Health correspondent EITHNE DONNELLANasks health spokespeople for the political parties where they stand on a number of key issues
1. How will you tackle the trolley crisis in hospital emergency departments and in what timeframe?
NIALL Ó BROLCHÁIN, GREENS: We will do this by taking pressure off emergency departments by having more people seen by GPs and primary care teams, by ensuring there are enough beds and staff to deal with the peaks in demand, and by improving administrative processes, so that people do not spend longer in hospital beds than they need to.
JAN O'SULLIVAN, LABOUR:Labour will begin from day one to implement our reform plan, which will end trolley queues by treating more people in the primary care system, allowing GPs to refer patients directly to wards, paying hospitals for the work they do rather than the current system that encourages them to do less to save money. In the first months of government, we will lift the moratorium on replacement of frontline staff where beds or operating theatres are closed because of a shortage of nurses, etc.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN:Tackling the trolley crisis would be a priority for Sinn Féin in government and, in opposition, something we would pursue vigorously with the new administration.
This requires immediate action including the reopening of some 1,500 public hospital beds currently closed through cuts, and ending the recruitment embargo.
DR JAMES REILLY, FINE GAEL:We will put in place an emergency plan to accommodate the predictable surge in activity that occurs every winter.
However, a longer term solution lies in placing more emphasis on chronic care provision in the community, allowing greater access for GPs to diagnostics such as X-ray, ultrasound and endoscopies, so that they can diagnose and treat more patients without the necessity for attending hospitals.
BARRY ANDREWS, FIANNA FÁIL:More medical assessment units will help to ease the problem. The average number of people on trolleys has decreased by half since 2005 and, last year, the number of patients seen and discharged within six hours of attending emergency departments increased by over 10 per cent.
2. Will you continue with current HSE plans to reconfigure hospital services which will see the withdrawal of some acute services from local hospitals?
NIALL Ó BROLCHÁIN, GREENS: We will need to review the reconfiguration plans.
JAN O'SULLIVAN, LABOUR PARTY:No. We will stop the process of reconfiguration for complete review because, at present, services are being taken away from smaller hospitals and patients are being forced into centralised services that haven't been given the resources to look after them. This cannot and will not continue.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN: No. We would end the over-centralisation of hospital facilities and reverse cutbacks in services at local hospitals. We would provide cancer care on a truly nationwide basis, with access to radiation oncology and other cancer services in all the regions.
DR JAMES REILLY, FINE GAEL:No. The service needs a full review so that the guiding principle of treating patients at the lowest level of complexity in a timely, safe and efficient fashion and as near to home as possible is adhered to.
BARRY ANDREWS, FIANNA FÁIL: Yes. We believe it will deliver best outcomes for patients.
3. Do you favour putting in place a system of universal health insurance cover? Over what timeframe?
NIALL Ó BROLCHÁIN, GREENS:We favour universal healthcare in the public service which is an entirely different thing to universal health insurance. Universal health insurance is effectively a new form of taxation. What we want to see is a single-tier public health system, which could be achieved within two to three years through restructuring, where people are treated equally regardless of their means or income.
JAN O'SULLIVAN, LABOUR:Yes we do. It's been Labour Party policy since 2001. We are going to begin it immediately we get into government. By the end of four years it will be in place at primary level and at the end of six years it will be fully in place throughout the acute system.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN: Sinn Féin advocates a universal, single-tier healthcare system with equal access for all based on medical need alone. This should be funded by fair and general taxation rather than health insurance. We do not favour handing over control of our health services to for-profit insurance companies. We would establish a Health Funding Commission to help plan the transition to a universal system.
DR JAMES REILLY, FINE GAEL:We will introduce universal health insurance when in government, but it will take two terms to fully bed in. This will be a radical reform and cannot be completed in full in one term.
BARRY ANDREWS, FIANNA FÁIL: No. We believe it's far too costly a model for this country at the moment given economic conditions. We favour expanding the benefits insurance companies offer to include primary care as part of the shift away from hospitals to more care in the community.
4. Will you regulate home help and other homecare services, both public and private?
NIALL Ó BROLCHÁIN, GREENS: Yes. We feel that homecare and home help are absolutely crucial and they need to be fully regulated, supported and improved.
JAN O'SULLIVAN, LABOUR: Yes, that is something that urgently needs to be done.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN:Yes, definitely. It is a scandal that this sector is not properly regulated. We should put in place regulations, on a statutory basis, for the home care sector, to empower and resource Hiqa to monitor compliance with these regulations and to establish proper qualifications, pay and conditions for homecare workers.
DR JAMES REILLY, FINE GAEL: Yes, and Hiqa will have a major role in this in terms of setting standards and ensuring that they are adhered to.
BARRY ANDREWS, FIANNA FÁIL: Yes, definitely. We are committed to legislating in this area to protect the elderly.
5. Will you rescind the decision to locate the new national children's hospital at the Mater hospital site in Dublin?
NIALL Ó BROLCHÁIN, GREENS: We need to see it happening as soon as possible but at the most effective cost and we would be prepared to look at alternative sites, but not if it's going to delay the process by five years.
JAN O'SULLIVAN, LABOUR: I don't know. if we are in government, our policy is to review the basis of the decision to locate the hospital on the mater site, but our priority is to ensure that the national children's hospital goes ahead. So we will not put the project in jeopardy, but we will make a quick decision on where is the appropriate site.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN:A ministerial-led review of the decision is now required given the concerns on location and the financial question marks over the project. This should be carried out in a short timeframe by the new minister and his or her department, not by consultancy firms.
The key concern is what is happening to Temple Street, Crumlin, and Tallaght. These hospitals need to be properly resourced and supported to continue to provide excellent hospital services for children. If the national children's hospital goes ahead on the Mater site, provision for inpatient care (overnight beds) for children at Tallaght should remain and the Crumlin Hospital site should be used for public healthcare provision.
DR JAMES REILLY, FINE GAEL:This issue has to be fully reviewed with all the facts on the table. Specifically, I am given to understand that a 440-bed hospital of this nature should cost €440 million. If it transpires that the additional cost of €200 million is due to this hospital's location, then this is not something in such a deep recession that we cannot afford to ignore. A national paediatric hospital is a priority for Fine Gael.
BARRY ANDREWS, FIANNA FÁIL: No, definitely not.
6. What proposals have you to cut waiting times for outpatient appointments?
NIALL Ó BROLCHÁIN, GREENS:There isn't an easy answer to this. The only thing I can say is the single-tier public health service will make waiting lists equitable and as efficient as possible.
JAN O'SULLIVAN, LABOUR: Under Labour's one-tier system, long waiting times will end because all consultants and all facilities, private and public, will be available for all patients.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN:This needs to be tackled as part of the fundamental reform of the health system. We must end the piggy-backing by the private healthcare sector on the public system, including consultants carrying out excess private work in breach of their contracts. We want to see all public hospital consultants working in the public hospital system only, for which they are very well paid.
DR JAMES REILLY, FINE GAEL: We are going to use a special delivery unit, made up of clinicians and managers, who will meet the clinicians and managers of hospitals and set targets which, once agreed, would be non-negotiable.
This unit will report to the minister on progress made – weekly and on a daily basis if necessary. In the North, this resulted in the clearing of a 57,000 person waiting list in an 18-month period for £36 million . Compare this with the €300 million that has been spent on the NTPF over the last three years.
BARRY ANDREWS, FIANNA FÁIL: Obviously, there are going to be waiting lists in any health system. As well as continuing with existing policies we would like to see expanded use of technology to ensure referrals are by e-mail rather than snail mail and that all patients have unique patient identifiers. If GP specialists looked after particular patient subgroups, it would free up more capacity in hospitals and that would have an impact on waiting lists.
7. Will you scrap prescription charges?
NIALL Ó BROLCHÁIN, GREENS: Yes. We have a difficulty with prescription charges because there is clear evidence that they do stop some people from getting drugs when they need them.
JAN O'SULLIVAN, LABOUR: Yes. We have a proposal to remove prescription charges and have costed the change. Their removal will be part of our proposals for universal primary care cover.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN: Definitely, yes. The burden for State savings on medicines should not fall on medical card patients. There are major savings to be made in generic prescribing, proper reviews of medication use, elimination of waste and ending the profiteering of manufacturers and distributors of drugs.
DR JAMES REILLY, FINE GAEL: Yes, as I believe the small saving made on the one hand will be lost as people are discouraged from taking their medication – thus falling ill and ending up in hospital. One night in hospital exceeds the cost of a year's medication in most cases. In the UK, where such charges apply, they do not apply to the lowest one-third of income earners – the very people who are covered by our medical card scheme.
BARRY ANDREWS, FIANNA FÁIL:No. Unfortunately they are necessary in these economic times. GMS costs have risen dramatically in recent years.
8. Will you abolish the HSE?
NIALL Ó BROLCHÁIN, GREENS: In its present form, yes. It needs to be restructured, but we can't keep tinkering with the system. There are restructuring plans in place, but they need to be followed through. Ultimately, we need a health service that works for the people of the country. At present, that is not the case.
JAN O'SULLIVAN, LABOUR:We won't abolish the HSE on coming into government. What we are going to do is devolve various functions of the HSE, for example we will give hospitals control over their own budgets.
CAOIMHGHÍN Ó CAOLÁIN, SINN FÉIN: Yes, while maintaining and strengthening our public health system. We would restore direct ministerial and departmental responsibility for health services which are funded by public money and remove the top heavy bureaucracy of the HSE, diverting the savings made to frontline care.
DR JAMES REILLY, FINE GAEL:Yes, the HSE will cease to be as we wind it down over a period of years.
We will introduce universal health insurance, so that the HSE has no further role in acute care in either hospitals or general practice. Longer term care will be taken over by a new health procurement agency.
Many of the people working in the HSE may well transfer to health insurance companies, while others will move to the new agency.
BARRY ANDREWS, FIANNA FÁIL: No. We believe the HSE is a work in progress and is entitled to a full 10 years to allow its benefits to flow.
There are some very good examples of its work but it seems afraid to sell the good things that are going on, but undoubtedly we need continuing transformation in some areas of the HSE.
I would like to see it being more answerable to the Oireachtas, for example.