Radical plan to make HSE 'lean and accountable'
Dail committee proposes hospital access charge abolition
The HSE's governance structures are "not fit for purpose" and should be dramatically overhauled, according to a draft report by a powerful Dail committee.
The Committee on the Future of Healthcare has recommended replacing the HSE with a "leaner national centre" which would oversee the health service.
It proposes slashing the number of HSE national directors reporting to the director general and relocating them to other areas of the health service.
This new national centre would support hospital groups, community health organisations and national ambulance services which would be responsible for frontline care.
The draft report, which has been seen by the Sunday Independent, also calls for the appointment "at the earliest opportunity" of an independent board to oversee the HSE.
The new 'Health Service Board' would be directly accountable to the Health Minister and the HSE director general would have to answer to the board.
"Given this leaner model of national level service management and coordination, and the more direct leadership and accountability linkage between patient experience, frontline providers and senior management created through it, the work of integrating service provision is centralised, and becomes the heart of the system," the report states.
The proposals are in line with views expressed by Health Minister Simon Harris when he appeared before the committee.
The cross-party committee chaired by Social Democrat Roisin Shortall has been tasked by Mr Harris with developing a 10-year vision for the health service.
A number of radical objectives have been proposed in the draft report and members will vote on the recommendations in the next two weeks.
It recommends the abolition of access charges for public hospital care, which are currently capped at €800-a-year for patients who do not have medical cards. Emergency Department fees would be removed once primary care had been fully introduced.
The committee proposes reducing the prescription charge for medical card holders from €2.50 to 50c. The threshold for drug reimbursement for non-medical card holders would be cut from €144 to €72.
Free GP care for everyone should be introduced within five years, according to the committee.
It also calls for legislation to be introduced to ensure patients would not have to wait longer than 12 weeks for an operation. It also wants to see waiting times in emergency departments reduced to four hours.
It also recommends introducing of a health card (Carta Slainte) for all Irish residents by 2020 which would entitle people to publicly funded health and social services based on their needs.
The card would incentivise people to use primary care centres rather than hospital by offering free or discount prices.
"A Carta Slainte will be introduced to the whole population over a five to 10-year period," the report stated.
It is projected that the additional €350-400m will need to be allocated to deliver universal healthcare annually for the first six years, after which additional costs are smaller.
The committee has controversially recommended phasing out the tax subsidy for health insurance and proposes using the revenue to fund its new vision for health service.
The report estimates that the landmark overhaul of the health service would cost the taxpayer an additional €5.4bn over six years.
Some of the massive investment would be used to hire 900 extra nurses to work in the community with older people and almost 600 additional consultant doctors would be hired over the next four years to meet the needs of an ageing population.
However, terms and conditions offered to consultants would be dramatically changed under the new plan. Consultants working in public hospitals would no longer be able to see private patients but would see their salaries increase.
There are also plans to make public hospitals more "attractive places to work for experienced, high-quality staff".