Health policy
As the new Dáil considers the best way forward for Ireland’s health services, eolas summarises the parties’ election campaign commitments.
Fine Gael
Minister: Dr James Reilly TD
Fine Gael’s first priority was to radically reform the current health system (2011-2015) and then to introduce universal health insurance, abbreviated as UHI (2016-2020).
The first phase would involve treating more patients in the community, especially those with chronic conditions. A ‘special delivery unit’ would report directly to the Minister on eliminating long waiting times.
Free GP care would be widened, as finances permit. Risk equalisation is needed to make the Irish insurance market work more effectively. An end to co-location was promised. Paying hospitals for the number of patients treated should increase productivity by 5-10 per cent.
“No A&E services will be withdrawn unless a demonstrably better service is put in place and is seen to work,” the manifesto also states.
Under UHI, insurance companies would take on much of the administrative burden; the market is expected to double in size. The state would pay for children, students, medical card holders and their families, as well as subsidising those on low incomes.
All insurance companies must offer a standard package, covering hospital, GP and maternity care, with no discrimination. State funding would cover long-term care, mental health and disease prevention.
Prior to UHI’s introduction, the HSE would be split into two organisations:
• a healthcare commissioning authority (HCA), to acquire “cure services” such as hospital and GP care.
• a care services authority (CSA) to acquire “care services” for the elderly, disabled and children etc.
The HCA would cease when universal insurance is introduced, with hospital- related staff employed directly by hospitals and other staff going to the CSA. Hospitals would also have more independence. A separate patient safety authority would provide advocates to ensure complaints are investigated.
Breast screening would be extended to 65-69 year old women. A national carers’ strategy, national dementia strategy and national children’s hospital were prioritised.
Labour
Ministers of State: Roisin Shortall TD & Kathleen Lynch TD
Labour aimed to roll out universal health insurance; the initial target was have all persons registered with GPs covered by primary care insurance by 2014. More GPs are also needed. The Exchequer- funded ‘primary care insurance fund’ would pay a capitation fee for each person registered.
Universal hospital care insurance would be phased in over six years. Similarly to Fine Gael’s proposals, hospitals would be paid according to the number of patients treated. Each patient could therefore be seen as a ‘gain’ rather than a ‘drain’. A 100 per cent subsidy on
insurance premiums for those on medical cards would fall to none for those who can afford to pay their own premium.
Medical card holders and uninsured patients would be automatically enrolled by a non-profit insurer, formed from the National Treatment Purchase Fund and the HSE’s purchasing arm. The HSE would continue to manage mental health, community care and social care.
Hospitals would gain independence from the HSE and be operated as independent, not-for-profit foundations or trusts, with local people sitting on
boards. Networks of smaller hospitals could also be set up. Hospitals and hospital groups would be free to compete to supply care to private or public insurers. This would not be a free market, the party emphasises.
The National Children’s Hospital, a new hospital for the north-east and relocating maternity hospitals to acute hospital campuses in Limerick and Dublin were priority projects. The party sees mental health care as best provided in the community, and is keen to develop a national ‘walk-in’ service for young people.
Fianna Fáil
Spokesman: To be appointed
“Now is not the time to dismantle a service that is still evolving,” Fianna Fáil said in its health policy statement. The party was committed to reducing duplication and diverting funding to front-line services. It wanted more integration within the system, and warns that universal health insurance would not be a panacea.
The HSE would continue in operation.
In public health, the party aimed for a tobacco-free society and would introduce graphic warnings on tobacco and alcohol products. Alcohol advertising near schools and colleges would be banned.
Other proposals included emergency care networks to co-ordinate A&E departments, national colorectal screening from 2012 and a national paediatric hospital by 2014.
Co-location would stop with the four hospitals which have already signed contracts. Health was only occasionally mentioned in the party manifesto, although this does back the ‘Silvertech’ initiative i.e. the HSE and multi-national companies working closely to introduce new health technology.
Sinn Féin
Oireachtas Spokesman: Caoimghín Ó Caoláin TD
Northern Spokeswoman: Michelle O’Neill MLA
Primary and preventative healthcare must be at the core of a new health system. Current health cuts would be reversed and the transition overseen by a ‘health funding commission’. Free GP services, dentistry and prescriptions were promised along with an end to co- location and public-to-private subsidies.
A state company would be responsible for drug distribution, using lower cost generics. All citizens would receive regular health screening. Twelve per cent of health funds would allocated for mental health, in line with World Health Organisation (WHO) guidelines.
Acute neurology and stroke services were prioritised.
In a separate section, ‘Uniting Ireland’, the party calls for all-island public services, including health. The party’s MEP, Bairbre de Brún, was the North’s Health Minister from 1999 to 2002.
United Left Alliance
The alliance incorporates the Socialist Party, the People Before Profit Alliance and the Workers and Unemployed Action Group. Its programme called for an end to “profiteering” in healthcare, with no co-location or subsidies to the private sector, and backed a free public health system.
The Socialist Party claimed that previous government policy subsidised private medicine at the expense of public healthcare. It demanded a hospice for the south east and faster diagnoses on the public system. The party also supports strike action by hospital workers in protest against cuts. Fine Gael’s policy is dismissed as a “charter for privatisation”.
