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Sláintecare cracks covered over by Covid starting to show through

Magahy and Keane resignations shrouded in mystery but public cares about waiting lists

Some 464 patients are waiting for access to hospital according to the daily trolley count. This is the worst figure since the Covid-19 pandemic began. Photograph: Frank Miller

If anyone still needed a reminder of the urgency for health service reform, there have been plenty in recent days.

Last week, latest figures showed over 900,000 people are on some kind of hospital waiting list, with most waiting lists getting worse rather than better.

On Monday, 464 patients were waiting for access to hospital, according to the daily trolley count by the Irish Nurses’ and Midwives’ Organisation. This is the worst daily figure since the Covid-19 pandemic began; at this rate, we’re in for yet another turbulent winter in the health service.

Four years after Sláintecare seemed to get all-party blessing as the plan that would end waiting lists and reform the health service, limited progress has been made and little consensus exists.


That has become apparent in the last week with the resignation of two key figures in the Sláintecare reform process, Laura Magahy and Prof Tom Keane.

Although accountability and transparency are supposed to be core principles of the process, we know little enough about the reasons for their resignation, with members of the Sláintecare Implementation Advisory Council effectively left in the dark about the manoeuvres in recent months at the top of the health service.

Management accountability

What the public wants to know is whether waiting lists will be eliminated, and whether those running in the health service will be made accountable for their actions.

In contrast, the main axes of difference in this latest health row seem to revolve around whether the Health Service Executive should be regionalised, and whether Sláintecare should be run out of the Department of the Taoiseach rather than the Department of Health.

Again, it is hard to see the average person caring all the much about whether the health services are delivered across six regions, as proposed, or 14 hospital and community health groups as at present – so long as there is prompt access and a good standard of care.

The irony is that now, in the fourth year of the 10-year plan, large amounts of money are finally available for reform. Or maybe that is the point, and that Sláintecare only “worked” when it was never likely to be a reality due to lack of funding. Now that more resources are there, the contradictions in the plan have become evident.

Lack of power

These include the tension between public and private medical practice; the devolution or otherwise of the provision of services; the overlap/rivalry between the HSE and the Department of Health; and the lack of real power given to the officials put in to run Sláintecare.

The Covid-19 emergency helped to paper over many of these cracks but now that the pandemic appears to be coming under control, these old problems are resurfacing.

Members of the Sláintecare Implementation Advisory Council are due to get the meeting they have sought with Stephen Donnelly on Thursday, but it is questionable whether the Minister for Health will have answers for all their questions.

A number of council members resigned over the summer over the issue of the Sláintecare draft consultant contract. Among those who remain, a number have indicated to The Irish Times they may resign if they are not fully briefed on the background to the resignation of Magahy and Keane.

With these two officials likely to be called before a Dáil committee shortly, this controversy is set to become an ongoing embarrassment for the department and wider Government.