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The Renewed Programme for Government – little new on health….

Posted in Blog by saraburke on October 16, 2009

The health section of the new Programme For Government has been called ‘all Fianna Fail’. But it is not all Fianna Fail, it’s all PD, with a few minor Green hints in it. It is PD health policy reflecting that we have had a PD minister for health for the last five years.

I presume the health section was written in its entirety by Oliver O’Conner who is Harney’s advisor in health. There are few new commitments in it, no costings, but there is no need for costings as there is little extra in it.

The leaked document by Irish Times’ Stephen Collins said the Greens were looking for a one tiered universal health system. And what did we get? The intro to the Renewed Programme for Government under health says “We will take further progressive, detailed steps towards building universal health services that provide high-quality care, fair access and affordability for all.” This is a far call from a commitment to introducing universal, one tiered, free care for all. More detail on the ‘Renewed Programme for Government’ here including colocation, cancer services, screening and vaccine, mental health and the Resource Allocation Working Group …Apart from the aspirations on universal health services, the Renewed Programme for Government puts a lot of emphasis on the Resource Allocation Working group which is currently chaired by Frances Ruane of the ESRI.

Last week, when I put it to Harney that what we have is far from one tiered universal access she also kicked to touch with the Resource Allocation Working Group. They are due to report by April 2010. The Groups is interesting as it is made up of medics, academics, only one person from Dept of Health and even two health economists. Plus recently apparently the Dept of Finance got itself a seat at the table – which must indicate soemthing about its power… So the big question is what will come out of this group? Will it recommend more of the same or something completely different?

Anyone looking at the health system would acknowledge it is a very complicated, unfair mix/mess. What we need is a way out. While the group is called Resource Allocation it has scope to look at how health service is funded and structured eg we know from international experience that more complicated systems can be more expensive, that those with different incentives, like we have, results in unequal outcomes eg how doctors and hospitals are paid for public and private  patients.

Given the people on the group, one could be hopeful (although no confident) that they might come up with a road map out of the unequal, complex, inefficient, system that we have. But we will have to wait til next April to find out.

Apart from the Resource Allocation working group, what’s in the health section? Basically it’s a cherry pick of bits of current government health policy that are happening anyway

  • the new build for the children’s hospital is in there
  • the cancer control programme focussed on eight designated cancer centres
  • “colorectal screening and cervical vaccination programmes at the earliest opportunity, in accordance with clinical priorities’.

Speaking to Dan Boyle yesterday he said he is confident they will happen in 2010 and 2011 respectively – but I suspect that was Prof Tom Keane’s plan anyway. Other commitments which are rehashes of government policy are

  • The Fair Deal
  • Primary care:, more teams, redeploying staff, chronic diseases… (heard that somewhere before)
  • Interestingly under primary care it refers to “modernised health eligibility legislation” which I assume is coded language for further restricting access rather than increasing it is but hard to tell.
  • “We affirm our commitment to improve income eligibility limits in the assessment for medical cards for children with intellectual disabilities” – they committed to this last time and nothing has happened.

In relation to co-location – the plan to co-locate private for profit hospitals on the grounds of public hospitals, the wording is to “Proceed with the current programme of co-location, limited to already committed projects under the existing project contractual agreements”. Now this is pretty similar to the wording in the HSE service plan which says they will proceed subject to “satisfactory banking arrangements”. You could given market conditions think this means virtually none of them would go ahead anyway. However, the Greens are indicating that this means just three of them would go ahead rather than the 7 which are in the Service Plan. Presumably, the ones going ahead are Limerick, St James and Beaumont, that means Cork, Waterford, Tallaght and Blanchardstown may not be going ahead.

Other public hospital commitments are very much in line with HSE plans to reconfigure and rationalise acute and emergency services.

Other Greens specific commitments include a commitment to “commence a bio-monitoring programme in 2010 to measure fluoride levels, which will provide robust baseline data on the level of Fluoride in the general population” – there has always been some disagreement over the safe or right levels of fluoride that should be in water so I presume that that what that’s about… And to “introduce stricter requirements for labelling of alcohol products.’ I presume that is government policy ignored to date but got in their by the Greens.

The section on mental health looks like a short version of plan that Minister Maloney has promised anyway – which is an implementation plan for the mental health policy: A Vision for Change. However, speaking to Dan Boyle he felt they had made specific progress regarding a commitment to amend the mental health act regarding involuntary committals and procedures.

My overall conclusion on health in Renewed Programme for Government is that it is pretty much more of the same. Lets hope the Resource Allocation working group comes up with something radical about changing the system we have because we need it….

So really the big things to watch are

  • Will co-located hospitals be limited to just three?
  • Will colorectal screening and cervical cancer vaccine happen soon?
  • What will the Resource Allocation Expert Group say particularly given the inability of the market to fill the gaps in the public health system in current economic crisis?

Time will tell….

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