The intention of Sláintecare was to take politics out of healthcare. Why then was it a document prepared by politicians with little regard to the actuality of health provision in Ireland currently? It is political decisions that have led to the most significant crisis this service has seen with regards to consultant posts unfilled and a manpower crisis in general practice exacerbated by a failure to reverse the Financial Emergency Measures in the Public Interest (Fempi) cuts imposed on general practice.
At the launch of the implementation plan for Sláintecare yesterday, Minister for Health Simon Harris spoke about previous and much lauded (at the time) health reform plans. Unfortunately, like all plans with no accompanying budget they have not improved healthcare delivery in Ireland to the extent we would wish and what we have seen instead with savage budget cuts is a drastic reduction in the number of beds available to patients, a crisis situation in general practice and a shortage of medical professionals that is unprecedented.
Healthcare in Ireland needs significant and urgent funding and there is simply no escaping that fact. The reversal of the 30 per cent pay cut to all new entrant Consultants needs to happen as a matter of urgency. The Fempi cuts need to be reversed for GPs as they will be for all those who suffered them.
We welcome in particular the recognition in Sláintecare of the urgent need to open more beds in Irish public hospitals. We also welcome the emphasis on universal healthcare. We welcome the recognition of the importance of community-based care and the need to address the recruitment and retention crisis that leaves us with almost 500 unfilled posts and a deepening GP crisis.
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But that doesn’t mean that everything in Sláintecare is to be commended. It was worrying to hear the Minister’s vagueness on what additional resources will be made available to support the implementation plan. And what resources were identified seem to be heavily focused towards grand building projects such as the construction of new elective-only hospitals when our existing stock of public hospitals is crying out for resources to simply keep going. And forgive us for being sceptical about the commitment to additional resources for community-based care (eg GP services) when the Government has failed to support general practice by reversing Fempi cuts that were imposed during the financial crisis, or about the challenges in funding a hospital system where private income of €600 million a year is to be lost.
Instability
The biggest concern as we move into the implementation phase must be the current instability of the public health system. If I had plans to develop and expand my current house, I’d want to be confident that the foundations of the current structure were solid and capable of bearing additional weight. In the Irish healthcare system, the foundations of each of the key pillars of the service – general practice, public hospitals, public and community health – are in a fragile state. The question my colleagues and I ask on a daily basis is not how the reformed health service will look in a decade, it’s how we can keep the current system going through the next few months.
As doctors we’re trained to recognise symptoms of illness. So we recognise that the clearest reflection of the ills of the Irish healthcare system at present is the recruitment and retention crisis among doctors. We have almost 500 empty consultant positions across the country. We have 700 GPs preparing to retire with no replacements in sight.
Yesterday’s media blitz painted a wonderful picture of the type of healthcare service the Minister aspires to creating. But he needs to be absolutely supported with adequate funding and to move quickly to ensure that there is proper engagement with the doctors he needs to provide care for the patients of Ireland.
Dr Peadar Gilligan is president of the Irish Medical Organisation