Analysis: Is the National Health Strategy dead in the water, asks Dr Muiris Houston, Medical Correspondent
Remember the National Health Strategy, that much-anticipated document which was launched last November? Have you noticed how little we have heard about it since? It has already missed a number of its own deadlines and questions are being asked about the Government's commitment to fund the ambitious plan.
These questions become more urgent following the decision by the Minister for Finance, Mr McCreevy, to write an opinion piece recently in the Irish Medical Times. Titled: "It's Payback Time for The Health Service", he said that "as Minister for Finance, I have been concerned for some time that the output of the health service has not kept pace with the massive increase in funding delivered to the sector in recent years".
He went on to say that these rates of increase were "clearly unsustainable". Mr McCreevy made it abundantly clear that, without systems to identify the outputs and outcomes being delivered by the present level of funding "no prudent Minister for Finance can justify committing more money to health".
Strong views delivered in his usual forthright manner. And on foot of them the question must be asked: does it spell the death knell for the health strategy, given its stated need for €12.7 billion over the next 10 years? General practitioners, who, along with others in the primary care sector, have most to gain from the strategy, are deeply worried.
As of late last week, its representative group had not even been asked to nominate members to the Primary Care Task Force, which was due to begin work in January.
They are also upset about the exclusion of general practitioner manpower issues from the deliberations of the Medical Manpower Forum. This is despite figures which show that almost one in three graduates of training programmes are no longer practising five years after qualifying.
Dr Brendan O'Shea, chairman of the Communications Committee of the Irish College of General Practitioners (ICGP), told The Irish Times that "high levels of doubt about the Primary Care Health Strategy were expressed at a recent ICGP council meeting". GP leaders have three principal concerns. Can the strategy be implemented when the quality management skills needed do not appear to be in place within the health service? Are resources going to be made available by Government in the light of Minister McCreevy's statements? And given the poor record of the HSEA on the industrial relations front, with GPs having to threaten a strike before previous agreements were implemented, will future promises be delivered?
"To judge the Government and the Department of Health on the health strategy, you look at a track record of missed opportunities in the past - how much credibility can you have when looked at in this context?" Dr O'Shea asks.
But informed sources insist that money is there for the implementation of the Primary Care plan and other elements of the overall strategy. They point to the deliberately ambitious time scales outlined in the action plan, not to be absolutely met, but as a spur to ensure that individual tasks are delivered.
The Irish Times has learned that an Assistant Secretary post - with responsibility for implementing the Health Strategy - is currently vacant in the Department of Health. Although an appointment is believed to be imminent, the absence of this person has clearly not helped in meeting deadlines. Sources also say that the Treatment Purchase Fund money is guaranteed, although they acknowledge that it will be late summer before we see patients being treated abroad under the scheme. But there seems to be less certainty about the kind of multi-annual funding which the Health Strategy clearly needs if it is to build over the 10 years of its life.
However, Mr McCreevy's warnings have not been without a receptive audience in some quarters of the health service. One source said there was an acceptance that value for money would have to be determined if further funding was to emerge.
As the Deloitte and Touche Value for Money Audit of the Irish Health System suggested, there is a need to undertake wide-ranging reform of the health system in a manner which could be shown to represent value for money to the taxpayer.
Prof Tom O'Dowd, Professor of General Practice and Community Health in Trinity College Dublin, is sympathetic to the McCreevy view. "The health strategy is borrowed from the corporate world and has gone for longer-term solutions. What we need is a basic reform of the health service to see where the money is going; short-term goals must be seen and cannot be allowed to remain invisible," he says.
While value for money concerns must be listened to, it cannot be at the expense of 'burying' the National Health Strategy, which still remains the best hope for delivering decent and equitable health care to all sections of society.