THE HEALTH Service Executive would be abolished and replaced initially by two separate authorities if Fine Gael gets into government, the party pledged yesterday.
It also promised to reduce the number of staff in the HSE by 8,000 over four years, one-quarter of them through a voluntary redundancy scheme and the remainder through natural wastage.
A Fine Gael statement said the party was committed to abolishing the HSE by 2016 but at a press briefing in Dublin its health spokesman, Dr James Reilly, said it would be gone by 2014 or 2015.
Dr Reilly said the existing “monster” that is the HSE, which had been established by Fianna Fáil leader Micheál Martin, would be replaced by a healthcare commissioning authority which would purchase services from hospitals on a price per procedure rather than block budget basis, and a separate care services authority would procure and manage long-term care services on behalf of the State.
He said local hospital trusts would be established with which patients, staff and members of the local community would have a real say in what goes on in their local hospital, but ultimately accountability for the health service would be restored to the minister rather than left to a quango.
Fine Gael also pledged to renegotiate hospital consultants’ contracts as well as putting in place a new contract for GPs. Dr Reilly said he had not budgeted for many more consultants as the ones in the system were already doing a lot of work they did not need to.
He added that the days when consultants could earn €150,000 from the State and another €300,000 from the VHI were over. Fine Gael also promised a free age-appropriate annual check up for individuals, but this would not be provided in year one due to its cost.
However, beginning next September, it would extend the national cervical cancer vaccination programme to another 70,000 second-level students so all girls would be vaccinated by the time they leave secondary school. There is no commitment to reopen closed acute hospital beds.
Ultimately, Fine Gael’s plan to improve health services would take 10 years to implement. In the first phase it would improve primary care services to ensure more people are treated in the community and a “special delivery unit” made up of clinicians and managers would be established to agree targets with hospitals to reduce waiting lists.
In the second phase of its plan, beginning in 2014, it would change the way hospitals are paid with the setting up of a healthcare commissioning authority and a care services authority. The commissioning authority would be replaced when a system of universal health insurance is introduced around 2016.
Once in place, everyone would have health insurance providing free GP care, with the State paying for children, students and those with medical cards, and subsidising those on low incomes. This would be provided by private health insurers and overseen by an “insurance scrutineer” who would be accountable to the minister, as is the case in the Netherlands.
Dr Reilly insisted the plan could be delivered within two terms for the money already going into the HSE and private insurance policies. He said huge sums could be saved in the HSE on overtime – but was not specific on the amount – and on drugs, and by moving the treatment of chronic illness out of hospitals and into the community.
He said existing HSE staff would move to work for the two authorities that would replace it and ultimately some could migrate to the new insurance companies providing universal cover.
Reacting to the plan, Mr Martin said Fianna Fáil opposed the abolition of the HSE and cautioned that Fine Gael had failed to factor in hidden costs in its insurance model of healthcare.
Speaking in Cork, he added that the last thing the health service needed was another overhaul.
“We do not believe in the privatisation of the HSE as advocated by the Fine Gael party. We do not believe in the privatisation of employees and their contracts with the HSE,” he said.