I am sorry to say that I think the long-awaited Oireachtas Healthcare Report which sets out a strategy for the Irish healthcare services for the next 10 years is more than a bit daft. It has great objectives and convincing arguments in its 187 pages. The problems, as I see it, is in how it suggests we achieve them.
Most people in the country, including myself, would agree that we should have a single tier healthcare system, where each person would have timely access to diagnostic and treatment services according to their clinical need, regardless of whether they were public or private patients. As far as public health services are concerned, the Oireachtas report – to which all political parties including Fine Gael have signed up – plans to implement this by making every patient in the country a public patient.
This contrasts just a tad with Fine Gael’s previous position – which it was still pursuing less than two years ago – whereby a single tier system was to be achieved by making everybody in the country a private patient. At that time Fine Gael wanted all citizens insured for healthcare through a partially state subsidised Universal Health Insurance scheme, effectively making them all private patients. Now it supports the abolition of private medicine in public hospitals, effectively making us all public patients.
After several years of consultations, discussions, working parties, reports, and sundry old guff, the then Fine Gael-led government quietly dropped the idea of universal health insurance, on the grounds that we couldn’t afford it – something which had concerned even some of the mathematically challenged among us from the beginning.
Now, we are off again and assured that we can afford to introduce free primary and hospital care for everyone – and it will only cost us an additional €380 – €465 million a year over the ten year implementation period. We have also been promised transitional and legacy funding arrangements to a total of €3 billion over six years, to boost reinvestment into ”one off system changing measures, training capacity and capital expenditure.” So, it appears that we will all get universal health care for an additional investment of between €6.8 – €7.6bn over ten years.
But it is not quite that simple because under the new scheme, the hospitals and their funders stand to lose a minimum of €7 bn over this 10 year period – the very least they could have been expected to earn from private patient charges, if as is highly unlikely, those charges were pegged at their current rate.
Again, I’m no mathematician, but how can you take out €7bn from the health service, invest less than €8bn and then extend free services to nearly half the people of the country, who up to now were more or less paying for these services for themselves?
Another area which is perplexing me is how this is going to solve – or even marginally assist – our appalling hospital waiting list problems.
As I see it, the same number of people will require hospital admission whether they are paying for it or not and I can find no proposals in this report for the major expansion required in acute hospital beds and ICU beds – that is being left to the capacity review group.
Neither do I see any concrete plans for how we are to tackle the linked problem of our current inability to recruit and retain GPs and hospital consultants. At present, GPs are becoming more and more reluctant to provide the greatly increased range of services required of them and we have 400 consultant posts, which are not filled on a permanent basis, with consultants’ disillusionment such that there are now no applications for some posts. The move to treat more and more chronic disease at primary care level makes sense for patients and the medical profession – but it cannot be done without the requisite resourcing – and we see no real sign of that in the report’s projected figure of €455 million over five years.
Then there is talk about what in effect would be a ring fenced levy to fund this entire scheme, apparently on the basis that people would be less reluctant to pay out if they knew it was going specifically to health funding. Now, if my memory is not playing me tricks didn’t we have that for many years in the past as part of our PRSI social protection payments, until it appeared to have been magically subsumed into the general taxation pit, with very limited dental, ophthalmic and aural care the only health benefits.
The Government believes it cannot afford to make us all private patients, I would query if it can afford to make us all public patients. Now, I wonder is there a third way?