Minister for Health Simon Harris TD speaks to eolas regarding health expenditure, Sláintecare priorities and abortion legislation, as well the challenges of anticipated winter pressures and Brexit.
The Taoiseach has said: “Of all areas of Government expenditure, health demands the greatest level of reform… It is one of the highest levels of expenditure per head of population anywhere in the world, which given our relative youthful population is hard to justify.” How do you intend to improve health spending in terms of efficiency?
I think the Taoiseach is articulating the frustration some people have. There are huge resources allocated to health and we have yet to create a health service that is perfect. I understand that frustration, but I think it is important to have context. The health service is demand-led. We don’t have the luxury of telling patients to come back next year when there are more resources available. The health service has to adapt to the challenges that present throughout the year. We can prepare but we cannot provide for every eventuality. If you examine the overrun this year, it included €40 million for Storm Emma, an increased spending on new and existing medicines, increased pay-outs from the State Claims Agency and increased spend on older people. Nobody could argue that these areas did not require resources.
The reason healthcare is so expensive in Ireland is down to the model we have. It is not as efficient as it could or should be. The majority of activity occurs in the hospital environment, not in a community setting. We have to change the destination of travel.
In saying all of that, the Health Service Executive will receive a Budget of €17 billion next year and people expect an improved, efficient service in return and I, as Minister, am fully aware of that.
That is why this year we have done things differently this year. We have directed the HSE to prepare their budget in a different manner. Everything must now be seen through the prism of Sláintecare – the 10-year plan to reform the health service. Efficiencies must be made. Reforms must be introduced. Every single hospital manager around the country must be aware of that. The days of blank cheques are over.
“Sláintecare is not another report destined for the shelves. It is a plan agreed by every party in the Oireachtas, embraced by the Department of Health and the Health Service Executive.”
But we shouldn’t allow this narrative to persist whereby people claim additional money is not matched by improvements. Additional resources have resulted in significant improvements across the health service. We often fall into a trap of believing everything that happens in the health service is bad, but we should never forget the hard work and dedication of those who work in our health service or the fact that 84 per cent of patients reported good or very good experiences of their hospital care via the National Patient Experience Survey.
What are your current priorities with regard to the implementation of Sláintecare?
Sláintecare is a really exciting project. For the first time ever, we have a 10-year plan to reform the health service. This plan will outlive me as Minister for Health and probably my successor too. There is something refreshing about that. We now have a clear blueprint for reform.
As you know, Laura Magahy has been appointed executive director and she is doing an incredible job. We have also appointed Tom Keane as chair of the Sláintecare advisory council. Nobody can doubt Tom’s track record of reform and we are really lucky to have him. I expect to be in a position to publish a plan early next year detailing very clearly the policies that will be in place by this time next year.
Sláintecare is not another report destined for the shelves. It is a plan agreed by every party in the Oireachtas, embraced by the Department of Health and the Health Service Executive. It is a plan that can and will work.
People, most particularly those in the health service, have reform fatigue. They want tangible evidence of improvements and Laura and her team are determined to be open and transparent about the work they are doing. My priorities continue to be taking steps to reduce waiting lists and bring the care back into the community. I also want to see improvements in HSE governance and I hope to be able to make appointments to the HSE board over the coming weeks.
The pace may appear to be slow, but these measures are the foundations of change within our health service.
Ireland is still the only western European country not to have universal health coverage for primary care. How will Sláintecare address inequalities in access to healthcare?
As you know, I have asked Donal de Buitléir to examine the separation of private practice from public hospitals. That report is due to be submitted by the end of the year.
I am quite clear that I do not believe a person’s ability to pay should not determine their level of access to health services. But I acknowledge the separation of private practice from public hospitals can be quite complicated and I hope the Buitléir report will address those issues.
“Our EDs will not be a nice place to be this winter and should be avoided, if possible.”
The Government has tried to address the cost of healthcare by other means. We have reduced prescription charges, legislated for children with disabilities to get medical cards, given carers medical cards, given hundreds of thousands of people free GP cards and in 2019, we will reduce car parking charges in hospitals. This does not equate to universal healthcare, but we are making incremental changes which have significant impact for patients.
As Minister, what are your aspirations for the Regulation of Termination of Pregnancy Bill?
My aspiration and absolute determination is to have a safe, woman-centred service in Ireland.
The people made a very clear decision in May – to remove the Eighth Amendment and issued legislators with a clear instruction to care for women in this country. Significant resources have been allocated to provide termination of pregnancy services in this country. As Minister, I am absolutely committed to ensuring this service is available to women in crisis pregnancies in January 2019.
The introduction of any new service is always challenging but my Department and the HSE is working tirelessly to ensure women in crisis pregnancies will have a safe service in place in early 2019.
I also want to preside over a service respectful of those who conscientiously object. I respect the fact that there will be many who work in the health service who do not feel comfortable with the provision of this new service. I want to see a system whereby those views are respected and upheld.
However, my absolute priority is the service user – the woman – and ensuring she feels safe and respected. This is about compassion and care at a time of crisis and I am eager that this service will be in place in January. Women have waited long enough.
What steps has the Department of Health taken in anticipation of increased demand this winter?
This winter will be a challenge for the health service. There has been a huge amount of work undertaken by the health service in preparing for this difficult period. Over €30 million has been allocated including €16 million for social care supports. This includes 550 homecare packages and additional aids and appliances. There will be more beds too.
I think we need to be honest with people in this regard. This will be a difficult time for the health service, but I want to assure people everything that can be done is being done. I am really encouraged by some of the new and innovative things the HSE is trying in this area.
Its efforts will be focused on an enhanced focus period from the 17 December 2018 until 13 January 2019. There will be ‘Winter Ready’ clinics in the community established, diagnostic access for GPs for acute presentations increased, and arrangements are being made for private providers in terms of access to diagnostics and access to inpatient beds for post-trauma surgery patients and for stepdown patients.
The challenge will be most acute in our Emergency Departments. Our EDs will not be a nice place to be this winter and should be avoided, if possible. This is particularly the case for older people. We are extending the opening hours, and expanding the services in Local Injury Units, Minor Injury Units and key Primary Care Centres to offer people an alternative to the EDs.
In the context of Brexit, how is your Department working to mitigate the challenges posed to Irish healthcare?
Nobody in Government is under any illusion about the difficulties Brexit poses. The Department of Health and its agencies including the HSE has been engaging in intensive Brexit preparedness and contingency planning in the area of health.
A number of issues are being examined and contingency planning for a range of eventualities is underway. A key issue will be to ensure that there is minimum disruption to health services and that essential services are maintained on a cross-Border, all-island and Ireland-UK basis. Priorities include ensuring continuity in the supply of medicines/medical devices, ensuring access to services, manpower in our health services, continuation of existing cross border health co-operation and public health arrangements.
This work is informing requirements and ensuring that we are prepared in all scenarios.