Ditch Sláintecare if you want to hang on to the single-tier health service

Coronavirus provides opportunity to modernise Irish healthcare

Stalled construction of national children’s hospital: The outbreak of Covid-19 has highlighted many of the shortcomings in our health service. Photograph: Alan Betson

While this is a time of great difficulty for those who have lost loved ones infected by Covid-19, it is also a time when we are witnessing the very best of the Irish nation. The dedication of the medical, nursing and ancillary staff has been a revelation to all our citizens. Their commitment is exemplary, and it is wonderful to see the outpouring of appreciation from the public. It is striking what can be achieved when we work together.

For the first time in living memory, we have also witnessed the amalgamation of public and private health systems to deal with the extraordinary circumstances the country has been plunged into.

There is widespread agreement all citizens should be cared for in a similar and equitable fashion not only now but after the crisis has abated. However, the current temporary measures to unify the public and private health sectors are far from satisfactory and unsustainable going forward.

Perhaps now is the time to reconsider the concept of universal health insurance (UHI) proposed by the Fine Gael government in 2011. It proposed that following substantial healthcare reform, access would be “according to need and payment would be based on ability to pay”. Unfortunately, these plans were abandoned a few years later on cost grounds.


UHI was a State-backed scheme where all citizens have health insurance cover and contributions are made according to their means. Each individual can attend a hospital or doctor of their choice, and both the public and private facilities are covered by the scheme and available to them.

This system applies in many countries. France is a particularly good example where the public and private hospitals are equally available to patients when they become ill. It has developed an excellent healthcare system where competition between both services has led to a healthy dynamic. The same applies in Singapore which has an exemplary healthcare system and is now recognised as one of the best health services in the world.

National insurance plan

The outbreak of Covid-19 has highlighted many of the shortcomings in our health service, and herein lies two clear opportunities. First, the introduction of a national insurance plan with a one-tier level of healthcare. Second, this needs to be supported by a healthcare infrastructure and services Bill to rapidly address structural capacity and service constraints.

Sadly the ill-conceived Sláintecare report fails to address any of the current needs, realistic capital requirements or, importantly, the relationship between the public and private sectors.

The hallmark of a well-developed healthcare system is fivefold. It should be evidence-based, safe, equitable, cost-effective and timely. Unfortunately, over time our public health service has proven unable to care for patients in a timely manner, and this has resulted in 50 per cent of the population subscribing for private health insurance.

The UHI model would drive significant investment by the independent sector so that patients have both a choice of facility and medical personnel to care for them. A spirit of competition is required in all aspects of life and should also apply to healthcare.

One could ask a question: do we really need a private health sector? It is evident that no country in the western world has been able to provide a comprehensive healthcare system that meets the needs of its citizens. Most countries with nationalised health services such as the UK, France, Spain and even Singapore all have health systems supplemented by private services. In Ireland, the private hospitals play an important role, not only by providing much-needed capacity, but by continuously investing in their infrastructure and innovation. Indeed, they have provided several new services long before they were available in the public sector.

Capacity shortfall

A carefully co-ordinated healthcare infrastructure Bill could address current shortcomings. A report 10 years ago addressed the shortage of intensive care beds and advised doubling their capacity. Sadly, this did not occur and, at the onset of the current crisis, we had five fewer intensive care beds in the public system than we did back then.

Our hospitals are largely obsolete. The average age of the three Dublin maternity hospitals is 151 years. Our public teaching hospitals, with the exception of the new Mater hospital, averages 44 years. A recent report states that more than 60 per cent of hospital diagnostic equipment is “past its sell-by date”. Electronic health records and digital technology in healthcare are largely non-existent.

Regarding primary healthcare, only 150 of the 500 facilities recommended in a report 10 years ago have been provided. One in five of those that were constructed have no GP to run the centre. The provision of modern, well-equipped primary care facilities would encourage more medical graduates to specialise in general practice. In fact, an integral part of the overall planning requires a revision of the points system and greater intake of medical students in the future to adequately staff our healthcare services.

If we could provide a modern, cost-effective health service and support our dedicated medical, nursing and allied healthcare personnel, they would return to work in Ireland permanently and not just during a pandemic.

Overall, we require significant healthcare investment in this country. The private sector has been called upon to help meet demands in this unprecedented crisis and, as clearly demonstrated over time, it will not prove lacking. In the coming months, there is a unique opportunity to garner cross-party support and the goodwill of our citizens for a stimulus package to modernise our healthcare system to a standard we all deserve.

James Sheehan is a retired orthopaedic surgeon and developer of the Blackrock, Galway and Hermitage clinics