Oireachtas health committee not able to cost proposals

Plans for universal health system must start with primary care, committee says

The Oireachtas committee planning the health service’s future has said it will not be costing its proposals, despite a requirement to do so in its terms of reference.

The committee said it will not be possible to fully cost proposed funding models “given the timeframe and available data”.

Instead, it said the Department of Health may be "mandated" to fully cost proposals, subject to agreement.

Research currently being undertaken by the Economic and Social Research Institute may also allow for some “initial indicative costings” of a transitional plan, according to an internal plan seen by The Irish Times.


The terms of reference of the committee say it should examine different funding models for the health services, make recommendations on the models best suited to Ireland and “have these models fully costed”.

The plan says legislation will be needed to ensure the Minister for Health is held to account for implementing the plan and health service staff and managers for their performance.

Entitlements for all

It says the committee agreed that access to all aspects of primary and community care, including diagnostic tests, chronic care, mental health and drugs should be entitlements for all. Care should be integrated and patient-centred and entitlements should be based on clinical need.

The work of developing a universal health system must start with primary care, according to the committee. This would include not only access to GPs and public health nurses, but also access to essential medication, aids and appliances, mental health and community and social care services.

“Having fully functioning primary care services, free at the point of delivery for all citizens, is central to enabling people to access care where they live in the community, to maintain better health, and to manage chronic disease.

“It is also key to making our health system sustainable and affordable. Citizens need to be empowered to monitor and manage their own health.”

The committee believes a “transitional fund” will be needed to enable the transfer of care from hospitals to the community and primary care over the period of the plan. Investment will also be needed in manpower so there are sufficient resources to provide a universal health system.

Easing burden

Additional funding should be directed at easing the current financial health burden on people causing “impoverishing and catastrophic” payments for essential healthcare, the report says.

The committee believes the system should be funded through general taxation or social insurance “or some combination of the two”.

The report says all services should be universal and care should be provided free at the point of delivery. Care should be provided on the basis of medical need. It says there are “substantial” amounts of unmet need that must be reduced over time.

The report also suggests a dedicated, independent office to monitor and oversee implementation of the plan.

The all-party committee, which is chaired by Social Democrat TD Róisín Shortall, received more than 150 submissions. It plans to report back within three months.

Paul Cullen

Paul Cullen

Paul Cullen is a former heath editor of The Irish Times.