Health reform plan coming off the rails

  • Niall Hunter, Editor

Some of you may still remember the 'political whirlwind' that occurred in February 2011.

No? Well, this metereological phenomenon is described in moving detail in the Programme for Government:

"The stroke of a pen, in thousands of polling stations, created this political whirlwind. The public demanded change and looked to parties that would deliver the change they sought."

If the people were looking for major change, perhaps they were looking to the wrong parties, because 'at the stroke of a pen' this week, with the apparent postponment of the free GP care plan, the Government's promise to significantly reform our health service went badly astray.

The Programme for Government said: 'Universal primary care will remove fees for GP care and will be introduced within the Government's term of office'.

Perhaps they meant another, future Government, in another country, on another planet. Because all this Government has done to date is to make some people pay extra for primary care.

Far from delivering anything resembling free GP care, the current Government has delivered the exact opposite: a €1.50 per item prescription charge for medical card patients, and a removal of full medical cards from thousands of over 70s and other medical card holders.

Strangely, these decisive actions were not included in the list of promises in the Programme for Government.

Free primary care is a key component of the eventual introduction of universal healthcare funded by universal health insurance, which promises equal access for all to GP and hospital care.

Health Minister James Reilly has told us time and again that a properly developed GP and primary care system, eventually free of charge at the point of access, is a key part of the reform programme.

This will involve the transfer of a wide range of services from hard-pressed hospitals to the community, and community and hospital services working seamlessly together in an integrated and more efficient system.

Now, these ambitious plans are in serious trouble, as is Minister Reilly (yet again).

The Department of Health's 'non-denial denial' today of media reports about the scrapping of free GP care will do little to boost public confidence.

In fact, the more one reads back on what has been promised on health reform, the more fictional it all now seems.

Universal primary care, we were told, would be introduced in phases so that additional doctors, nurses and other primary care professionals can be recruited.

Well, in turns out that even the first, modest phase of free GP care for all, to include long-term illness patients, cannot be introduced. It was supposed to have been put in place over a year ago. It has come off the rails, apparently, due to 'legal difficulties.

For legal difficulties, perhaps read 'we spent the money on other stuff' and 'we can't get GPs on board for this'-type difficulties.

Surely it wasn't beyond the Parties of Permanent Revolution elected just over two years ago to work out in advance whether they could afford the €15 million to provide even the first phase of free GP care, never mind the rest of it.

Surely some better groundwork could have been done to ensure a practical implementation of such a plan, in order to avoid 'legal frailties' or industrial relations issues.

As for recruiting hundreds of extra primary care staff, €20 million was promised for this last year and not delivered on. It was reheated and promised for this year and has again not been delivered on.

And as for new primary care centres, last year's row over the choice of centres only served to mask the fact that so few of these centres had so far been built, and how far down the road it will be before a reasonable network of new centres will see the light of day.

To date, in terms of health reform, the emphasis has been on writing endless discussion papers and policy documents, drawing up lists, issuing press releases, promising things again and again, blithely ignoring any potential practical issues, and still ending up as remote as ever from delivering something concrete that will give our long-suffering population a better health system.

And no, the much vaunted reductions in trolley numbers and waiting lists, which are still fairly high in any case, do not constitute health reform, merely a sticking plaster solution on systemic dysfunction.

And Fianna Fail's righteous indignation that the Government's health policy is 'in tatters' gives us little comfort, as these tatters bear an uncanny resemblance to the state of the previous Government's excuse for a health policy.

In fact, to give limited credit to the current Government, at least it has a health policy of sorts.

Its predecessor stands accused giving us a make-it-up-as-you go-along pig's ear of a health service (co-location plans, tax-breaks for private hospitals, record trolley numbers, er, the HSE, etc. The horror story is endless.).

However, it is of little credit to the current Government, and little comfort to the public that demanded change, that its health record to date is only slightly less bad than that of the previous crowd.

One example of how sloth-like the reform programme has been is the planned abolition of the HSE.

The plans for new directorate structures for the existing HSE were announced last summer. These structures, which were only intended as an interim reform pending the abolition of the HSE around 2014-15 to make way for universal healthcare, have yet to be set up.

James Reilly has some serious ship-steadying to do if he is to prove to the public that his health reform plan actually exists beyond all those dusty discussion papers and if so, whether it can actually work.

What we need from Dr Reilly now are realistic timetables for reform, a more transparent attitude in explaining what can still be salvaged from the wreckage and some idea of when we can finally expect things to change.

Failure to do so might mean that this particular political cat has finally passed the ninth stage of his feline existence.

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