SECOND OPINION:Absence of health promotion means proposals will fail, writes JACKY JONES
WE WILL be electing a new government in a few days and we need to know what the three main parties are offering us in terms of future health plans. Will any of them make a difference to you and your family?
The plans of Fianna Fáil, Fine Gael and Labour have a lot in common and some differences but, in reality, there is not much to choose between them.
First, none of the parties has much to offer in terms of promoting health and wellbeing, although the Fianna Fáil plan mentions it on the second page and refers to the introduction of graphic health advice warnings on tobacco. The Fine Gael and Labour plans do not propose any health promotion actions. This is a big disappointment because unless the new government takes the promotion of health seriously, their plans will fail whatever party or parties are elected.
All three plans emphasise the development of primary care teams (PCTs), but there are huge discrepancies in numbers depending on which plan you read. Fianna Fáil claims there are 394 PCTs up and running, Fine Gael says there are only 97 with just 10 fully functional, and Labour claims 11 are fully functional and the rest are virtual. The true figure probably lies somewhere in between.
The number of teams is, in my opinion, less important than how they are functioning. It is very difficult to get different disciplines to work together in an interdisciplinary way and this is not just an Irish problem.
The way health professionals are trained and socialised “on the job” is a big barrier to team working. People are trained in a discipline with and by others from that discipline and they learn the mindset. The system still supports parallel working, for example departments produce their annual business plans in isolation from other departments. What is needed is a shift from vertical to horizontal ways of working. Calling groups of people a team does not make it so, and unfortunately none of the three parties addresses this problem.
Prevention and management of chronic diseases are covered in all three plans but without any specific proposals about how this is going to be done other than more screening and an emphasis on PCTs. Fine Gael will provide a “national body test”, so at least we have that to look forward to.
The plans say nothing about whether the prevention programmes will focus on individual lifestyle changes or whether the PCTs will work with local authorities to create healthier environments. Even Canada, often hailed as having a great health service, seems stuck at an individual lifestyle change approach even though its own government policies call for inter-sectoral action. There is no reference in any of the plans on the cross-sectoral approach that is required if chronic diseases are to be prevented.
Fianna Fáil will keep and develop the HSE, Fine Gael will get rid of it and Labour will keep a version of it but hand accountability for services back to the minister for health. Both Fine Gael and Labour will introduce universal health insurance whereas the Fianna Fáil plan does not say how they will reform the present inequitable system of funding the two-tier health services. One has to wonder if any party studied the Report of the Expert Group on Resource Allocation and Financing in the Health Sector published last year and accompanied by two volumes of evidence gathered from home and abroad. This group looked at how health services are organised and funded in, among others, the UK, New Zealand, Canada, Germany, the Netherlands and the US.
This report concludes that it doesn’t matter whether services are funded through taxation or insurance, what counts is how effective the system is. It does not recommend the Dutch system, which is proposed by Fine Gael, nor does it recommend separate insurance funds for primary and acute care as proposed by Labour. In fact, it says all systems have their own problems.
The main messages in this report are: full integration of services at every level, development of the medical card system, and putting incentives into the system for patients and providers, so that people will behave in ways that are good for their health. It points out that there are scant rewards for activities that promote health and wellbeing, and it recommends that financial incentives should align all actors in the system consistent with promoting health and wellbeing. In fairness to Labour, it uses some parts of the report, Fianna Fáil barely refer to it and Fine Gael ignore it altogether.
So who should we vote for? The plans have little to choose between them, so you are safe enough in terms of your future health if you vote for your favourite candidate.
Jacky Jones recently retired as regional manager of health promotion with the HSE