Government’s efforts to reform the health service have largely foundered

As it enters the final months of its term in office, the Fine Gael and Labour Coalition has found itself with some good news to tout in the normally troublesome area of health.

One of the Government's promises – free GP care for the under-sixes and over-70s – has been realised, albeit at a slower pace than had been envisaged.

A planning application has been submitted for the new National Children's Hospital at the St James's Hospital campus in Dublin city centre, possibly marking the beginning of the end of a saga that has dragged on for years. The 2011 Programme for Government bluntly said "the National Children's Hospital will be built" and the Coalition can credibly claim it is following through on that promise.

Minister for Health Leo Varadkar says the hospital can be open by 2019, although this assumes everything will go to plan on a project that was first mooted in 2006.

However, does progress in areas such as free GP care and the National Children’s Hospital mask a wider lack of achievement after four and a half years in office?

Fallen short

The Coalition now finds itself in a position where it is often accused of having no

health policy

. Varadkar is described by critics as an apologetic spokesman for what can’t be achieved rather than acting like the person in Hawkins House who has the power to effect change.

Any fair assessment of the Government’s health policy must acknowledge it has fallen short on many of the promises it made when seeking office.

Like all governments, this one took office promising change, proposing to fundamentally transform the way the health service is structured and funded through the policy of Universal Health Insurance (UHI). This was (and remains) the Coalition’s key health policy and the one other goals would help achieve.

Yet UHI – which would seek to eliminate the country’s existing two-tier health system by effectively making everyone a private patient – has dogged the Coalition.

First championed by Dr James Reilly when he was Fine Gael’s opposition spokesman for health, UHI was supposed to be within touching distance by now.

The Programme for Government agreed with Labour, saying UHI would be introduced by 2016, with the "legislative and organisational groundwork for the system complete within this Government's term of office".

Labour privately attempted to undermine Reilly – who later said the plan would be fully in place by 2019 – when he attempted to sketch out the details in a White Paper. The Department of Public Expenditure and Reform also had its say, claiming the plan could threaten the financial viability of the State.

Varadkar, as part of an attempt to reduce the temperature around health, put the plan on ice when he became Minister for Health last year.

The revised introduction date of 2019 was deemed too ambitious, Varadkar said. He said he would review the scheme and his language has changed from talking about universal health insurance to universal healthcare.

Varadkar’s review found the annual cost of UHI could be between €2,000 and €3,000 to cover a standard package of benefits for one adult. The risk of UHI is that it will be a hard political sell to ask people to pay more for, in many cases, getting the same standard of care.

UHI is still Government and Fine Gael policy but the true test of whether it will survive will come when election manifestos are launched in the coming months.

Writing in The Irish Times recently, Varadkar said an additional €1 billion was needed to meet demand in the health service.

Whether the funding for future health needs comes from the Exchequer or an insurance-based system such as UHI is secondary to whether enough money is made available, and whether it is correctly spent, he added.

Starting off from a position where it spoke of radically reforming the structure and funding of the health services, Fine Gael has now effectively once more started a debate on how much money should be spent on health, and how the system should be paid for.

The debate has come back to where it started.

At this stage in the electoral cycle, the entire population was supposed to be covered by free GP care, not just the under-sixes and the over-70s, who have been catered for over the summer.

Yet free GP care is just one of a number of areas where the Coalition over-promised and under-delivered – it has now left itself open to the charge of failing in what it set out to do.

Main problems

However, it can point to the introduction of the scheme for under-sixes as evidence it is taking children’s health seriously. It has also begun to tackle childhood obesity.

The idea of a sugar tax to reduce the consumption of fizzy drinks was often floated, but was never introduced by Minister for Finance Michael Noonan. Reilly lobbied Noonan in advance of Budget 2014 for a 20 per cent tax on sugary drinks in an effort to tackle childhood obesity and its consequences for adulthood.

Successful initiatives include requiring GPs to weigh two- and five-year-old children to track the risk of obesity.

In 2013, the Department of Health and the Department of Children also launched a three-year campaign to tackle overweight in young people. The campaign, led by Safefood Ireland, aims to encourage parents to reduce children's portion sizes, cut back on treats and sugary drinks, and reduce the time children spend in front of TVs and other screens, but the concrete policy of a sugar tax has never been realised.

The main problems the Department of Health faced in recent years have, unsurprisingly, centred on spending and cuts.

Despite its best intentions and promises, the Coalition has seen its health policy dictated by the spending squeeze necessary in the bailout and its efforts at reform have largely foundered.