Wednesday 7 December 2016

The Fine Gael foundation document fails to provide a clear vision for a fair health service

Published 09/04/2016 | 02:30

'You would not know there were 533 people on trolleys that day; that many people do without health and social care as they cannot afford it; that the majority of the population, who cannot pay privately, often have to wait longer to access essential diagnosis and treatment' (stock photo)
'You would not know there were 533 people on trolleys that day; that many people do without health and social care as they cannot afford it; that the majority of the population, who cannot pay privately, often have to wait longer to access essential diagnosis and treatment' (stock photo)

It seems like the drafters of Fine Gael's 'foundation document' presented to Independent TDs last Tuesday live in a different world to most of us mere mortals. A cursory read of the health section would lead you to believe that we lived in a country with a decent health service.

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You would not know there were 533 people on trolleys that day; that many people do without health and social care as they cannot afford it; that the majority of the population, who cannot pay privately, often have to wait longer to access essential diagnosis and treatment.

In February 2016 there were 45,952 people waiting over one year for a first appointment with a hospital consultant and 7,482 people waiting over one year for public hospital treatment.

In fact, reading the draft discussion document, you would never know that we have a divisive, unfair, inefficient health system of dubious quality.

The health section of the document is in effect a rehash of existing Fine Gael-driven health policy, with a few vague extras thrown in as a sop to some Independent TDs. The section has seven points that cover the hot topics in health but ultimately lack any detail, substance or ambition.

The first point, about shifting care from hospital to the community, is a well-hackneyed policy since Micheál Martin launched the largely unimplemented Primary Care Strategy in 2001. For such a shift to materialise there needs to be increased funding of primary and community care. Why does the document not specify exactly how much will be allocated over time to these key areas? This would ensure that there are adequate staff in primary and community care - and that its intent has a chance of actually happening.

The expansion of the numbers and role of community and public health nurses is not mentioned, despite being key to making healthcare outside hospital workable. Neither is it clear to whom increasing access to diagnostics and chronic disease management in the community applies. For primary care to do more of what currently takes place in hospitals, this must apply to everyone.

The longest section is 'creating a healthier Ireland' - which is critically important to every citizen and for making our health system sustainable. A whole range of unrelated commitments are thrown in here, from implementing existing healthcare policies to legislating in areas such as organ retention and assisted human reproduction, all of which were already government policy or were in the Fine Gael manifesto - and are largely unrelated to public health.

It is well established that the majority of factors that impact on health lie outside of the health system, that policies that reduce health inequalities through the redistribution of income and wealth, sustained investment in the early years of life, high-quality housing and access to education, lead to better health. Yet the critical role of these other public policies is not even acknowledged.

The two sections on hospital care - focusing on emergency departments and reducing waiting lists - merely restate existing policies that have proved largely ineffective to date. Many reviews - a good way of stalling any progress - are promised.

Most notable in its absence is any focus on quality care and the recruitment and retention of healthcare staff. These are inextricably linked. Having sufficient numbers of skilled staff who feel valued directly results in quality care and improved health outcomes for patients. These issues require attention of their own in any 'foundation' document.

One review that is not in there, which would be worth doing, is a review of hospital groups: are groups the best way to progress delivering safe, effective hospital care? Will the next government repeat the mistakes of the past, of reorganising structures rather than reforming how healthcare is delivered?

In the last section, on health funding, there is no mention of universal health insurance, Fine Gael's flagship project five years ago. Instead, there is a commitment to universal healthcare, alongside a promise of a new, unspecified health funding model. It recommends Oireachtas hearings that would "allow the next government to make a final decision on the best way forward to finance Universal Healthcare". Although this could be interpreted as a fudge, it could also be a way of seeking a much-needed consensus on the type of health system we want to have, or how best to fund it.

Seven weeks without a government may not seem to make any difference, but it does. Politics matters in all areas of public policy, but it really matters in health. The absence of political attention to specific areas means priorities are sidelined. The essence of government is to make political choices in the public interest.

The 'foundation document' health section is drivel, reading like the lowest common denominator in Irish health policy. It shows that talk of 'a new type of politics' and of 'consensus policy' are utter baloney.

The people need a government that lays out a clear, ambitious but deliverable plan for a fair, high-quality health service. This week's shenanigans indicate we won't be getting that any time in 2016.

Irish Independent

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