There are some potential sticking points on the Fianna Fáil/Progressive Democrats health programme for government, writes Dr Muiris Houston, Medical Correspondent
As joint authors of the recent National Health Strategy, which outlined a 10-year blueprint for the health services, you would not expect that the PDs and Fianna Fáil would have much difficulty in agreeing the health component of a programme for government.Both parties' election manifestos gave a clear commitment to implementing the "Quality and Fairness for All-Health Strategy 2001".
According to the Progressive Democrats election manifesto, "in implementing it we will place an emphasis on the following: (a) Ending waiting lists for treatment using the Treatment Purchase Fund; (b) Expanding primary care teams for more community services; (c) Extending services for people with intellectual disabilities; (d) Extending 'step-down' facilities for after hospital care of older people; (e) Using the private sector to contract for public health services".
None of these priorities should cause problems for Fianna Fáil - it has given a commitment to ending hospital waiting lists in two years; the party is fully committed to expanding primary care and developing community services for the elderly and says it will "end waiting lists for appropriate care places for people with disabilities".
Private sector involvement in the provision of public health services is a clear PD goal. If the boom years were to continue, this might be a problem for Fianna Fáil, who would be more responsive to calls for increased public funding of the hospital services. However, with hospitals and health boards already signalling budgetary difficulties, it may well suit the senior Government party to agree to private finance initiatives as a way around the drought in public finances.
The Progressive Democrats- inspired Treatment Purchase Fund - in which patients are to be treated privately in the State or sent abroad - is guaranteed €30 million this year. But the party's manifesto wants this to increase to at least €300 million over five years. Fianna Fáil might like the effect this would have in helping them to achieve their commitment to end waiting lists in two years. But how will their negotiators react when they realise money will be guaranteed for patients to be sent abroad while at the same time hospital wards are closed at home because health boards have run out of money? So the amount of money for the Treatment Purchase Fund is a likely sticking point in this week's negotiations.
Medical cards are another problem area. PD policy on medical card eligibility is based on medical need and income - in other words, no change. Fianna Fáil want to give free health care to an extra 200,000 people, with a bias towards families with children. Again, one side or the other will have to blink on this issue.
A restructuring of health agencies will also be on the agenda. The PDs will not feel as protective of health boards as Fianna Fáil might. Both sides will be conscious of the Deloitte & Touche Value for Money Report which has recommended major surgery for the health boards and other management agencies.
A likely first step will be to take the running of acute general hospitals away from health boards and give them to the new National Hospitals Agency.
This new body - promised under the National Health Strategy - will be expected to ensure that front-line services to patients reflect the increased funding which the system has already received.
Regional cancer care policy will have to be agreed. While Fianna Fáil does not go into specifics on the issue, the PDs have stated: "Regional cancer care centres will be established so that patients do not have to travel 100 miles for on-going radiotherapy."
All in all, health should not be a make or break issue for the negotiations.