A threadbare health plan


So. Minister for Health James Reilly is going to announce the introduction of free GP care for children under five years of age in the autumn. And Government ministers have agreed “in principle” to do something about breaking the link between alcohol advertising and sport at around the same time. It is all a bit threadbare. Such deliberately orchestrated pre-announcements, in advance of hard decisions, are designed to create the impression of progress at a time of political drift.

The reality is that Government plans for the introduction of health service reforms and the establishment of a system of universal health insurance are running far behind schedule. Some months ago, it abandoned formal commitments to extend free GP visits to people with long-term illnesses and to those on the high-tech drugs scheme. They were to have been the introductory phases of a free GP care system for all. Now the Government is talking about starting with the under-fives and extending the service to all other age groups by 2015. But the proposal has not been discussed in detail with the Irish Medical Organisation whose members will require payment for any additional services provided.

Governments should learn from harsh experience about the inadvisability of announcing services before charges are agreed. Medical cards for the over-70’s cost the State multiples of what had been estimated, because that pre-election commitment was made in advance of negotiations. As a former negotiator with the IMO who is now under pressure from the Troika to cut health spending, Dr Reilly should be fully aware of the dangers involved. So far, negotiations concerning the phased introduction of a universal GP service have been painfully slow. But the Minister continues to insist that free care for all can be introduced within the lifetime of this Government. That is a hugely ambitious undertaking, given the current lack of progress.

Delay within the Department of Health regarding the passage of legislation has also been a matter of concern. As plans for the consolidation of public hospitals into self-governing trusts move ahead, legislative details are awaited. In the same way, there has been delay in providing information on pricing, funding and service provision under a universal health insurance scheme which is due to start in 2016.

Dr Reilly’s commitment to change the “inefficient, hospital-based model of healthcare” is commendable. But the kernel of the problem, involving an over-staffed administrative system that encourages inactivity is not being addressed. Ministers appear oblivious of the role being played by their senior officials who, as Senator John Crown pointed out, crudely ration healthcare in a perverse belief that it saves money and, as a consequence, give us such a poorly managed healthcare system.

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