Images: John Crowley
By Conor Kenny and Rachel Petticrew
On October fifth, at the Harbour Hotel in Galway city, Róisín Shortall, T.D. for the Social Democrats, and Niall Ó’Tuathail, Social Democrats candidate for Galway, presented a new plan for a national health system as compiled by the cross-party Committee on the Future of Healthcare at an open public discussion. The new plan, called Sláintecare, is a comprehensive restructuring of the current Irish health system designed to move towards a single tier, a publicly funded method with a much greater focus on primary, community-led care.
The event began with an invitation from the Committee on the Future of Healthcare chair Róisín Shortall TD and Social Democrat candidate Niall O’ Tuathail for guests to pose questions about Sláintecare, and to share their thoughts and personal experiences of the current health system. Frustration and concern regarding mental health services and continual cuts and lack of funding was a prominent theme, as well as long waiting lists, difficulty of access and a crisis in community care for those living in rural areas, particularly the elderly.
Former Minister of Health Ms. Shortall then introduced those in attendance to Sláintecare, and spoke about its inception and the steps taken by the Committee of Future Healthcare, which was formed to create the proposed national health service eventually leading to the deliverance of the motion to the minister of health. The fourteen member cross party committees plan focuses on creating a primary care system based on allowing everyone to have access to affordable, universal health care based on need rather than ability to pay. The plan involves a restructuring of the current system and proposes moving treatment to a more locally and community related system with the establishment of local health care centres that will be equipped to provide a wide range of services. The committee consisted of TDs from several political parties, and was warmly received in the Dail, with a ‘first time unanimous agreement in getting a good health service”, said Ms Shortall. 89 TD’s have signed the motion, including Minister for Health Simon Harris.
Sláintecare is a proposed Irish national health service. Influenced by European health systems and the NHS in the UK, the motion proposes a health service that is accessible to all, which is publicly funded and aims to provide better quality healthcare while reducing the cost to do so. It is a three phase plan, to be introduced over a ten year period. The main targets in this time, which Mrs. Shortall called a “realistic timeframe”, are to create more primary care centres, moving services from hospitals to local care units, therefore reducing hospital waiting lists and making healthcare accessible in rural areas, and to the elderly. According to Ms. Shortall, “80-90 percent of health needs can be met in the community”.
The plan involves a lot of required improvements and changes to the current system such as: increased training for medical professionals, introduction of five new pieces of legislation, improving mental health and spending funding more effectively as well as the introduction of a new medical card scheme; the Cárta Sláinte. The Cárta Sláinte, similar in some respects to the current medical card, will be backed by proposed legislation to make those who possess it legally entitled to healthcare rather than the current system which makes one eligible but not legally entitled. According to Mr. O’Tuathail:
‘It would basically give a medical card to everyone […] so basically it’s a legal entitlement that everyone has access to healthcare when they need it and that money isn’t going to be a barrier to you getting that. […] Instead of paying for it upfront or through your health insurance you’re paying for it through your taxes. […] Everyone’s chipping in but everyone gets the same service no matter if you’re rich or poor.’
A point that was mentioned during the presentation was an idea based around updating and expanding the current data system used by the HSE. A more effective gathering of patient data, such as; A&E admissions, number of GP visits, the number of medical procedures that are happening, across the country. Whilst this is a significant project (it will be a six year program costing in the region of 895 million according to Róisín Shortall) it is an essential investment that will pay for itself over time. Mr. O’ Tuaithail elaborated on how this can help patient treatment;
‘By having that data at a patient level you can do those kinds of things like; predict how patients are going to develop, put them in programs before they actually get sick, you can design treatment for specific patients, you can use algorithms to improve healthcare. There’s a whole load of stuff you can do but you need to invest in it.’
The Sláintecare report promises a shift in Mental Health services from institutions to community centres, and notes that the current treatment system is overley reliant on medication, and lacks qualified health professionals such as counsellors, speech and language therapists and occupational therapists. This deficiency in counselling services and ‘talk therapies’ has caused a nationwide over-dependence on medication and hospital services, including A&E’s. These problems in the Mental Health sector have caused problems in providing mental health services in schools and in early diagnoses in children. I questioned Mr. O’ Tuathail as to whether Sláintecare will include an investment in mental health education and increased availability of counselling services in secondary schools.
“I think mental health is probably one of the most underfunded parts of our health system and it needs a massive increase in funding to catch up. Overall, we probably spend on the side of too much on healthcare in general, but on mental health we’re way underspending what is needed to give people proper services. In terms of schools, early intervention is really important. We are talking about giving guidance counsellors a form of counselling training, enough to be able to help students and to be able to triage the people who are really in need of counselling services.”
Perhaps the biggest focus of the event was on the need for primary care centres in communities nationwide, and therefore reducing waiting lists in hospitals. Conditions in hospitals are causing junior doctors to emigrate, something Sláintecare sees as essential in reversing. A programme will be launched to bring back GPs and nurses who have emigrated, and for them to be centrally involved in the reform. Shortall stressed the need for doctors to be valued and receive the same job satisfaction as in other European countries. When questioned as to how the proposed health service would prevent junior doctors from emigrating, and whether working hours for junior doctors would be reduced to align with other european countries Ms Shortall responded;
“Absolutely. We would also shorten training period for doctors which is longer than other countries. The follow on training (internships) in hospitals is much longer than other countries and that needs to be dealt with.
“The problem is that there are too many people that are doing okay in the system as it is that are holding back reform because they’re happy to continue on with what we have, but it’s the people who have left the country that we need to be catering for. There’s a need for government to take charge, to start saying this is what the country needs, these are the terms on which we want people to work for us rather than being dictated by different groups of employees within the health service.”
On the subject of whether he believed the potential abolition of the SUSI grant would further the decline in the number of junior doctors, Mr. O’ Tuathail said the following;
“The SUSI is very restrictive at the low income level and a lot of people are priced out of education because they’re just above that income level and they can’t afford to go into education. Medicine has a long study period, if you don’t have the money behind you, you can’t do it. It’s really important that this shouldn’t be a barrier to anyone going into education. That’s why we are very supportive of increasing the SUSI thresholds and reducing fees so that everyone can afford to be educated. We need to be training more doctors and more nurses.”
The Sláintecare plan is a huge undertaking, but it seems to be a positive step forward in bringing Irelands healthcare system up to the standard its people deserve with a public system with timely access available to all.
If you would like to know more about Sláintecare the full report can be found on the Oireachtas website or follow the link below: