THERE HAS been a long-running failure within the health services to implement government policy. Political commitments to reform and specific legislative measures have crashed and burned because of opposition from vested interests.
Fundamental change is again being promoted, this time in the form of universal health insurance. Minister for Health James Reilly is in charge. It is a decade-long project, being undertaken at a time of severe financial cutbacks, and progress is slow and uncertain.
Bickering between the Government parties has not helped, with Labour Minister Róisín Shortall complaining about her senior colleague’s unilateral behaviour in the Department of Health. Dr Reilly’s willingness to cut deals with GPs and hospital consultants in order to make progress or to minimise disruption has given offence. His approach – deliver results and we will not worry about the rules – seeks to avoid interminable negotiations in a department described by Brian Cowen as “Angola” because of its multifarious landmines.
With €868 million due to be cut from health spending this year, there will inevitably be a reduction in frontline services. Dr Reilly readily admits this. But neither he nor his department will say what services are likely to be affected and to what extent. This kind of bureaucratic secrecy is not new. But it is an insult to service users; inhibits the creation of an integrated system and encourages turf wars between health professionals. The Minister’s plan to replace the Health Service Executive and its 10 directors with seven individuals responsible for the purchase and provision of services is being hailed as a step along the road towards a universal health insurance system. But the precise nature of what is intended is so opaque that Ms Shortall has called for the publication of a White Paper.
So far, there has been little evidence of public consultation or community profiling in the preparation of new service plans. Instead, the needs and demands of service providers – rather than consumers – are taking precedence. There is a sense of emergency repairs being undertaken, rather than fresh foundations being laid. All the time, behind the scenes, the struggle goes on to maintain a failed two-tier health system that practically guarantees waiting lists and has been largely controlled by hospital consultants.
At a time of falling incomes and high unemployment, medical inflation has risen and pressure is being exerted on public services. The cost of private insurance rose rapidly, becoming unaffordable for many people as the VHI responded to competition and penalised its older clients. A Government health levy was increased by 40 per cent to address this issue and to fund community rating. But long-promised risk equalisation legislation is still awaited. Community care services are under intense pressure. Public nursing homes may close and access to private facilities is uncertain. Members of the public require reassurance and a clear explanation of what, exactly, is being done on their behalf.