State needs to invest more in primary health care, health expert urges

The Government needs to invest more money in primary and community care in order to alleviate pressure on the hospital system including both emergency departments and general wards, a leading health research expert has urged.

Dr Sara Burke, research assistant professor of health policy at Trinity College Dublin, said the reform proposed in Sláintecare involving a move towards primary and community care was the correct approach, but more funding was needed to implement the transition properly.

Dr Burke told the Dublin Economics Workshop in Wexford that while investment in the hospital sector had been reduced around 2013 due to austerity measures, it was still the case that the hospital system was receiving more funding that primary care.

“Yes, we don’t have enough consultants and specialist nurses in hospitals but in order to solve the hospital crisis we really need to front-load primary and community care to ease the pressure on hospitals and make that shift away from hospitals,” she said.

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Dr Burke, who is the principal investigator in a team of researchers at TCD examining how Sláintecare is being implemented, said that initially there had been little progress in implementing the politically-agreed reform package in 2016 and 2017 due to a number of external factors.

These included a focus by the 2016 Fine Gael-led minority government on repealing the Eighth Amendment in 2018 but somewhat ironically the advent of Covid 19 in 2020 had led to many of the proposals included in Sláintecare being introduced almost by default, she said.

Dr Burke said that in February 2020 there had been a singular focus in health on coping with Covid 19 and once it was realised that Covid 19 was not going to be a short-lived episode there had been a very fast rolling out of Covid 19 infrastructure such as PPE, test tracing and setting up of vaccination centres.

Dr Burke, the author of Irish Apartheid: Inequality in Irish Healthcare, said what was notable about the State’s response to Covid 19 was the universal way in which measures were rolled out, which was in keeping with one of the basic principles of the Sláintecare programme.

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“What we saw with the freeing up of hospitals for surge capacity was that, almost by default, you were making Sláintecare happen because you had to provide critical care in primary and community care settings,” she said.

Another notable feature was that Covid 19 had facilitated the introduction of several reforms proposed in Sláintecare such as the introduction of e-prescriptions, which health reformers had been seeking for decades without success but which were introduced within a matter of days of the pandemic.

However, since the easing of the emergency measures introduced to cope with Covid 19 and the resignation last year of Sláintecare director Laura Magahy and chairman Dr Tom Keane, the progress made towards implementing the reform measures had stalled, said Dr Burke.

“It was exactly this time last year that Laura Magahy and Tom Keane resigned and my take on their resignations would be that they didn’t feel that they had the political or institutional support to implement the reform or the possibility of reform that they were meant to deliver.

“A year ago, I was a little more optimistic that the crisis was going to be a trigger to introduce that long haul that is health reform — what our research is seeing now is the system is reverting to type, but we will keep on researching and monitoring progress on implementation in the years ahead.”