MARTIN WALLtakes a look at the policy issues awaiting the new minister for health as he or she takes office
WHEN THE new minister for health (whoever that may be) arrives at Hawkins House tomorrow, he or she will face a range of problems that are well known and widely flagged.
The health service this year will have to be run with significantly less resources and fewer staff, emergency units continue to experience overcrowding and, at any stage, an unanticipated crisis or an industrial relations difficulty can be expected to emerge from the woodwork.
However, there are also a whole host of policy issues awaiting the minister’s attention which have not been so widely publicised, some of which could prove highly controversial in their own right.
One of the most contentious issues could be the review of eligibility entitlements in the health service, which was commissioned by the former minister Mary Harney in the wake of the controversy over the illegal nursing home charges.
Prior to the collapse of the Fianna Fáil-Green administration, a memo had been circulated to the cabinet setting out, in broad terms, new and more specific definitions of health and social services and laying down criteria for eligibility. More importantly, this memo also outlined the circumstances in which charges may be levied.
No decision was taken on this review by the outgoing government. However, controversy can be expected if the review is seen as a cover for watering down existing universal entitlements or for the introduction of new stealth charges.
With the new programme for government, agreed by Fine Gael and Labour at the weekend, setting out a commitment that the HSE will “cease to exist over time”, the new minister will also have to decide where a draft memorandum of understanding drawn up between the Department of Health and the HSE will fit into this new arrangement.
The draft memorandum, which was originally drawn up last December, aims to set out the division of roles and responsibilities between the HSE and the Department of Health. A finalisation of the draft was put off to allow the new minister to have an input into the process.
The new programme says that the VHI will remain in public ownership – a decision that will save immediately on the estimated €1 million cost of hiring outside consultants to advise on the planned sale of the company.
However, the new minister will also face a whole raft of issues relating to the private health insurance market.
On Thursday of this week, he or she will have to face a case in the European Court of Justice in which the European Commission has brought infringement proceedings arising from the fact that the VHI is currently not subject to regulation by the Central Bank.
The new minister will also have to decide whether to ask the VHI to implement the controversial recommendations of the recent Milliman report on reforming its claims costs.
The company has said that this could involve subscribers having to seek approval in advance before they undergo treatment.
The new minister will also inherit a Bill drawn up by the outgoing administration prohibiting female genital mutilation. This legislation will be enacted in the new administration.
Furthermore, the government will have to consider its attitude to alcohol as a new National Substance Misuse Strategy Steering Group is nearing completion. Its report will deal with issues such as pricing, availability, marketing and sport sponsorship.
Issues arising from the controversies surrounding long-stay and nursing home charges have not gone away and the new programme says that current policy will be reviewed to allow for the development of an equitable system of financing community and long-term care.
However, the new minister will find that a number of legal cases are currently pending. Some of these relate to the €500 million repayment scheme established by the government several years ago following the scandal over illegal charges levied on elderly patients in long-term facilities.
There is also the possibility of a new investigation by the Office of the Ombudsman.
The Office for Older People in the Department of Health has also begun work on putting in place a clear legal framework dealing with access to, provision of and charging for long-term care community facilities. This will include home help, homecare packages, day care and other services. The department hopes that a draft memo for government will be available by the summer.
Childcare and children’s rights has been a subject of much controversy over recent years and this is likely to continue. The Department of Health had planned to bring a Bill to government on a children’s rights referendum at the beginning of February and this issue is likely to re-emerge once the new administration is formed.
New emergency legislation could be required to amend section II of the Child Care Act, as the department believes that a pending Supreme Court appeal could, if successful, have implications for the HSE’s powers to undertake an investigation/assessment of alleged child abuse while a criminal trial is ongoing.