Sunday 23 October 2016

Maeve Sheehan: Politicians all dried up on big ideas to fix broken health service

Parties produce variations on 'throw money at it and hope'

Published 03/01/2016 | 02:30

DIFFICULT TASK: Dr James Reilly, right, was castigated for his performance as Health
Minister, but his successor, Leo Varadkar, has not performed any better in the role. Photo: Gerry Mooney
DIFFICULT TASK: Dr James Reilly, right, was castigated for his performance as Health Minister, but his successor, Leo Varadkar, has not performed any better in the role. Photo: Gerry Mooney
PROBLEMS: A&E waiting times remain long

Enda Kenny came to power with a "revolutionary" plan for changing the health service. Fine Gael's "big idea" was for universal health insurance, free GP care for all, slashing hospital waiting lists and abolishing the Health Service Executive and setting up hospital trusts.

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Six years on, almost five years as Taoiseach under his belt, the remnants of Kenny's big idea are swinging in the wind. Universal health insurance (UHI) has effectively been abandoned as way too costly and managers are still struggling to contain the numbers of patients on trolleys.

The man he appointed to implement this grand plan, Dr James Reilly, was ignominiously moved from Health to the Department of Children.

Free GP care has been rolled out for under-fives and over-70s but it will take another term before it is rolled out for all. The HSE has been stripped of its independence, and is still expected to be a fully functioning entity while it languishes on death row.

Hospitals have been organised into trusts or groups but Fianna Fail claims this is the road to privatisation.

As far as health goes, Kenny is out of "big ideas" and has been stung enough to stop making promises that may come back to haunt him.

At a pre-Christmas briefing with journalists last week, he refused to repeat the pre-election promise he made in 2011 to eradicate the practice of sticking patients on trolleys while they wait for treatment.

Instead, he talked about how "numbers have come down", although he did have the decency to say that the "health service" was his "biggest regret" as Taoiseach.

It's probably fair to say that health is the biggest problem the Government has failed to solve. Six years of austerity have taken their toll: massive budget cut; staff reductions; emigrating nurses and consultants; bed closures; home help hours cut; the primary care centres supposed to keep people out of hospital rolled out at a snail's pace.

Neither the Government, nor anyone else on the political stage, is offering any further big ideas to salvage it.

As the battle lines for the general election are drawn, the debate is dominated by the usual suspects of tax, pensions, austerity, water charges and property tax.

So far, health hasn't got much of a look in.

In the pre-election foreplay of the recent weeks, most of what politicians have had to say on the subject has tended to be reactionary condemnation of the latest trolley crisis or waiting list scandal.

Perhaps the dearth of big ideas is a measure of how dire the system has become, and few have the stomach for changing it.

A smattering of policy documents were published during the year, mostly offering more of the same and demanding huge amounts of money.

Fianna Fail's health policy is largely about undoing what the Fine Gael and Labour coalition promised. It will abolish Universal Health Insurance, but that policy is effectively dead anyway since the ESRI calculated what it would cost.

Fianna Fail has promised to spend €450m on health, partly financed by a 20pc sugar tax that will generate €58m a year. It won't abolish the Health Service Executive and will restore its independence by giving it back its budget.

It also plans to bring back the National Treatment Purchase Fund. It will enforce new hospital hours, doctors will become salaried employees of the HSE and primary care will be rolled through.

Sinn Fein's policy document echoes the Government's own aspiration for universal healthcare for all. The party has promised to raise €3.3bn by raising taxes for those on higher incomes to create free GP care for all. It promised to hire more than 6,000 staff, automatic medical cards for children with disabilities, no hospital charges, free prescription drugs, universal dental care and has come up with a new "integrated hospital waiting list management system" to cut wait times. The party admitted that it could cost up to €30bn and that it could take "many, many years" to deliver.

The Labour Party makes much of its support for parents, child care and free GP care on its website, but mentions nothing about universal health insurance.

Renua has published policy documents on its website on topics such as childcare, banking and government reform but has yet to publish one on its plan for the health service.

The Taoiseach, meanwhile, still clings to the vestiges of Fine Gael's tattered health plan. At his pre-Christmas briefing, he insisted that UHI was still "on the agenda" and part of a long-term plan and that free GP care would be extended to all.

But there is no doubt his vision has been impaired. Instead of introducing "revolutionary change", last month he talked of "competent management" of the health service.

Of course, in his first months as Minister for Health, Leo Varadkar made an impression by not making promises but setting "priorities" and owning up to the problems.

He has accepted that Universal Health Insurance is "not affordable", in the words of the ESRI, and has instead focused on the micro stuff, such as management, good housekeeping and efficiency, while pressing home how much more money he needs to throw into the abyss.

In his view, investment is the solution. "Yes, we have a massive job to do in fixing the health service. No one should pretend otherwise. But we have only just emerged from the deepest recession in Irish history. So only now can we start increasing expenditure and investment in Irish health care. It means catching up on the best part of a lost decade."

In the past year, he threw €117m to fix the emergency department overcrowding - the big health crisis of 2015.

In an end-of-year comment piece, he listed some of his achievements as increasing access to homecare packages, opening 173 community beds to get more people out of hospitals and more community-based medical-intervention teams to call on those in need. He says there are now 500 more nurses and an extra 78 consultants in the system.

Nevertheless, the general election will be contested against a backdrop of a still deeply troubled health service and the executive in charge of it swinging in the wind.

Overcrowding is no longer at crisis levels but it remains a problem and we will hear more about it in 2016.

Nurses in emergency departments of seven public hospitals planned to go on strike last month to highlight chronic understaffing and the effects on patient safety. Strike action was averted at the 11th hour, but the unrest and low morale continue to fester.

On top of all this is the continuing financial crisis at the HSE. It needs to save €100m in 2016. It has yet to say how it is going to achieve this.

The Irish Medical Council clearly anticipated a barrage of promises about the health service when it launched its own campaign last year to put health at the top of the election agenda. It demanded that political parties should be forced to submit their policies to rigorous costing by an independent fiscal agency - a proposal that makes sense after the fiasco of universal health insurance. Fine Gael never costed the great white hope of the health service, and it took the Economic and Social Research Institute to suggest it was unaffordable.

When Leo Varadkar first took up his job as Minister for Health in 2014, the Sunday Independent asked experts for advice on his behalf. The advice wasn't rocket science: secure a decent budget and spend it wisely on things that will help unclog the system - home care, primary care centres, step-down beds - and attend to the detail.

And no "big new promises".

Sunday Independent

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