Saturday 15 December 2018

Kevin Doyle: Slaintecare is just political wizardry to get politicians on all sides off the hook

The latest plan to fix the health system is the result of a convenient consensus by both Government and Opposition, writes Kevin Doyle

Minister for Health Simon Harris. Photo: Collins
Minister for Health Simon Harris. Photo: Collins
Kevin Doyle

Kevin Doyle

Margaret Thatcher questioned the value of consensus in the battle for any "great cause". She believed it was the process of abandoning all beliefs and policies in search of something no one believes in but to which no one objects.

It would be interesting to know what she would make of ''new politics'' and more particularly, its offspring, Slaintecare.

According to the glossy announcements last week, the plan to transform our forever ailing health and care services is "built on consensus".

In essence, it is a plan that belongs to everybody and at the same time, belongs to nobody.

It falls to the Minister for Health Simon Harris to figure out its implementation and the newly appointed executive director Laura Magahy to see it through.

In theory, the 10-year plan is a good idea. It means that no matter who is in government after the next election, the strategy should remain the same.

But in reality it's a piece of political wizardry that attempts to get both the Government and the Opposition off the hook with voters when it comes to our health system.

Let's just look at what happened to Mr Harris's big launch during last week.

Firstly Fianna Fail executed a perfect hit job on the minister by releasing figures showing nearly one million people on waiting lists.

Only the most naive of political observers would think it was an accident that this information landed out on the same morning as the launch.

So as he stepped forward with some good news about the future, Mr Harris was pulled very much back into the present.

The minister ploughed ahead, while in a press release Taoiseach Leo Varadkar talked about the "overwhelming consensus that a transformation is needed in the way we deliver care".

According to the script, Opposition TDs were then supposed to row in with their support for the plan that they were actively involved in writing.

And for the most part they did, before shouting "but…"

Social Democrats co-leader Roisin Shortall, who chaired the Oireachtas committee which produced the report, said the launch was a "resounding endorsement of the plan and a clear acknowledgement that our health system is dysfunctional".

However, after one positive paragraph, she moved on to five negative ones questioning the minister's commitment.

Sinn Fein's Louise O'Reilly "cautiously welcomed" the launch of the plan, but warned that it threw up "many questions which the minister needs to answer".

For the Labour Party, Alan Kelly went further, accusing Fine Gael of "quickly backing away from the core proposals" of Slaintecare.

And on it went. Government saying it is implementing a plan agreed by everybody, and Opposition saying it isn't implementing it properly.

Meanwhile, back in the real world, very few actually believe Slaintecare will be the panacea that the politicians seem to think it is.

At best, the Government might manage to implement some of the actions and make a small dent in the crisis.

Parts of the plan are simple enough. It won't be a big challenge to establish an accountable HSE board. We had one of them before James Reilly dismantled it.

Launching "a programme of public engagement on Health Outcomes and a nationwide series of events in 2019/2020 to promote health and well-being" will give Simon Harris and Leo Varadkar another day out.

There are also parts of the plan that money can move along. The minister said that within three years, he'll increase bed capacity in public hospitals, start the planning process for new elective hospitals in Cork, Dublin and Galway, and improve the HSE's IT systems.

Where Slaintecare is likely to fall down is on the structural, cultural and practical changes needed for actual reform.

Consensus will be in short supply when it comes to overhauling the way GPs work.

Likewise, how will ''new politics'' cope with developing a new eligibility framework for so-called "universal entitlement"?

Where are we going to find all the extra doctors and nurses that the experts say are needed for it to work?

How will the Minister for Finance Paschal Donohoe react to demands for a multi-annual budget to be set aside for the plan?

Mr Harris wasn't able to publish the overall cost of Slaintecare due to "significant contract negotiations" which will be required to roll it out.

And all of this has to take place without unsettling the day-to-day passage of patients through the health system.

In an ideal world, we would close down the service for maintenance and not reopen it until a workable solution was in place. But that's simply not an option.

The Government must try to bring all the stakeholders involved to the Slaintecare party while also being fully aware that it can't actually disrupt them too much or the creaking system might fall apart completely in the process.

It must all happen against the backdrop of 500 sick people on hospital trolleys in the middle of August, of 320 vacant consultant posts and one million people on waiting lists.

For Slaintecare to make an impact, it must also survive a general election in the next 12 months.

Who's to say that the TDs elected to the next Dail don't decide they can come up with a better all-party plan than the current crop did?

In any event, Simon Harris will be hoping that he manages to escape the Department of Health after the next election, lest it devour his political ambitions.

If Fine Gael remains in power, the Taoiseach may well see fit to leave the PR-savvy and Instagram-lovey Harris in the toughest of all offices.

But he may also decide that the only Cabinet minister to back Simon Coveney in the leadership contest has served his penance.

It was Mr Harris's idea, with a heavy nudge from Roisin Shortall, to commission a cross-party report on the health service.

He knew there is no ''winning'' in the health battle but believed a plan that everybody tentatively endorsed could open the door to a political ceasefire.

Fianna Fail's clever line of attack in recent days shows the war might only be heating up - but resolving our health woes isn't exactly its strong point either.

Sadly, though, nobody really believes that in a decade, Ireland will have one of the best healthcare systems in the world.

A large reason for that is that most people don't actually have any faith that the health service can be fixed at all.

Yet it's not too much to ask that politicians stop making the situation worse.

The rising waiting lists, summer trolley crisis and scandals such as that around CervicalCheck have to be stopped before real reform can take place.

Slaintecare offers a convenient consensus for all sides of Leinster House to seem like men/women of action - but it's unlikely to be the magic cure for our health system.

Sunday Independent

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