Government implements 16 of 58 health commitments

Barely one in four of the Government’s ambitious promises in health have been fully implemented since 2011, an analysis of the programme for Government reveals.

Six pages of the document agreed by Fine Gael and Labour before going into Coalition were devoted to health and mental health and approximately 58 separate commitments were made. The exact number of commitments in the document is subject to slight variation because of repetition.

Of these, just 16 – or 28 per cent – have been fully implemented, a line-by-line assessment of the programme by The Irish Times shows.

Half have not been implemented and the remaining 13 – or 22 per cent – have been partially implemented. With months left in the lifetime of the Government, the level of implementation of commitments is unlikely to change much before the next election.

Failed to deliver

The Government has completely failed to deliver on some of its biggest commitments, most notably the introduction of Universal Health Insurance (UHI) and the introduction of a single-tier health service to replace the current public/private mix.

The preamble to the health section of the programme promised, under the title “fairness”, to develop a “universal, single-tier health service, which guarantees access to medical care based on need, not income”.

The document went on to promise universal health insurance, universal primary care and universal hospital care. It envisaged the introduction of UHI by 2016, with the legislative and organisational groundwork completed during the Government’s current term of office.

However, the plan for UHI was widely criticised on grounds of cost and has been long-fingered since Leo Varadkar was appointed Minister for Health last year. None of the required legislation or organisation structures are in place and there is no prospect of its introduction next year.

Far from removing inequities in the system, Mr Varadkar ended up being accused of touting for business for insurers earlier this year by encouraging people to take out cover in to inject life into a moribund private health insurance sector.

The single biggest capital plan on the Government’s wish list, the construction of a new national children’s hospital, will not be realised. Originally envisaged to open its doors in time for the 100th anniversary of the Easter Rising in 2016, it is unlikely to be completed before 2020.

Planning permission

The main reason for this delay was An Bord Pleanála’s refusal of planning permission for the Mater site, but further time and money was lost by indecision and fumbling on the project during the Government’s term.

Major planks of the Government's reform programme for health, such as the abolition of the Health Service Executive, have also not been implemented. Although the vote has been returned to the Minister for Health, the HSE lives on.

Among the bodies promised which have never seen the light of day are the Patient Safety Authority, an Integrated Care Agency and the independent trusts which were supposed to take over the running of hospitals. Chairpersons and a few staff each have been appointed to hospital boards but by and large they have no boards, no legal status and as yet few real functions.

Their coexistence with the HSE makes for a confused organisational structure, not helped by the wider staffing crisis across many senior health posts.

Perhaps the biggest promise that has been implemented relates to the commitment to address the issues raised by a European Court of Human Rights judgment on the X case. This eventually resulted in changes to abortion law in the Protection of Life During Pregnancy Act 2013.

However, promised legislation on assisted human reproduction, stem cell research, post mortem procedures, organ retention practices and organ donations has not materialised.

Promises which have been kept include cuts in drug costs, the provision of a new cystic fibrosis unit, the introduction of risk equalisation in the health insurance market and the retention of the VHI in public ownership, and the abandonment of the previous government’s policy of co-locating private hospitals on public hospital lands.

Waiting lists

It is a case of “one step forward, one step backward” with some of the commitments made in 2011. As promised, a special delivery unit was established in the HSE to drive waiting lists down. It worked as long as the funding lasted, after which the waiting lists shot up again.

Similarly, commitments to cut doctors’ pay were fulfilled – with disastrous effect. These have been partially reversed after massive gaps in the supply of qualified consultants and GPs were identified.

The Government originally planned to extend free GP care on a phased basis on the basis of illness groups, and the programme for Government set out a specific timetable for implementation of this. But the plan proved legally fraught and successive deadlines were missed.

Despite opposition from GPs, Mr Varadkar succeeded in introducing free GP care for under-6s this year and plans to extend the service to older children at some time in the future. The wealthiest 10 per cent of over-70s who didn’t already hold a medical card were also provided with free GP care.