Shoddy proposals and pet demands – a new low for Ireland’s health policy
My analysis from the Irish Independent on 14 April 2016
Repeated surveys show that the state of our health system is the people’s number one concern. Yet Fine Gael’s health proposals (covered in previous articles) are very weak while health gets barely three pages in Fianna Fáil’s ‘Priorities for Government’ document.After a short, unperceptive critique of the current health system, Fianna Fáil makes promises under two headings – ‘actions within six… [and]… within 12 months’. Such short-termism suggest this party is not serious about going into any form of government, never mind a government that has any hope of lasting. Fianna Fáil says it will introduce multiannual funding for health, starting with the next budget. The HSE has already sought this and there is general agreement it should happen.
Fianna Fáil commits to greater transparency and consultation in the budgetary process. All parties are now advocating this in the form of an all-party budget committee and budgets being worked through the Daíl months before Budget day.
If Fianna Fáil gets its way, there will be a Minister of State with responsibility for Primary and Social Care with a seat at Cabinet. While this is one way of placing the much-needed emphasis on non-hospital care, there is also a possibility it will lead to a greater fragmentation of services for people. Internationally, the trend is on integrated pathways trying to ensure seamless care across the health system, with the patient at the centre, instead of segregating care inside and out of hospitals.
If in government, Fianna Fáil will allocate €100m to alleviate waiting lists, double what is in the Fine Gael document. Similar to Fine Gael, it pledges to give medical cards to children in receipt of the Domiciliary Care Allowance, reduce prescription charges for medical card holders (which Fianna Fáil introduced) and introduce a tax on sweetened drinks.
It wants a new GP contract and expanded role of rural GPs – both of these are already works in progress. Fianna Fáil specifies the need for more personal assistant hours for people with disabilities and additional homecare hours.
Similar to its health policy, Fianna Fáil’s health “priorities” are largely a restatement of existing policy without an ounce of vision for an improved health system.
Critically, its “priorities” fail to address the underlying causes of the failures of our system. It is planning to revive the NTPF to reduce waiting lists but there is no mention of dismantling unequal access to care, not a word on quality of care, nor how existing capacity (ie. staff and money) could work more effectively. More resources are needed in health but any priorities must specify how the additional capacity would ensure better health outcomes.
Any Fianna Fáiler asked about the next government spouts the same mantra about the importance of ‘building policy consensus’, ‘protecting and supporting the most vulnerable in our society’, ‘ending the two-tier society and ensuring that fairness will be one the hallmarks of the 32nd Dáil’.
The problem is the gap between their rhetoric and their ‘Priorities for Government’ document, whose health section is a clear indicator that they are not interested in policy consensus, ending the two-tier health system or fairness.
If a Fine Gael minority government materialises, Fianna Fáil will not sign up to any Programme for Government. However, there will have to be agreement on key policy areas beyond political reform, presumably in budgetary matters, health, homelessness and housing policy. That being the case, Fine Gael and Fianna Fáil’s shoddy proposals could merge with Independents’ pet demands for their own specific constituencies to reach a new low in Irish health policy.
International research on minority governments shows that having a clear strategy and long-term objectives are key to their success. Fianna Fáil is looking for health officials to have “full and open consultation” with the Oireachtas Health Committee “on what is required to meet demographic demands and unmet needs”, while Fine Gael is proposing that the Oireachtas Health Committee hold hearings on how best to progress towards universal healthcare. The real problems in the Irish health system are a result of government policy. And they can only be solved by sustained policy change, probably over the lifetime of three or four governments.
Given the absence of any clear strategy on health from the two largest parties, the possibility of Oireachtas-wide consensus on the future of healthcare throws a little light at the end of the gloomy political tunnel.
When the Green Party was negotiating a Programme for Government in 2007, Fianna Fáil negotiator Seamus Brennan told them “You are now playing senior hurling – but you are playing with lads with all-Ireland medals.”
Nine years on, there is no sign of any senior hurlers, never mind All-Ireland medallists. Maybe the two main political parties need party-wide Oireachtas hearings to reach a consensus on health. Or else a general election, which is sure to up their game so that they may finally grasp the urgent concerns of the population.