Stephen Donnelly has said he wants to stay on as Health Minister in the expected end-of-year cabinet reshuffle and has pledged to remove private care from public hospitals.
“I would love to stay on,” he said.
It comes after a turbulent first six months of 2022, which included damning reports of emergency department overcrowding, hospitals driven to the brink during the early Omicron surge, controversy over chief medical officer Dr Tony Holohan’s planned move to Trinity College and now another summer Covid-19 wave.
In an interview with the Irish Independent, Mr Donnelly said he gets on well with Tánaiste Leo Varadkar, who will take over as Taoiseach later this year and is expected to want to refresh the Cabinet.
“It’s not my decision on whether I stay on, but we are making real progress on access to healthcare, quality and cost,” he said.
“The Government is working well and I am optimistic about what we can achieve.”
He insisted the goal remained universal healthcare, with access based on need and not ability to pay. He wants the removal of private, fee-paying in public hospitals to be well under way once the Government folds.
Any newly-recruited hospital consultant hired under a modern contract, still under negotiation, will not be able to earn fees from insured patients in public hospitals.
As the cost-of-living crisis threatens people’s ability to meet basic costs, including GP visits and medicines, Mr Donnelly will be under pressure in the October Budget to deliver some financial respite.
“I have no agreement on anything yet, but two measures I have flagged are the removal of hospital inpatient and outpatient charges and financial support for IVF treatments,” he said.
The removal of inpatient and outpatient charges would leave patients with up to €40m in their pockets, but the HSE would need the income reimbursed.
Mr Donnelly could not say what form the support for expensive IVF treatments might take if given the go-ahead.
“I have to go through the process and I am not in a position at this stage to signal what the outcome will be,” he said.
The health service got €22bn in a national plan for 2022, but Mr Donnelly said this year’s Budget could be tight. He would not be drawn on whether it could be made easier to get a medical or GP visit card, or if the threshold for the Drug Payment Scheme (DPS) could be cut further.
He said the DPS threshold was cut this year to €80, free GP care for six and seven-year-olds is due this autumn and free contraception will be given to 17- to 25-year-olds.
The minister is also facing the retirement of chief medical officer Tony Holohan from next month. A full-time replacement was not expected until September, he said.
Dr Holohan would be a “huge loss” and his work on Covid had been “incredible”, he added.
Asked about the botched appointment of Dr Holohan to an academic post in Trinity College, the minister said “everyone agrees” he should have been given the full details around the proposal earlier.
It emerged at the time that the minister did not know Dr Holohan planned a secondment and would remain an employee of the Department of Health on a full €187,000 salary while working in Trinity.
He was also not told early on that Department of Health secretary-general Robert Watt had given a €20m letter of comfort – worth €2m a year over a decade – to the university to support the post, which Dr Holohan later decided not to accept.
However, Mr Donnelly said the “good news” was that Professor Breda Smyth, who is Director of Public Health in the HSE West and has “impeccable” experience, had agreed to take on the role temporarily over the summer.
The big challenge now, is Covid-19 vaccine fatigue.
Mr Donnelly urged over-65s, more of whom are ending up in hospital in this wave due to the virus, to get their second booster.
There will be fewer free HSE PCR tests available, but a vaccine that can target the Omicron variant could be here by late autumn.
Asked about emergency department gridlock and the long waits on trolleys, Mr Donnelly said the HSE had presented him with an action plan tailored to each of the 29 emergency departments in the country.
A team of troubleshooters from the HSE are now in University Hospital Limerick’s emergency department, after patient safety watchdog Hiqa said there was a patient safety risk there.
“The solution to emergency pressures is not the same in different hospitals. I am acutely aware of how bad it is in some emergency departments,” Mr Donnelly said.
He added that, in some cases, patients needing diagnostics were arriving at emergency departments on a Friday but not getting a scan until Monday because of a reduced service. Some emergency departments are using private diagnostic services to overcome this.
Emergency departments need more senior consultants on duty longer to make decisions on admission or discharge, but there are not enough to provide this level of cover.
“University Hospital Galway has sanction for eight consultants, but it has only managed to fill four. It probably needs 16,” Mr Donnelly said.
He said he had asked the HSE to treat recruitment of health staff “like Covid” and speed up the process. He also wants to change the pattern of seeing more people on trolleys early in the week, due to slower weekend discharges.
Asked about hospital waiting lists, he said progress was being made in the “ambitious” €350m plan launched earlier this year, but inpatient delays had been affected by the early waves of Omicron. He defended setting “stretch targets” to cut queues to their lowest in five years at the end of 2022, saying they might not be met but could generate better progress further than careful objectives.
Figures for May show 79,690 are waiting for inpatient care, 28,404 need a gastrointestinal scope and 624,444 are in the queue to see a specialist.
He insisted a growing range of teams were now in place in the community to reduce the need for people to go to hospital, which would previously have been the pattern.
They include teams who can support people with long-term illnesses such as diabetes, older people with frailty and other patients who can be administered IV treatments at home rather than in hospital.
Asked about accusations that he was dismissive of health officials on occasions, Mr Donnelly said his job was to push the Government programme. Discussions were always “positive and professional”, but his job was to challenge and seek more, he said.