Unions seek development of single-tier, publicly-run health service

Ireland should move towards developing over time a universal single- tier publicly-funded and publicly-run health service, the trade union movement has proposed.

In a submission to the new Oireachtas committee on the future of healthcare, the Irish Congress of Trade Unions (Ictu) called for the elimination of all forms of State subsidies for private healthcare provision.

It also urged that in future all healthcare staff should work exclusively for the public health system.

Congress said there should be a major increase in the amount of money allocated to the health service. It said health should be given a dedicated budget equivalent of a minimum of 10 per cent of GDP.

It also said in addition further capital funding must be allocated to pay for necessary infrastructure.

At present, the health service receives about €14 billion in State funding. The Ictu proposals could see this increase to about €25 billion.

The union movement said the public health service should be funded through a progressive general taxation system.

Ictu said that a cornerstone of its proposed health service reform programme should be “a declaration that the State will, over time, cease to fund or to subvent any form of private healthcare provision”.

“This will entail the phased elimination of all tax reliefs for private healthcare insurance and direct subventions, ie to existing private nursing homes,” it added.

“This funding should be redirected to specific programmes required for, or linked to, the implementation of the reform programme for the creation of a single-tier service.”

However the doctors' trade union, the Irish Medical Organisation, which is an affiliate of Congress, produced its own submission which disagreed in part with the Ictu proposals.

It said GP care was the cornerstone of any universal healthcare system and urged the retention of the current model of GPs being independent contractors. It also called for incentives to be provided for the development of infrastructure including premises, medical equipment, diagnostic and IT equipment.

It said access to GP care should be expanded on a phased basis taking into account income and medical need .

The Irish Medical Organisation also said waiting lists for specialist outpatient appointments and elective procedures would only be reduced following the introduction of a fully-resourced consultant delivered healthcare service. It said this would involve recruiting more than 1,657 consultants across all specialties. It also said that Ireland needed an additional 3,500 inpatient hospital beds to bring us up to the West European average.

Ictu acknowledged it could take more than a decade to plan and implement such radical changes to the health service. However it argued that it was imperative that over time “the existing two-tier health system - with contradictory incentives and ability to pay guaranteeing faster access to diagnostics and interventions -- was replaced by a single- tier, equitable and quality service”.

Ictu said an essential component of a single-tier public health service would be that all staff had to be directly employed.

Consultation

However, it said there would have to be widespread consultation on changes to employment contracts and many staff would be permitted to retain existing arrangements on a “red circled” or individualised basis.

“A network of primary care centres will act as the first point of contact for many accessing the health service, with the centres providing a range of key services and leading local health promotion campaigns. Service provision in the public hospital network will be refocused to reflect this change, but the network

will continue as the cornerstone of the health care system.”

Ictu said that primary care services must be provided by directly -employed health professionals.

It said staffing in primary care centres should be on the basis of the services operating every day of the week. It said such centres should offer sufficient diagnostic and support services to ensure that patients could access services at the most appropriate location and thus reducing the burden on acute hospitals.

It said the development of community-based health facilities was critical to the creation of a universal, single tier public health service.

It said there should be a significant increase in the number of public hospital beds as well as a major rise in the number of consultant posts in core specialities such as medicine, surgery, paediatrics, obstetrics and emergency medicine.

Ictu said at the heart of a transformed health service would be a consultant-delivered, team- based approach to patient care with all staff carrying out tasks appropriate to their qualifications.

It said the biggest challenge to the country’s health service was the increase in the number of older people living longer.

It said this would require the State to become “the principal provider of health care for older people”.

It said this would involve significant State investment in the development of facilities that would provide single room accommodation in residential settings.