Sláintecare may progress at slower pace due to cost restraints

Health reform move towards free GP care for all emerging as long-term objective

Minister for Health Simon Harris:  his  memo says it is essential the phasing of implementation is correct and aligned with health policy goals. Photograph: Aidan Crawley

Minister for Health Simon Harris: his memo says it is essential the phasing of implementation is correct and aligned with health policy goals. Photograph: Aidan Crawley


Speaking last Wednesday after the meeting of the Cabinet in Co Kerry, Taoiseach Leo Varadkar struck a note of caution about the Sláintecare plan to transform the health service and warned some of its reforms would have to be put in place at a “slower pace than maybe people would like”.

He indicated that the 8.6 per cent increase in health spending already this year meant it would be harder to find resources to fund the ambitious restructuring of the health service as envisaged by the all-party Sláintecare report.

Confidential Cabinet papers prepared for the meeting confirm the proposal for free GP care for all is one of the big ticket reforms that now seem unlikely to go ahead in the manner proposed by Sláintecare and it is currently viewed by Ministers as a long-term objective.

The Sláintecare committee report proposed extending access to free GP care to the whole population over five years, with 500,000 additional people benefitting from the initiative each year.

In a memo to Cabinet – which essentially shed light on the Government’s own thinking regarding the reform of the health service – Minister for Health Simon Harris said while universal services were an important long-term goal, it was essential the phasing of implementation was right and was aligned with health policy goals.

“There are significant issues involved in simultaneously furthering the objectives of improving the range and depth of services and rapid extension in access to new groups, given financial and human resource restraints.

“A key trade-off exists between service enhancement for those currently eligible for a service and expanding access to the wider population.”

Diminution vs enhancement

Harris’s memo stated failure to get this right could see poor targeting of investment and those currently eligible actually experiencing a diminution rather than an enhancement of services.

However the memo said Harris recognised that a decisive shift to primary care – a central point of the Sláintecare reforms – was extremely difficult so long as there was universal and largely free access to hospitals but with much of the population subject to cost barriers in accessing primary care including GP services.

“It is crucial that eligibility issues do not become a barrier to the appropriate shift of activities from hospitals to the community. For this reason, the Minister intends to signal support to expand eligibility on a phased basis to move towards universal healthcare in the long term and agree that income should be the primary basis for phased extension in eligibility .”

Such a stance would appear to rule out any further expansion of free GP care on age grounds to additional cohorts of children.

Harris said he was not asking the Government to take any decision on this issue at this point and that the Department of Health would undertake further analysis.

Private patients

Harris also told Cabinet no decision was required at present on another key element of Sláintecare – the separation of private patients from public hospitals – pending the report of an expert group on this issue.

The Minister asked Cabinet to back a 104-point implementation strategy for Sláintecare to be put in place over three years. However, he said some recommendations of the all-party Sláintecare committee were not to be put in place at this time.

These included the establishment of a national health fund, which Harris said was not a priority for the initial stages of reform, but could be considered again later, as well as the introduction of a new “e health” card to provide a statutory basis for entitlements. He said this was “premature” pending further work on the best approach to extending eligibility entitlement to community services.

Harris said implementation of previous health reforms had fallen short of the level of ambition required.

He said the new Sláintecare executive director, Laura Magahy, would seek to source a range of expertise in areas such as change management, clinical leadership and communications.

As well as the planned new Sláintecare advisory group chaired by Dr Tom Keane, who oversaw the cancer care reforms several years ago, a top-level delivery board including senior civil servants in a number of Government departments will also be set up.