Pitfalls of predecessors a danger for positive Harris
Being Minister for Health is a big, important job and Simon Harris has got off to a good start. In his first interview in the post, he specified that he wanted to take party politics out of health.
While health policy choices are inherently political, any attempts to take the party politics out of them are extremely welcome and demonstrate a good understanding for what is required in this tricky ministerial job.
Minister Harris intends to do this by setting up a cross-party Oireachtas committee to hold hearings with relevant stakeholders, for them to reach a consensus on a 10-year plan for health.
Harris has stated it takes more than one term and consistency across governments to successfully introduce such a long-term reform plan. Realistically, this may need to be a 15- to 20-year plan to bring about the change required for a decent health system.
For such a plan to be viable, there needs to be a shared vision amongst the public and politicians about what type of health services we want and how they should be funded. A good starting point would be an Oireachtas-wide consensus to work towards a universal, high-quality health system.
All parties expect Fianna Fáil to advocate a universal health system in one form or another.
Centre-left and left politicians advocate a tax-funded, universal system. Sinn Féin is the only party with a well-researched, comprehensive health policy that details how to undo our two-tier system.
Fianna Fáil also produced a health policy last year which, in effect, seeks to maintain the status quo of our two-tier health system funded through general taxation, that would still allow private patients to skip the queue, as well as promising more of everything to everyone.
In 2011, Fine Gael and Labour committed to a "universal, single-tier health service, which guarantees access to medical care based on need, not income". They planned to deliver it through a flawed model of universal health insurance which they have now wisely abandoned.
Such strong commitments to universalism are missing in the Programme for Government published last Wednesday. This programme has been rightly criticised for being too aspirational but the health section is sadly lacking any ambition. It is a rehash of yet-to-be-implemented existing government policy, alongside some shoddy concessions to Fianna Fáil and the Independents.
Last Tuesday, 89 opposition TDs proposed a motion which endorses the Government's plan and the "need for consensus at political level on the health service funding model". The motion specifies '"he need to establish a universal, single-tier service where patients are treated on the basis of health need rather than on ability to pay… with the intention of adopting a 10-year plan for our health services, based on political consensus…".
Minister Harris responded with openness to this health motion, indicating a change in the realpolitik. He also wants the plans to be costed so that there can "be honest debates… about the real cost of the proposals".
No sooner was the minister's announcement in the public domain than an apparent spat between Fine Gael and Fianna Fáil emerged over dismantling the HSE.
The Programme for Government states: "We will continue the process of dismantling the HSE, evolving it into a Health Commission. We will advance progress made on Hospital Groups before strengthening their capacity to be stand-alone statutory Trusts."
There is nothing new in this, it has been government policy since 2011 to dismantle the HSE into hospital groups and then trusts.
Some have voiced concerns that establishing trusts is an effort to break up the component parts of the HSE, to gear it up for privatisation. Speaking to health service leaders this week, Minister Harris wanted "to reassure everyone that the only goal of this process is to facilitate the HSE to move to new structures that will devolve more decision making to the level of the hospital or the community, and to ensure greater accountability".
One of the fatal mistakes of the HSE foundation was to centralise power and control to a monolith. If the new structures decentralise control, that is welcome but it is unclear now how workable they are and whether having different structures overseeing hospital and community care will make care more fragmented for the patient.
The health part of the Programme for Government is without specific priorities, targets, costings or detail, but there is one health priority for the first 100 days - "the reactivation of the National Treatment Purchase fund [NTPF] to reduce hospital waiting lists".
Buying private care for long-waiting public patients (in the guise of the NTPF) can reduce the waiting times for individuals but we know from before that spending hundreds of millions on private care does not resolve the underlying causes of high numbers of people waiting too long in the public system.
Minister Harris has enthusiasm and energy. He also has the ear and support of Michael Noonan and Enda Kenny, which is critical for health policy to succeed. However, he must not make the same mistakes of his predecessors - of reorganising structures and contracting out care to the private system rather than resourcing the slow, hard grind of improving access and the quality of care in the public health system.
If he can do that and at the same time reach Oireachtas-wide consensus on health reform for the decades ahead, this so-called brave new politics might actually bring about a better health system.