Sláintecare – a solid foundation


Sir, – Prof T Joseph McKenna, a physician for whom I have the highest regard, argues that Sláintecare is neither affordable, feasible, nor fit for purpose (“Sláintecare is built on shaky financial foundations”, Opinion & Analysis, February 12th). I respectfully disagree.

He puts forward the €600 million to €700 million, now paid for the care of private patients in public hospitals, as a necessary supplement to public funding. Unfortunately, in the absence of reliable data on hospital costs, it is unclear if hospitals actually make any money on this work, but the cost to the economy is evident, both the opportunity costs of providing unnecessary services, and the burden on those queuing for care in the public system.

He notes our ageing population, and expresses the usual alarm at the burden this will place on our services, although that this “burden”, of people living in fairly good health, for longer, is well understood, can be quantified, and has been met, quite easily, by most other EU health services.

He compares our services to the current crisis in the NHS. I do not argue that the NHS is perfect, far from it, but it has provided ready access to affordable care for most people, something our services have yet to achieve. Its current crisis results from a failure to provide reasonable funding. I would argue that our service is in a worse state than the NHS. The most distinctive features of our service are that it is costly, hospital centred, has long queues for services, and does not provide for universal access to primary care. Irish patients face exceptionally high out-of-pocket costs, as well as high insurance costs. Our use of private insurance to avoid queues, and the opportunities for private practice, paid fee per item, which are open to most consultants, both contribute to this.

The costs of Sláintecare are high, and this is inevitable. Comparing these revenue costs, to the €1.5 billion capital costs for the new children’s hospital, is not very useful. A better comparison is with the costs of demographic change alone – which are about €450 million a year. The costs of inaction are likely to be much higher. Our system is slowly falling over, costs are rising, and staff recruitment is getting harder.

Dealing with all of this will require a major change in how we deliver and fund healthcare. This change will take at least a decade. The current “system” is no longer fit for purpose, and is increasingly unstable. Sláintecare is neither perfect, nor finished, but it is a good start. – Yours, etc,


Professor of Health Systems,

School of Nursing

and Human Sciences,

Dublin City University,

Dublin 9.