Election 2020: How are parties going to implement Sláintecare?

Sláintecare’s greatest strength is that it was devised by an all-party Oireachtas Committee with a specific remit to reach political agreement on a 10-year plan to reform the health service. This strength is also its weakness, making it extremely difficult for the political parties’ to carve out their health pitch in this election.

How do the political manifestos compare to the 2017 Sláintecare report they signed up to? The terms of reference of the Oireachtas Future of Healthcare Committee specified “the need to establish a universal single-tier service where patients are treated on the basis of health need rather than on ability to pay”. Election 2020 is a first in Irish history where all politicians of every political hue agree on the future direction of healthcare, the first time all parties commit to universal healthcare.

The Social Democrats’ manifesto is truest to the 2017 Oireachtas committee’s roadmap, although lacking detail. Their endorsement is not surprising given that Róisín Shortall initiated the cross-party motion that established the Future Healthcare Committee and she ably chaired the committee that secured consensus on Sláintecare. The Social Democrats’ position is that Sláintecare’s “fully funded implementation” is “an absolute red line” for any potential coalition negotiations.

Fine Gael’s manifesto also commits to implementing Sláintecare and “making a long-term financial commitment to deliver it”, a late but significant acknowledgment that substantial additional resources are needed to make Sláintecare happen. Their current stance prompts the question: what were Fine Gael doing since Sláintecare’s publication in May 2017? The answer may be that it took Simon Harris until his first winter as Minister for Health to realise that Sláintecare was the solution to the perennial challenges facing health. It then took the Department of Health time to embrace Sláintecare. Only in the second half of 2018 was momentum gathered with government signing up to Sláintecare as official policy, the establishment of the Sláintecare implementation office and the appointment of Laura Magahy as its director. Much of the last 18 months since then have been spent laying the foundations required to deliver the complex, whole-scale reform that is Sláintecare.

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Credibility gap

Yet Fine Gael’s previous failure to realise its promise of universal health insurance still haunts it, as do more recent failures to deliver policy commitments made in areas such as maternity care and neuro-rehabilitation services. Having former minister for health James Reilly trying to win back his North Dublin Dáil seat by championing a new private hospital in Swords, which is totally contrary to the essence of Sláintecare, does not help. While Simon Harris’s commitment to Sláintecare is manifest, Fine Gael need their party, leader and Minister for Finance wholly behind it to close their credibility gap in health.

All the parties pledge to reduce waiting times. And most of them pay heed to the system-wide responses detailed in Sláintecare which can remedy poor access. Key to this is more investment in staff and resources in the public health system; reorienting the system to provide much more care outside of hospitals; better prevention and management of chronic diseases; access to diagnostics, primary and social care , with low or no charges; and introducing accountability and better governance into the health system.

Fianna Fáil breaks from the mode on waiting lists by committing to double the money spent on the National Treatment Purchase (NTPF) from €100 million to €200 million. During this election, Fianna Fáil claims they invented the NTPF, they didn’t. The PDs did. Fianna Fáil says Sláintecare states that investment in private hospitals is part of the Sláintecare plan – it doesn’t. The Sláintecare report outlines international evidence on reducing waiting times including contracting care to the private sector but Sláintecare does not recommend it as a strategy, recognising that it does not address the causes of the long waits in the public system in the first place. It’s 18 years since the NTPF’s establishment (nine years each of Fianna Fáil and Fine Gael-led governments) yet waiting lists are close to their highest-ever levels.

Short on detail

Prior to Sláintecare, Sinn Féin was the only political party with a detailed, costed plan to deliver universal healthcare. Their 2020 manifesto fully endorses Sláintecare, going a bit further on some matters, pitching it as a platform for an all-island national health system. Both the Labour Party and the Greens’ manifestos also endorse Sláintecare, yet they are equally short on detail.

Many of the parties claim to cost their health proposals, some do cost some of them, but none of them give details that allow proper scrutiny of their figures.

Interestingly, only the Fine Gael and Labour manifestos explicitly commit to De Buitleir Review Group’s recommendations to introduce public-only consultants, with just Fine Gael putting a timeline on it. At Fianna Fáil’s health launch, Stephen Donnelly eventually pledged that Fianna Fáil would take private care out of public hospitals and its manifesto commits to a new consultant contract. The overall endorsement of Sláintecare by Sinn Féin, Labour, the Greens and Social Democrats assumes that they too sign up to this commitment.

Over the last few decades, Ireland has experienced a myriad of botched attempts at health reform. But none of these took a whole systems approach, none of them had adequate political support or were given the time or resources needed to implement change.

In this respect, Sláintecare has the potential to be a game changer. Election 2020 is the first really big political test for Sláintecare. The make-up of the next government will be decisive in determining whether the Sláintecare consensus will hold. And whether our political leaders will demonstrate the courage required to resource and implement the systemic change that is Sláintecare and finally be in a position to provide equitable access to quality healthcare for people in Ireland.

Sara Burke is a research assistant professor in the Centre for Health Policy and Management, Trinity College Dublin. She co-ordinated a research team which provided technical support for the Oireachtas Committee which produced the 2017 Sláintecare report