription charges for some people, while welcome, hardly constitute health reform.

Indeed, one wonders, had Fianna Fáil not been so insistent, under the terms of the ‘Confidence & Supply’ agreement, would as much have been allocated by the government in Budget 2018 towards the Treatment Purchase Fund to help reduce the growing waiting lists of people in need of various medical treatments. Using medical parlance, the Solidarity Party fairly accurately described it as a ‘Band-aid budget to cover gaping wounds in society.’ 

And, the biggest of these has to be the difficulties people encounter in accessing the public health care service. Only last week, Joe Duffy’s ‘Liveline’ radio programme marked the 10th anniversary of the death of Susie Long, a young mother who had to wait seven months for a colonoscopy to get a diagnosis and subsequently died of bowel cancer. 

Susie’s case caused a huge public outcry at the time with Taoiseach Bertie Ahern admitting that the system had failed her. One would have expected something to have been done to prevent this from ever happening again, however the two-tier health system still prevails and those with private health insurance still have the advantage over those depending on the public health service.

In Cork last weekend, Minister Harris announced the establishment of an independent group, chaired by Dr Donal de Buitléir, which will examine the impact of separating private practice from the public hospital system. This is something that must be made a priority as the Oireachtas Committee on the Future of Healthcare, in their report last May, leaned towards a public health service on similar lines to Britain’s National Health Service. 

The Committee concluded that our healthcare system must be re-orientated to ensure equitable access to a universal single tier system, and that the vast majority of care takes place in the primary and social care settings. The report said: ‘This shift away from the current hospital-centric model will enable our system to better respond to the challenge of chronic disease management, to provide care closer to home for patients, to deliver better value-for-money and to maintain a strong focus on health promotion and public health.’ 

Admitting that the current HSE governance structure is not fit for purpose, Minister Harris announced his attention to establish an independent board to strengthen the oversight and performance of the organisation, which he himself is quick blame when things go wrong.

The Minister also announced his intention to launch a public consultation next month on the future alignment of hospital groups and community health organisations, as recommended by the Sláintecare Report, in order to identify how best to support population-based health planning and delivery.

As part of Budget 2018, the Minister said, he had secured €1m in funding to establish a programme office to drive reforms arising from Sláintecare office and that preparations to recruit a lead executive are under way. This is important as implementation must happen at pace due to the urgency of the need for reform of the health service.

In the meantime, the government needs to look at more investment in general practice, especially in rural areas, in order to take pressure of our hospitals. This will increase again in the depths of winter, so anything that can be done in advance to alleviate it will help.