There is a lot of truth in the old Irish proverb “Tús maith leath na hoibre”. When embarking on new projects, individuals and organisations invariably prioritise getting off to a good start. In that context, there are grounds for concern over the approach of the Departments of Health and the Taoiseach to the Sláintecare report on the health service.
The report – drawn up by the Oireachtas Committee on the Future of Healthcare – sets out a transformation blueprint for the troubled health system. Aiming to remove political point-scoring from the sector, it takes a 10-year view of health needs and represents a consensus on the best way forward.
Sláintecare emphasises the urgent need for reorientation so that the majority of care takes place in primary and social care settings. It faces considerable challenges: reversing the current difficulties in recruiting and retaining staff to allow for sectoral expansion; and persuading a population used to accessing most of their care in acute hospitals that a better standard of chronic illness care will be available in the community.
That the first key deadline of the report, the establishment of an Implementation Office in the Department of the Taoiseach by the end of July, has passed without apparent progress contradicts the priority given to it by Leo Varadkar. Without political resolve and determination by the Taoiseach and Minister for Health Simon Harris, the necessary reform will not be delivered.
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The central role of politics in health service provision was was cited by HSE chief Tony O’Brien when he told the MacGill summer school that the sector is still dogged by a lack of political support for difficult decisions about services in smaller hospitals. And he made a pointed reference to the political courage that was needed to successfully reform cancer care in the 2000s amid opposition to the centralisation of services.
Sláintecare is a well structured cross-party consensus designed to operate beyond a narrow electoral cycle. As such, it sets our a more credible path than the piecemeal change of the past.