Sláintecare: What's the story?
Healthcare in Ireland is a disaster, simply put. Ireland is the only wealthy European country which does
not provide universal healthcare - roughly 40% of the population enjoy a medical card (allocated on both
medical need and means), while the other 60% face hefty out-of-pocket charges, or pay for voluntary
medical insurance, which allows them to ‘skip the queue’ in public hospitals. It’s not for lack of funding
though. Ireland is the fifth largest spender on healthcare in the world, and the Health Service Executive
(HSE) have made overruns of €500 - €700 million an annual occurrence. The system has been crying for
reform for years.
not provide universal healthcare - roughly 40% of the population enjoy a medical card (allocated on both
medical need and means), while the other 60% face hefty out-of-pocket charges, or pay for voluntary
medical insurance, which allows them to ‘skip the queue’ in public hospitals. It’s not for lack of funding
though. Ireland is the fifth largest spender on healthcare in the world, and the Health Service Executive
(HSE) have made overruns of €500 - €700 million an annual occurrence. The system has been crying for
reform for years.
Enter the Sláintecare report: forged with an historic all-party consensus, adopted as Government policy
and hailed as the reform plan to fix the healthcare system. Published in 2017, it proposed the separation
of public and private care, the prioritisation of primary care, a new HSE board, and the phasing out of
out-of-pocket fees. You couldn’t beat it with a stick, as they say. Chaired by Roisín Shortall of the Social
Democrats, the report provided for its own implementation, calling for a Sláíntecare Programme Office
and biannual progress reports.
and hailed as the reform plan to fix the healthcare system. Published in 2017, it proposed the separation
of public and private care, the prioritisation of primary care, a new HSE board, and the phasing out of
out-of-pocket fees. You couldn’t beat it with a stick, as they say. Chaired by Roisín Shortall of the Social
Democrats, the report provided for its own implementation, calling for a Sláíntecare Programme Office
and biannual progress reports.
The report was published May 2017, and this is where the issues begin. I don't want to be over-critical
of Leo Varadkar’s government; reforming an entire healthcare system is a monumental task. However,
in this case it is crucial that the proposed reforms happen, and the Government has hardly been
convincing in its approach.
of Leo Varadkar’s government; reforming an entire healthcare system is a monumental task. However,
in this case it is crucial that the proposed reforms happen, and the Government has hardly been
convincing in its approach.
First, let's look at the two government documents produced since May 2017. The Department of Health
spent the next year and a half formulating an implementation strategy - which might have been
forgivable if the resulting document were a serious affair. It was not. It was necessarily broad in its
scale, but it crucially the report lacked a budget, implying that the Department was not fully
committed. It is vague in key areas - it suggests we build ‘more’ primary care centres, but it doesn’t say
how many more. The Irish Times summarised the main goals and their respective timelines here, and a
quick perusal reveals much reviewing, assessing and the like.
spent the next year and a half formulating an implementation strategy - which might have been
forgivable if the resulting document were a serious affair. It was not. It was necessarily broad in its
scale, but it crucially the report lacked a budget, implying that the Department was not fully
committed. It is vague in key areas - it suggests we build ‘more’ primary care centres, but it doesn’t say
how many more. The Irish Times summarised the main goals and their respective timelines here, and a
quick perusal reveals much reviewing, assessing and the like.
2019 saw the publication of the first Sláintecare Action Plan for 2019, which is a mixed bag. It contains
plenty of timelines for necessary actions, and gives the impression that the Implementation Office has a
busy year ahead. However it too is effectively neutered by the lack of a budget. Two years on from the
original (fully costed) Sláintecare plan, and the government still hasn't published a single document with
a euro sign. Shortall described it as 'another report on a report'. Another worrying sign is that the plan
for the whole of 2019 was published well into the first quarter, suggesting agreement was hard to reach.
All signs point towards a lack of government commitment, in a policy area where it is desperately needed.
plenty of timelines for necessary actions, and gives the impression that the Implementation Office has a
busy year ahead. However it too is effectively neutered by the lack of a budget. Two years on from the
original (fully costed) Sláintecare plan, and the government still hasn't published a single document with
a euro sign. Shortall described it as 'another report on a report'. Another worrying sign is that the plan
for the whole of 2019 was published well into the first quarter, suggesting agreement was hard to reach.
All signs point towards a lack of government commitment, in a policy area where it is desperately needed.
Government documents aside, what progress had actually been made? The Progress Report for the first
quarter of 2019 cheerily details that all '28 deliverables are on track'. However a quick hour's googling
makes the cheeriness look artificial. Maybe these on track, but how inclusive is this in terms of the 2018
strategy? A number of goals set for 2018 have not been met: There is no sign of the Patient Safety bill
on oireachtas.ie; the new HSE board was supposed to be set up last year, but had its first meeting last
week (Source),; here has been no report from the Independent Review Group on disentangling private
and public healthcare; the new patient safety, complaints and advocacy policy hasn’t been published yet.
quarter of 2019 cheerily details that all '28 deliverables are on track'. However a quick hour's googling
makes the cheeriness look artificial. Maybe these on track, but how inclusive is this in terms of the 2018
strategy? A number of goals set for 2018 have not been met: There is no sign of the Patient Safety bill
on oireachtas.ie; the new HSE board was supposed to be set up last year, but had its first meeting last
week (Source),; here has been no report from the Independent Review Group on disentangling private
and public healthcare; the new patient safety, complaints and advocacy policy hasn’t been published yet.
I don’t claim to have uncovered a scandal, but the evidence certainly points to a level of sluggishness on
the part of the Government. It is easy to imagine why. Overruns in the HSE budget are an annual
occurrence and have reached the €700 million mark in recent years (Source). As the Sunday Business
Post pointed out this weekend, government departments are frustrated at working with tight budgets,
only to see the Department of Health receive annual supplements approaching the billions. Making the
case for even more investment is hard, but necessary; if the Irish system is to recover from its historic
underfunding, then it needs complete backing from both the Taoiseach and the Minister for Finance.
Otherwise a costly and inefficient system will be left in place because no government has had the courage
to invest in its replacement.
the part of the Government. It is easy to imagine why. Overruns in the HSE budget are an annual
occurrence and have reached the €700 million mark in recent years (Source). As the Sunday Business
Post pointed out this weekend, government departments are frustrated at working with tight budgets,
only to see the Department of Health receive annual supplements approaching the billions. Making the
case for even more investment is hard, but necessary; if the Irish system is to recover from its historic
underfunding, then it needs complete backing from both the Taoiseach and the Minister for Finance.
Otherwise a costly and inefficient system will be left in place because no government has had the courage
to invest in its replacement.
What should be done about this? It would be perhaps too optimistic to expect the current
government to pull up its socks; better to think about the next government, which will likely be elected
early in 2020. As well, Brexit has provided, and will continue to provide ample excuse for procrastination.
The onus, then, is on the opposition, and they must make Sláintecare not only party policy, but a key
campaign promise. A strong showing from the Social Democrats, who are the most committed to
Sláintecare, would help. As would plenty of opposition campaigning - too many people have never
heard of the plan, and getting the public to vote on it is crucial. It may take longer than the ten years
envisaged by the Committee, but reform as vital as this takes perseverance.
government to pull up its socks; better to think about the next government, which will likely be elected
early in 2020. As well, Brexit has provided, and will continue to provide ample excuse for procrastination.
The onus, then, is on the opposition, and they must make Sláintecare not only party policy, but a key
campaign promise. A strong showing from the Social Democrats, who are the most committed to
Sláintecare, would help. As would plenty of opposition campaigning - too many people have never
heard of the plan, and getting the public to vote on it is crucial. It may take longer than the ten years
envisaged by the Committee, but reform as vital as this takes perseverance.
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