Largest health budget ever is first step to delivering Sláintecare

The Minister for Public Expenditure Michael McGrath, in announcing its largest budget ever on Tuesday, prefaced his remarks by saying that the billions in additional resources provided over recent years to the health services had failed to deal with deep-seated and systemic challenges. He maintained that a “a step-change” in approach was needed.

“We must grasp the nettle, implement Sláintecare and re-double our commitment to a publicly funded, universally accessible health service.”

It is certainly true that more money than ever before is being invested in health in the year ahead, a fact acknowledged by representative bodies on Tuesday.

However there have been several announcements of health service initiatives over recent weeks and it will probably take time to work out just how many beds and staff set out in the budget are actually new and on top of those already in place and how many are currently in existence but are to be now funded on a permanent basis.

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For example the Minister said up to 16,000 additional posts across the health sector would be provided. However the Department of Public Expenditure’s budget documentation published on Tuesday says that this 16,000 increase is based on the number of staff in place before the Covid-19 pandemic struck. The HSE said at the weekend that 5,000 additional personnel had been taken on since the start of 2020.

The budget for 2021, however, goes a fair way towards addressing criticism that the commitment of governments to the Sláintecare reforms had not been matched in significant additional funding over recent years .

The Government’s budget documentation makes clear its priorities for 2021 have been to replace, as far as possible, the lost capacity and activity due to the impact of Covid-19 while moving to the Sláintecare model of care and addressing known capacity deficits.

A total of €467 million will go towards increasing critical care, acute medical and surgical as well as sub-acute and community bed stock. And there will also be significant investment in community services, another key component of Sláintecare which in a time of a pandemic is doubly important as they can keep patients out of hospitals.

The budget also allocates €50 million to pay for new drugs to deal with various conditions including cancer which are becoming available. Last year the HSE and the pharmaceutical industry made clear that despite rising health expenditure, there was little or no additional money available in 2020 to pay for new medicines which were coming on stream.

The Minister for Health Stephen Donnelly has in recent times signalled that he wants to see progress on putting in place measures set out in various expert reports and strategies on key parts of the health services, which, in a number of cases, have effectively been lying on shelves.

Nearly €150 million is now to be designated for accelerating the implementation of cancer, maternity, trauma, gynaecology, infertility, dementia, carers and palliative care reviews and strategies , among others.

The new health budget also contains major investment to deal with waiting lists which the effects of Covid-19 have made worse.

There will be a €210 million " Access to Care Fund" to deal with the impact of reduced capacity on access to scheduled care caused by the pandemic " and to ensure the provision of complex time-dependent work such as cancer and cardiovascular care can be maintained". The budget for the National Treatment Purchase Fund, which also seeks to reduce waiting lists, is to increase by €30 million to €130 million .