Sir, – While the idea of focusing "on the prize" of universal healthcare may offer much-needed motivation to those working on it, it will be on the granular details that their real emphasis must remain if progress is to be made (Kevin Callinan, "It's time to refocus on the Sláintecare prize", Opinion & Analysis, October 18th). In discussion of Mary Harney's efforts to overhaul the system, Mr Callinan criticises her policy of "co-locating private hospitals on the grounds of public ones" as if it had made some difference to the delivery of Irish healthcare. It's worth noting that none of the proposed hospitals were ever built, despite being specifically mentioned in many consultants' contracts. The contract changes were very premature.
The reason this matters is because we seem to be about to make the same mistake again. The Minister for Health is keen to negotiate and introduce a Sláintecare contract this year. The process will probably necessitate an increase in doctors’ wages, just as Mary Harney’s initiative did. However, the most crucial tenet of delivering Sláintecare will be construction of the three hospitals it envisages in Dublin, Cork and Galway. The evidence of the children’s hospital project, and Tallaght before it, is that these ventures will take about 20 years. Putting the contract in place will make little or no difference to the service delivered in the interim. Perhaps in a similar timeframe we could produce the “world-class opportunities for . . . research” that are also referred to in the article, though how long it takes to build such an institution is hard to even speculate on. We do know, though, that our current generation of doctors are less than enthusiastic about the contract as it is proposed (“Doctors say they would emigrate rather than sign public-only contract”, News, October 12th), and are unlikely to wait around while such institutions are built.
Regarding Mr Callinan’s view that under a system of equal access to care “private insurance will be a very distant and secondary consideration”, it seems it would probably be simpler to say that such insurance would be non-existent. It’s surely impossible to envisage half the population paying for insurance to provide what is already available for free, and funded by their taxes.
An interesting assumption underlies the conclusion of Mr Callinan’s article, that healthcare would in a united Ireland be based on the Sláintecare model. He suggests that the “chaotic mix of inequality” in our system would not fit with the values of Northern Irish people, who are accustomed to the NHS. There is probably no more meaningful test of a healthcare system than life expectancy. It is a point worth considering that despite the apparent equality of the NHS, life expectancy in the UK differs far more between the highest and lowest socioeconomic groups. Social Justice Ireland describes a five-year difference between the most and least affluent men in Irish society. In the UK the relevant figure is over nine years, as reported by Iacobucci in the British Medical Journal (2019). Rather oddly then, it seems that by some measures of healthcare outcome, Ireland is already more equal than the UK, despite our present “chaotic” system. – Yours, etc,
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BRIAN O’BRIEN,
Kinsale, Co Cork.