Sláintecare: ‘Single-tier’ health sector plan will face resistance

The Sláintecare plan is the third radical blueprint for overhauling the country’s health service in roughly a decade.

In Mary Harney's period as minister for health there was the co-location initiative under which private facilities were to be developed adjacent to public hospitals while under James Reilly there was universal health insurance, which in essence was to see everyone becoming a private patient.

Despite years of preparatory work on both plans, they eventually fell out of favour without being implemented.

The Sláintecare report emerged earlier this year on foot of the work of an all-party committee chaired by Róisín Shortall of the Social Democrats. Unlike the previous plans, it has backing across the Dáil.

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However it still faces significant challenges from financial, administrative, staff retention and industrial relations perspectives.

Sláintecare proposes the introduction over time of free GP and hospital care. There would also be reductions in prescription charges, and to the amounts people had to pay themselves for drugs and medicines. In addition the plan envisages universal palliative care being put in place along with improved dental services and greater access to homecare services.

But at its core Sláintecare would eliminate private medical practice in public hospitals, creating a single-tier system.

However the plan would not be cheap to implement.

The ten -year programme of reforms would cost €2.8billion, as it moved the focus away from hospitals towards primary care and social care.

The plan also envisaged the Government providing a once-off “transitional” investment of about €3 billion to pay for necessary capital investment.

‘Seed funding’

In the budget last Tuesday the Government provided limited “seed funding” for Sláintecare such as for the establishment of a programme office.

The Opposition strongly criticised what was described as a lack of real funding for the initiative.

Last weekend the Irish Hospital Consultants Association (IHCA) also raised serious concerns.

It pointed to the €600 million which is generated for public hospitals annually by private patients and it expressed scepticism that the Government would ever provide sufficient funding to compensate for the loss of this income.

Hospitals under Sláintecare would become impoverished, the IHCA contended, while it also argued that the elimination of private medicine from public hospitals would exacerbate the recruitment and retention crisis problems in the health service.

Consultants are not completely impartial observers in the debate over Sláintecare. The elimination of private medicine from public hospitals would inevitably see some doctors lose out on large amounts of money.

However the warning of potential exodus of doctors to other better-paying English-speaking countries has to be taken seriously given the vacancies and unfilled posts that have arisen on foot of previous cuts to medical earnings.

The question of compensation for consultants for loss of contractual private practise rights would also have to be factored into any overall costing for the new initiative.

Impact assessment

The work of the new group to assess the impact of the elimination of private care will be hugely important for the future of Sláintecare given that Minister for Health Simon Harris last weekend said he would be guided by its findings.

On Friday, Ms Shortall said any group set up to examine the impact of separating private practice from the public hospital system must be fully independent and free from conflicts of interest.

Separately the Government decision on Friday to re-establish a board to oversee the HSE may be seen as an acknowledgement that an error was made in 2011 when a previous governance structure was abolished.

At present the HSE is run by a directorship of senior management who report to the Minister without any outside oversight.

Nearly a decade and a half after the abolition of the health boards, the preparations are being made for another major structural change in health service delivery. However how long this takes to put in place and whether it will prove to be more successful than its predecessors remains to be seen.