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Reports promising to fix the health service come along almost as often as crises in our hospitals, and get about the same amount of meaningful attention. By one estimate, upwards of 40 reviews, plans and programmes are gathering dust in the Department of Health after being published in recent years and promptly forgotten.
The 185-page report by the Oireachtas Committee on the Future of Healthcare is the latest effort to address the scandal of long waiting lists, high trolley numbers and a generally dysfunctional system. Members of the committee deserve credit for the huge work put into the document over 11 months, time that could more profitably have been spent, arguably, minding votes in their constituencies.
There is widespread recognition that the health system needs urgent reform rather than being tinkered with
The report is detailed and coherent, and benefits from the academic expertise provided by researchers at Trinity College Dublin. Ultimately, though, the only things that matter about this report are: will it be implemented and can it work?
The fact its findings are supported by a cross-party consensus (bar Solidarity TD Mick Barry) should help. There is also widespread recognition that the health system needs urgent reform rather than being tinkered with, and also that things will get much worse if nothing is done. Given the ageing of our population, the decrepit state of infrastructure such as ambulances and IT and the growth in demand, the system is heading for collapse unless urgent action is taken.
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The attraction of shorter waiting lists and lower charges, as proposed by the committee, is more than superficial for the hundreds of thousands of people living lives of misery due to logjams in the system. Whether they are prepared to pay more in taxes to fund the nirvana of universal healthcare is another matter.
Lack of costings
The report falls down in its failure to cost its proposals in any detail. Extra spending of almost €6 billion is proposed – more than €500 million a year – but the committee was unable to agree where this money would come from. With an election possibly only around the corner, no politician wants to go on the canvass with the millstone of impending tax increases around her neck, cross-party consensus or not. Better to push that task on to some future minister for health and government.
The likelihood of this report being implemented depends greatly on the co-operation of so-called vested interests – shorthand for the doctors and nurses who work in our hospitals, as well as the various insurers, nursing-home owners and so on who make their living in the sector.
The initial reaction from these groups has been tepid. One would think a report promising a massive injection of funding into the health system might be welcomed by that same system, but many key organisations were unenthusiastic, even hostile.
The Irish Hospital Consultants Association, breaking quickly from the traps to signal its opposition, warned of the risk of "catastrophic failure" if the loss of private income to public hospitals is not replaced. The Irish Medical Organisation claimed free GP care was not achievable – notwithstanding the promise of extra funding and the fact that a GP, Michael Harty TD, drew up the proposals as a member of the committee. The Irish Pharmacy Union said the report was "lacking in substance".
It seems to be lost on these representative groups that the report is exceedingly kind to them. There is little in the recommendations about streamlining services or saving money on the millions paid out each year in professional fees and drug costs. While proposing to remove private medicine from public hospitals, the report proposes even greater reliance on private practitioners – GPs, pharmacists, dentists and so on – in the delivery of an expanded primary care system. There is talk of extra pay for consultants to compensate for the loss of private work, and incentivised packages to help recruit and retain qualified staff.
Doctors and nurses
Lest we forget, Irish spending on health is among the highest in the OECD and our nurse numbers are high (although doctor numbers are low by international standards). As the report correctly identifies, we need to focus more on providing health services in the community than on building bigger hospitals; the report should not be judged on its failure to say how many new beds are needed.
The British national health service was not created incrementally, or by pussyfooting around a status quo
One would like to think this report will succeed where others have not. Even if the required funding comes through, the response from the vested interests does not augur well. Without the support of Irish healthcare professionals – those currently in the system, and those in training or abroad – this plan doesn’t stand a chance.
As the committee learned from expert witnesses, the British national health service was not created incrementally, or by pussyfooting around a status quo. A similar "big bang" approach might eventually be needed in Ireland if the dream of a single-tier health system is ever to become a reality.
- Paul Cullen is Health Correspondent