Counting the cost of Sláintecare


Sir, – I welcome Prof Anthony Staines’s letter (February 19th) in response to my Opinion & Analysis piece on Slaáintecare, of February 12th.

The motivation for providing this opinion was to stimulate discussion and a greater appreciation of the proposed healthcare plan for the next 10 years in Ireland.

I strongly support the aims of Sláintecare except the proposed eradication of private patients from public hospitals. This is not for any ideological reasons but because to do so would be to undermine the other goals of Sláintecare. Apparently Prof Staines does not see the €600 million to €700 million annual income to public hospitals for the treatment of private patients as being an important issue. It is irrelevant whether this income represents 90 per cent cost and 10 per cent profit or 10 per cent cost and 90 per cent profit. What is clear is that in order to continue the healthcare service at the present level of activity this income must be replaced in order to cover the treatment of public patients replacing private patients and to cover the supplement from the private patient income to the care of public patients. The provision of this money doubles the cost as estimated in the Sláintecare report. However, as a result of this there will be no additional patients treated, and in some instances it will be the same patients who receive treatment.

To dismiss the cost of insuring “fairly good health” in our aging population as “the usual alarm” is to ignore the reality that the rapidly increasing high-maintenance older population is the fundamental cause of the spiralling healthcare expenditure by which virtually all healthcare systems are challenged, as instanced by the current funding crisis in the NHS. While Prof Staines argues that “our service is in a worse state than the NHS’, it should be noted that life expectation is slightly longer in Ireland and than in the UK and that the recently published “Concord 3”( Lancet, January 31st, 2018) report shows that Irish cancer outcomes are similar to those in the UK.

The transition from hospital to community-centred care is not merely a matter of redirecting patients. The chronic specialty care provided in hospitals cannot be reproduced in the community without considerable investment including specialty training for general practitioners. In addition there must be full development of supporting services. Ireland has a regrettable history of establishing services but without giving them adequate funding leading to the unsatisfactory provision of such services, eg surgical correction of childhood scoliosis, bariatric surgery. If the goals of Sláintecare are to be realised there must be a comprehensive cost estimate and a realistic commitment of the exchequer to sustain funding of the reformed healthcare programme. It is not enough to recognise that Sláintecare is expensive and to hope in some unspecified way that there will be “a major change in how we deliver healthcare funding”. – Yours, etc,


Dún Laoghaire,

Co Dublin.