Sir, – Following the resignations of senior members of Sláintecare, the Minister for Health must be ambitious in setting up his new board and in providing direction. Our health services have been badly in need of reform for many decades, and it is the legacy of successive governments tinkering on the margins of change and producing reports, which for the most part are filed and forgotten. The Covid-19 pandemic has left an increasing demand for health care services, and we now have almost a million people on a waiting list, with many waiting more than 18 months. We have had many published action plans to deal with waiting lists, but all have been abject failures, as the waiting list continues to grow.
One of the greatest deficits in healthcare in Ireland is the lack of universal coverage for primary care. International trends and the evidence suggest that comprehensive primary healthcare services are the root of modern health service delivery. In its absence, we have total reliance on secondary health services, which results in total dependence on our hospital system.
There is no denying that health needs are infinite and resources are finite, but the challenge for any review of the current system is to examine where and how resources are targeted, finding models of efficiency and the creation of new services.
The OECD Observatory report 2018 indicates that health spending in Ireland per capita is higher than in most countries. However, a key factor is that Ireland’s public health spend, at 70 per cent, is below the EU average.
Reform represents challenge and change and that must be a key consideration in Sláintecare discussions. We cannot continue with a system of healthcare where demand for basic services is outstripping services, and there must be change. “If history repeats itself and the unexpected always happens, how incapable must man be of learning from experience” (GB Shaw). Ironically, in the case of healthcare in Ireland, it’s the “expected” that always happens! – Yours, etc,
SEAMUS COWMAN,
Professor Emeritus,
Royal College of Surgeons
in Ireland,
Dublin 2.
Sir, – The decision to appoint the HSE director general and Department of Health secretary general as co-chairs on a new programme board to implement the Sláintecare plan would be comical were it not so serious. Were the Department of Health and senior HSE management capable of reform, we would not require Sláintecare in the first place.
Prior to even commencing with Sláintecare, the first step needs radical reform of both Department of Health and HSE senior management. Any reform must include independent oversight of senior management in both the HSE and Department of Health. Doctors and nurses are subject to regulatory body oversight and face public fitness to practice hearings for failings.
In contrast, HSE and Department of Health senior management are not currently subject to any independent oversight. This two-tier level of oversight is deeply discriminatory and profoundly unfair to frontline doctors and nurses, particularly given that many case errors are as a result of inadequate resourcing by the HSE and Department of Health.
Proceeding with Sláintecare without first reforming senior management in the Department of Health and HSE and introducing some long-overdue managerial accountability will be the height of folly and carries huge financial risks for the Irish taxpayer.
The suggestions that Department of Health and HSE senior management can essentially reform themselves is quite frankly ludicrous. – Yours, etc,
RUARY MARTIN,
Sandyford,
Dublin 18.
Sir, – It comes as no surprise that the implementation of Sláintecare has run into difficulties. In April 2019, the long-awaited new national oral health policy, Smile agus Sláinte, was announced. This was the first national oral health policy in the history of the State. The policy document was five years in the making and is more than 150 pages long.
In the document, it is stated that “most of the oral healthcare will be provided by local dentists and their teams”. Over 90 per cent of these “local dentists” are members of the Irish Dental Association. Despite numerous requests, the association was denied any representation in the development of the Smile agus Sláinte policy and offered no meaningful engagement in its preparation. Drafting any policy document without proper consultation with those who will be required to implement the policy is inevitably going to create difficulties. – Yours, etc,
CONOR McALISTER,
Dentist,
Dublin 12.