Health system reform deadlock is hopefully coming to an end

May 15, 2017

In the Sunday Independent on Sunday 14th May 2017, co-leader Róisín Shortall TD wrote about why our health service is not fit for purpose but radical reform proposals have cross party backing. Here is the article:

Most people would agree that our health system is broken. Few would disagree that something must be done. Yet so many previous attempts to sort the mess out have ended in failure, stifled by vested interests, by incoherent planning, by lack of will and the loss of political momentum, that it is difficult not to despair.

Desperate to protect themselves and their loved ones, citizens who would never otherwise feel the need for private insurance are paying more and more in soaring premiums.

Meanwhile, those who cannot afford to go private, or those who – whether insured or not – require basic emergency treatment, face a nightmare of trolleys and waiting lists.

Little wonder that many politicians and public servants regard the health department as a potential career graveyard, a hazard to be skirted and not a problem to be solved.

I believe that these people are wrong, and I am not alone. For the past 10 months, away from the clash of politics and money, a cross-party committee of TDs has been quietly working to agree on a 10-year vision and plan for a radically reformed health service.

The task of the Committee on the Future of Healthcare has been to give effect to a principle agreed by the unanimous Dail vote to establish it, taken last May. This is that in future all of our people should have access to an affordable, universal, single-tier healthcare system, in which patients are treated promptly on the basis of need, rather than ability to pay. The committee is only weeks away from agreeing a final report, which will be presented to the Dail.

Many of the details have yet to be voted on, and no doubt disagreements will arise, but I believe that most Irish people will be both surprised and heartened by the degree of cross-party consensus which has emerged to end the present expensive and broken two-tiered system of health provision.

A key concern is the need to disentangle the public and private systems, including the established practice of allowing publicly paid consultants to treat their private patients in public hospitals.

Equally, the lack of transparency in the hospital funding system gives rise to concerns about hidden cross-subsidisation of private interests by public funds.

This issue has, I need hardly say, been much in the news of late.

The committee has examined whether the present targets for public hospitals to bring in income from private patients has created perverse incentives, pushing public patients to the end of ever-lengthening waiting lists.

Should we designate some hospitals for elective-only work, so that pressure from overcrowded emergency departments does not force less urgent operations to be cancelled, as so often happens at present?

Would this help consultants to push ahead with their elective work, dramatically reducing the present waiting times?

The low morale of healthcare staff was a recurring theme raised with the committee. Our aim is to expand capacity but also to ensure that front-line staff are valued and trusted as key change-makers in the reform programme.

If we can persuade them that the will exists for genuine reform, we can start to attract home those thousands of doctors, nurses and other health professionals who have despaired of our present dysfunctional health system and taken their skills and energies abroad.

Equally, it is accepted that the HSE in its present configuration is not fit for purpose and requires major realignment to finally provide accessible and equitable service delivery throughout the country.

Critically also, there is a determination on the part of the committee to legislate for a far greater level of accountability at senior management level within the HSE and indeed across the health service, including at clinical level.

There is no disagreement on the need to make primary and social care the centrepiece of our system and the committee has set out detailed, costed plans to switch the focus of services to the community.

I cannot delve into specifics of the committee’s forthcoming report until we formally vote on all the reforms currently on the table. Naturally, our proposals will have budgetary implications – we estimate that between €400m and €500m extra per year will be needed to fund future reforms, in addition to funding for demographic and other pressures.

These figures must be put in the context of a health service which is seriously underperforming for people, despite being significantly resourced.

Ireland currently spends €19bn a year on the health service – this is among the highest spend per capita in the EU. Of this, 70pc comes from general taxation, and 15pc comes from out-of-pocket expenses – the fees that many pay for GP visits, appointments with consultants and medication costs.

Despite the fact that 44pc of Irish people have private health insurance, this funding stream accounts for only 13pc of the annual €19bn health spend.

Naturally, the driving ambition of the committee’s work is to see its recommendations implemented. To do this will require a practical and consensual approach, with politicians continuing to work together to deliver lasting reforms that put people at the heart of any new system of health provision.

While hard decisions lie ahead, we know that we have to succeed: opportunities like this do not come along often.

Róisín Shortall TD is chair of the Oireachtas Committee on the Future of Healthcare

This article was originally published in the Sunday Independent.