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What's going on with the government's Sláintecare plan for the health service?

The office in charge of the reforms saw two key departures this week.

SLÁINTECARE LAUNCHED WITH some ambition in 2017, promising to reform the Irish healthcare system and make it a near equivalent to the famed ideal of Britain’s National Healthcare Service, with the two-tier divide between public and private healthcare to be eradicated and waiting lists to be drastically reduced.

These plans were thrown into confusion this week following the departures of two key figures charged with overseeing the programme, Professor Tom Keane and Laura Magahy. 

Magahy was the executive director of the reform programme while Keane held the role of chair of the Sláintecare Implementation Advisory Council (SIAC), an approximately 20-strong diverse group of medical professionals and patient advocates.

The resignations were greeted with “shock, regret and concern” by around a dozen members of the group in a statement released on Friday. 

Key among the concerns raised this week was that the plan was failing to implement new regional structures for the HSE which, in the words of SIAC member Eddie Molloy, would break down “the monolithic HSE into six regional, more or less self-contained, health systems”. 

For one of those who helped develop Sláintecare in its early stages and has examined its progress since, Trinity’s College’s Professor Steve Thomas, a key question lies in whether political parties and government departments are willing to fully back the entitlement to free care which lies at the heart of the reforms. 

This week’s events leave a question mark hanging over what happens next and whether the reforms can be steered back on course, amid frustrations at delays in implementing the major parts of the ambitious project.

The origin of Sláintecare

Sláintecare came about in the aftermath of the 2016 General Election, when some TDs, eyeing an opportunity amid the new, fractured Dáil, formed a cross-party committee examining the future of healthcare in Ireland.

The priorities of its ten-year plan:

  • End the situation where the better-off can skip waiting lists and access healthcare ahead of those on the public list
  • Provide universal free access to GPs
  • Reduce waiting lists by refocusing on community healthcare schemes

slaintecare 747 Happier times: HSE CEO Paul Reid, the then Minister for Health Simon Harris TD and Executive Director Slaintecare Laura Magahy with a map of the new regional areas for healthcare Credit: Sam Boal / RollingNews.ie Credit: Sam Boal / RollingNews.ie / RollingNews.ie

The chair of the committee responsible for Sláintecare, Social Democrat co-leader Roisin Shortall, has been among those calling for answers from the government following the resignations this week. 

She believes Keane and Magahy “were very frustrated” around the regionalisation aspect of the plan to restructure the health service, “in terms of integrating hospitals and community services on a regional basis”. 

This structure, which was initially in place before the HSE was founded, will devolve power from the central Executive and provide the new regional health areas with more autonomy – the idea being to make them responsible for the planning and delivery of integrated health and social care services for their locality. 

Professor Steve Thomas, Professor of Health Policy and Management at Trinity College Dublin, headed one of the teams that helped develop Sláintecare in its early stages and has since been tracking its progress through research for TCD. 

While Professor Thomas agrees that regionalisation has been a “sticking point” for many, with “resistance” seen from several quarters, he told The Journal that the other issue which seems to be blocking implementation is one of the key pillars in the overall plan: universal care. 

file-photo-executive-director-of-slaintecare-laura-magay-has-announced-her-resignation-and-will-leave-along-with-chairperson-dr-tom-keane-who-will-leave-the-programme-as-his-term-as-chair-is-ending-e Dr Tom Keane who announced his departure from Sláintecare earlier this week Credit: James Horan / RollingNews.ie Credit: James Horan / RollingNews.ie / RollingNews.ie

“It’s not just about making sure there’s more capacity, it’s also about making sure that people are on a level playing field. Are we really going to enable people to be entitled to free care?  There’s a kind of a philosophy in that.”

The pandemic provided the “architecture” for how some of the health service may look if Sláintecare is successfully implemented, said Professor Thomas, particularly in how GP consultations for Covid issues have been free of charge across the board.

He agrees that breaking down the current health system into regions “hasn’t really got traction”.

While every political party is on the record as buying into Sláintecare and supporting it, some parties will “of course” prefer some elements to others, Professor Thomas said. 

“They have to decide what they’re prepared to go with, as a political choice.

“I think there are some quite key philosophical points on which the government needs to decide, like, am I going to back entitlement [to free care]? Am I going to back this notion of regionalisation?”

3883 Sinn Fein Sinn Féin TD David Cullinane Credit: RollingNews.ie / Leah Farrell Credit: RollingNews.ie / Leah Farrell / Leah Farrell

Sinn Féin Health spokesman David Cullinane told The Journal that delays are evident across the programme, pointing to how “seemingly no analysis has yet taken place” on the future cost of providing universal GP access. 

According to an answer provided to the Sinn Féin TD from the Department of Health, extending GP care without charges to all citizens who do not currently hold a medical card or GP visit card would encompass a further 2.88 million people approximately.

“It is not possible to definitively calculate the cost of universal GP care without charges, as a whole or by annualised income brackets, given the wide range of payments and variables that have to be accounted for,” said the department. 

“Such a calculation would require a complex and detailed modelling exercise to account for a range of demographic changes, future projections of service demands and variation in the number of GPs and the allowances that could be paid.”

The TD told The Journal: “It is deeply problematic that no analysis or modelling has taken place for this when it was supposed to be implemented over five years, starting in 2017. Negotiations of course need to take place with GPs and the IMO but the modelling could still be done.”

Achievements to date 

Professor Thomas strongly believes that away from the main roadblocks, “a lot has been done” on contracts for consultants and GPs along with “a massive investment in primary community capacity”. 

For now, SIAC member and consultant at Tallaght University Hospital Anthony O’Connor insists a “frank meeting” is needed with the health minister. 

He told RTÉ’s Drivetime earlier today that a “redoubling” of efforts from the government backing the programme is also required.

The need to quickly fill the shoes of the departed Magahy and Keane is also important to restore confidence, according to Professor Thomas. 

“It’s a knock, undoubtedly, so it really depends on how agile the government is in responding. But though it’s a hit, I do think it may refocus minds.”

Earlier, Health Minister Stephen Donnelly published the latest mid-year progress report for Sláintecare. It details a total of 112 deliverables for the first six months of the year. Of those 112 deliverables, 109 are either on track or have been progressed. 

“Given what our health service has faced in the last 18 months, this is remarkable progress and a fantastic testament to the hard work and dedication of staff right across the Department of Health, the HSE and all of the partner organisations who work together to deliver Sláintecare,” Donnelly said. 

“As Minister for Health, my priorities now are to build on the success to date detailed in this report by implementing a detailed waiting list plan, progress work to build new elective hospitals around the country, scale and mainstream integration innovation and implement the eHealth Programme,” he said.

Concern

However, in a statement this evening, The Irish Hospital Consultants Association (IHCA) was scathing of the progress made, calling it a “sobering week for Irish healthcare with record waiting lists, resignations and lack of meaningful solutions”.

It comes as the latest figures released today by the National Treatment Purchase Fund (NTPF) showing over 907,600 people on some form of NTPF waiting list be treated or assessed by a Consultant, an increase of 66,167 people (8%) since this time last year and an increase of almost 124,000 (16%) since August 2019.

The IHCA called on the Department of Health and HSE to respond immediately by “releasing the long-awaited multi-annual waiting list reduction plan and providing realistic targets and timescales for the reduction of Ireland’s shocking waiting lists.”

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