GREATER CLARITY and public consultation are required in relation to Government plans for reform of health services, the eventual abolition of the Health Service Executive and the creation of a universal health insurance system. During the past 18 months, Minister for Health James Reilly has announced decisions on HSE restructuring and a reallocation of responsibilities.
But public knowledge of what is intended in relation to a chaotic and dysfunctional system remains low. At the very least, a White Paper that sets out transitional arrangements and the precise nature and financial impact of the proposed insurance system is needed.
There are signs of slippage in the Government programme. Reorganisation of the HSE and the appointment of seven directors with specific responsibility for different aspects of public healthcare have been delayed. That divesting process was intended to facilitate a smooth transition to structures under a universal health insurance system. Legislation to that effect was to have received Dáil priority in the new year but is still awaited, as is Dr Reilly’s offer of “a precise timetable for further reform”.
Eight years ago, the HSE was established in response to the excessive spending and incompetence of regional health boards. It became a catch-all, obese organisation, independent and over-staffed, presiding over a succession of health scandals. Yet, some good work was done by the HSE and important administrative changes were introduced. Now, it is being dismantled. Last autumn, community welfare services were transferred to the Department of Social Protection. Responsibility for childcare will shortly pass to a new child and family support agency.
All of that is happening against a background of reduced spending and falling staff levels. Budget cuts of €2.5 billion will have been implemented by the end of this year while staffing levels will have fallen by 8,700 since their high point in 2007. Dr Reilly acknowledges that frontline services will be reduced as a result of these economies, but he refuses to say what areas are likely to be affected. At the same time, he promises a reformed health system based on need rather than income; improved primary and a restructured hospital sector where “the money follows the patient”.
Circumstances could hardly be less favourable for this 10-year project. Demand for public health services has grown with unemployment; the number of people with private insurance has fallen as costs have risen and risk equalisation legislation remains stalled. Behind the scenes, a struggle by medical interests to retain the two-tier health system goes on. A start has been made. Free GP care is being phased in and greater emphasis has been placed on the provision of primary care and community services. Healthcare and hospital issues generate public emotion and political controversy. That is why the Government should explain precisely what it intends to do in a White Paper, while setting out the implications of change and the costs involved.