Healthcare plan faces significant hurdles

As anyone bundling their family into a car for a summer holiday will understand, it’s all well and good knowing where you are going, but getting there can be more difficult than expected.

Healthcare plan faces significant hurdles

As anyone bundling their family into a car for a summer holiday will understand, it’s all well and good knowing where you are going, but getting there can be more difficult than expected.

On Wednesday, Health Minister, Simon Harris, published the Government’s long-awaited roadmap for the Sláintecare report on how to finally fix the health service.

The 10-year plan — green-lit 15 months after the document was first launched — has outlined a series of wide-ranging changes to the creaking system.

However, knowing the destination is only half the problem, with the minister facing five crucial, political health hurdles over the coming months, before the reforms can even get out of first gear.

Divisive contract negotiations

The lofty goal of a single-tier, public-only, free-at-the-point-of-entry health service might sound perfect for patients, but try telling that to doctors, who risk losing out on considerable amounts of money.

In order for the central point of the Sláintecare reforms to become a reality, Mr Harris and his officials will have to negotiate with both GPs and consultants. And, as his predecessors, Mary Harney, James Reilly, and Leo Varadkar will testify, that is not an easy task.

First up will be the continuation of talks on the new GP contract, with the aim of extending the existing policy of free GP access for all children under the age of six, with GPs unlikely to let their patient fees be cut without substantial State benefits in return.

A similar stand-off is also coming into view in hospitals, with Mr Harris conceding, at Wednesday’s launch, when asked by the Irish Examiner, that consultants may have to be compensated financially, if they are blocked from treating private patients.

Bigger bills for 200,000 private patients

The admirable aim, of an entirely free public health service, also causes a second political problem for Mr Harris, as existing private patients could be forced to pay more over the coming years, before the changes are introduced.

The Health Insurance Authority has warned that 200,000 people who have health insurance plans could see their bills rise by up to €300 over the next decade, while Sláintecare is being introduced, due to a “structural decline” in the private system.

Mr Harris will no doubt argue that it is a necessary bump in the road towards a better health service. He’s right.

But politicians’ bread and butter is the here-and-now, not the far-distant tomorrow, and asking hard-pressed voters to pay hundreds of euro more for healthcare is never the easiest sell.

Record waiting lists and trolley counts

Speaking of the here-and-now, while talking up the future is worthwhile, Mr Harris will need to ensure he doesn’t take his eye off the present, if he wants to still be in the driving seat when the benefits of Sláintecare appear.

This week alone, the health service has again been in the news for all the wrong reasons, with Wednesday’s launch coming on the same day as it emerged that almost one million people are on waiting lists, even as 520 people were on hospital trolleys.

While health service crisis fatigue is a well-documented plague in this country, the figures are shocking and demand real investment and emergency action.

And although Mr Harris, and other government officials, are right to say the scandals show the need for reform, unless long-overdue progress is made quickly, they could ultimately undermine any public confidence in the Sláintecare plan.

Show me the money

A major stumbling block in Wednesday’s Sláintecare plan was obvious: money, or the lack of any.

Despite talking up a series of sweeping healthcare reforms, Mr Harris pointedly declined to explain how much the Sláintecare plan would cost and where the money would come from.

He may be playing his cards close to his chest, due to necessary negotiations with companies, medics and — dare we say it — cabinet ‘colleagues’, but the issue has already become a genuine bone of contention.

A transitional fund, likely to cost €3bn, is due to be put in place over the next 12 months, while Sláintecare is ultimately expected to cost an extra €2.6bn a year, when it finally becomes a reality, in 2028.

But it is still unclear where the money will come from, with the Department of Finance pointedly saying, earlier this year, that the existing health budget will have to pay — a comment that sounds suspiciously like service cutbacks now for reforming funding in the future.

Staffing levels

If the ambitious Sláintecare reforms are to have any chance of getting off the ground, the health service will need to retain and increase staff numbers.

And that is far easier said than done.

The Public Service Pay Commission is due to report to Mr Harris, later this month, on ways to help existing doctors and nurses to stay in the system, instead of leaving for more prosperous alternatives abroad.

Similarly, Sláintecare has made it a priority to increase Ireland’s consultant numbers by at least 600 over the next decade — a figure that was replaced by a more general commitment in the implementation plan itself.

The issue is already firmly on Mr Harris’ radar, and it would be wrong to say the Government is doing nothing to address it.

But it shouldn’t be lost on anyone that while a shiny, happy, full-reformed health service is a wonderful aim, all this will be pointless if we have no-one to run it.

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