The Government is undoubtedly seeking to make inroads into the very contentious problems of waiting lists and hospital trolleys in its health budget for 2018. But critics will argue that it will make only a modest start.
The extra €471 million put aside for capital spending over the next five years sounds impressive, but the Department of Health argued just a few weeks ago that it needed an extra €2 billion. The money given will allow all contracts in train to continue, including the new national children's hospital, the most expensive single building project ever undertaken by the State. More will be needed, however, if the ambitions contained in the Government's 10-year capital programme, scheduled to be ready by Christmas, are to be realised.
The Government is to spend €55 million next year so more patients on waiting lists can have their procedures or surgery provided by the National Treatment Purchase Fund. A further €37 million will be used to tackle delayed hospital discharges, which contribute significantly to the trolley crisis in emergency departments by tying up beds.
Minister for Health Simon Harris, already bitten badly on the issue last winter, said on Tuesday he would not set new targets for waiting lists this year, lest it provoke another round of bad headlines. He also said he did not want a repeat of such investments producing only short-term results, with lists spiking again shortly afterwards.
Ministers will discuss an update on the Sláintecare reform programme next Friday. Yesterday’s budget illustrated movement on some of its objectives, such as reducing prescription charges and lowering drug-payment thresholds. But there will be little sign in 2018 of the €3 billion needed to move as much medical care as possible from hospitals to the community, which ministers for health have talked about for nearly 30 years.
Such a shift would require a whole new contract to be negotiated with family doctors, but the budget provides just €25 million to move towards a primary-care-focused health system. The Irish Medical Organisation said this was "so woefully inadequate as to make it impossible for any significant development in terms of a new GP contract or new services for patients".
The National Association of General Practitioners said it was now considering industrial action – a move the Minister suggested could cause problems for it with the Competition and Consumer Protection Commission.
Harris indicated he would go back to the Government for more money if progress were made in talks with doctors, pointing to comments by the Minster for Finance that he wants a long-term deal with GPs. Harris again signalled that although doctors had their own objectives in the talks, the Government priority was extending free GP care to more children.
Negotiations with the IMO have been under way since February on a new contract; they have reportedly made significant progress in identifying and detailing general-practice priorities. These talks were expected to move on to the issue of resourcing new services in the weeks ahead. In the light of the budget allocation the IMO has sought urgent clarifications on this question, and a meeting is likely to be held next week. It remains to be seen, therefore, how much more progress will be made.