Key recommendations in the final report of the all-party Committee on the Future of Healthcare have been amended at the insistence of Fine Gael and Fianna Fáil members.
The committee tasked with producing a 10-year plan for the reform of the health service is to publish its final report on Tuesday.
One of the committee’s most radical proposed reforms is that private practice be completely removed from public hospitals.
However, following votes on the committee in which Fine Gael and Fianna Fail joined forces, the recommendation has been amended to include a provision that an independent analysis take place first.
The report now says that the committee “acknowledges that removing private care from public hospitals will be complex.
“It therefore proposes an independent impact analysis of the separation of private practice from the public system with a view to identifying any adverse and unintended consequences that may arise for the public system in the separation.
“Given the acknowledged need to increase capacity in the public system, it is imperative that any change should not have an adverse impact on the recruitment and retention of consultants and other health professionals in public hospitals.”
A copy of the final report has been seen by The Irish Times.
Private insurance
Currently patients with private health insurance can receive quicker access to many services in public hospitals. This is because many senior doctors have contracts which enable them to work in both public and private sectors, and the hospitals facilitate such treatment, charging health insurers over half a billion euro a year. The report acknowledges the State will have to replace this funding, which it puts at €649 million for this year.
The elimination of private care in public hospitals should be phased in over five years, it says.
The report also says health budgets will have to be significantly raised with a guaranteed €380-€465 million increase every year to fund increased services, while funding will also have to be raised to meet increased costs and demographic pressures. In addition, the report says that €3 billion should be provided over six years to meet once-off reform costs.
Taken together, the increased funding for healthcare would run to several billions over the committee’s 10-year time frame. Many of the costs would be recurring, meaning they would have to be provided for every year.
The report recommends a massive planned expansion in healthcare services, and says an entitlement to care should be legislated for by the Oireachtas.
Findings
It says that services must be expanded in a variety of areas and that many charges should be eliminated in the public system.
Among the other reforms and service expansion it calls for are:
* the adequate resourcing of child health and wellbeing services;
* the reduction and removal of charges;
* the expansion of primary care, social care, mental healthcare, dentistry, and
public hospital activity;
* the expansion of public hospital activity, including through removal of private care from public hospitals;
* the expansion of public hospital care, and specific waiting time guarantees;
* the expansion of health and wellbeing and other measures central to providing integrated care, and the doubling of the health and wellbeing budget;
* adequately resourcing of child health and wellbeing services, including implementation of the National Maternity Strategy;
* reduction and removal of hospital inpatient charges, reduction of prescription charges and drugs payment scheme threshold;
* expansion of primary care, including investment in community diagnostics, free GP care and fully staffed primary care teams to include counselling and other community based services;
* social care expansion, including investment in palliative care services, homecare services and community services for persons with disabilities;
* mental healthcare expansion and investment in primary care counselling and staffing of mental health teams;
* dentistry expansion including reinstatement of previous public dental schemes;
* public hospital activity expansion, undoing two-tier access to public hospital care, including increased access to diagnostics in the community, reduced waiting lists for first outpatient department (OPD) appointment and hospital treatment, and expanding public hospital capacity by removing private care from public hospitals.”
One of the strongest concerns of the committee is to ensure that this is "not just another report on the health sector which is not implemented". It calls for early implementation of the report, to be monitored by a unit in the Department of the Taoiseach.
