Powerful people will have to ‘give away’ power for Sláintecare to proceed, Oireachtas committee hears

Progress in implementing Slaintecare has been slow, according to the academics providing technical advice to the reform programme for the health service.

“In order for Slaintecare to be delivered, the people who currently have power have to give away that power, and they’re very slow to do it,” said Prof Sarah Burke, director of the Centre for Health Policy in Trinity College Dublin.

Ireland is “decades behind” other countries in developing its public health system, with many more specialists needed, she told the Oireachtas health committee on Wednesday morning.

Delivering Slaintecare will require years more of high political priority, resource allocation and skilled leadership, as well as engagement from citizens, staff and other stakeholders, according to Prof Burke.

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It will be “very hard or indeed impossible” to realise Slaintecare with piecemeal reform, she warned. “What is needed is whole system reform and recognition that we are really only now beginning of its proper implementation.”

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Sláintecare, a 10-year reform programme for the health services, was agreed by all political parties in 2017, but its implementation has been delayed. Prof Burke defined the plan as “how to ensure that everyone in Ireland gets access to the right care, in the right place, at the right time,” underpinned by delivering “more and better” public health.

She described progress in implementing Slaintecare as a “mixed scorecard”. “Each change that happens is welcome but not enough when situated within the bigger picture of whole-system reform.”

While there are many more staff in the health system, research shows “we are still making the mistakes of the past and putting them in acute hospitals” when most are needed in the community.

Momentum was lost after resignations from the Slaintecare leadership in 2021 but built up again last year, she said.

However, a lack of clarity on roles and responsibilities raises the question as to whether the right governance architecture has ever been in place, according to Prof Burke.

“Research is also finding the regional health areas’ design is a very top-down process, not inclusive of key stakeholders such as GPs, voluntary organisations and citizens.”

There are also “persistent delays”, with the HSE yet to publish a service plan for this year and Slaintecare yet to publish an action plan, she pointed out.

However, progress has occurred through increases in budget allocations and strong ministerial support for universal healthcare.