The future has arrived

An end to private healthcare in State-funded hospitals and removal of tax relief on private health insurance are apparently being strongly considered for inclusion in the Committee’s final recommendations. These issues have grabbed the headlines.

The debate about Ireland’s unusual, perplexing and highly unfair two-tier health system is an important one. The way in which healthcare is delivered also has a myriad of implications in respect of funding mechanisms.

Reportedly, the Committee is tempering its draft recommendation on ending private healthcare provision in public hospitals by suggesting compensation and better rewards for public hospital consultants. The Committee also looks set to propose reductions in out-of-pocket fees in respect of public hospital attendance charges, and prescription charges paid by medical card-holders, for example.

The fact remains, though, that there are very well-established consensus positions on vital reforms that did not require an Oireachtas Committee’s input. The biggest of these is the need for the oft-cited ‘decisive shift’ to primary care, which is pledged in the Programme for Partnership Government and copious reports and policy documents from across the political and medical spectrum over many years (<strong>see Niamh Cahill’s feature on page 4-5</strong>). This reorientation would undoubtedly help keep people out of hospitals.

The Oireachtas Committee appears set to put a price on the shift to primary care, by means of transitional funding of €500 million per year for the next six years.

Most healthcare professionals and health policy analysts agree that this change in healthcare delivery is the most crucial tenet of making the Irish health system fit-for-purpose. Buy-in, however, is the watchword. Whatever one’s opinion on Ireland’s health spending — and there are many — some form of significant transitional funding will be required, as well as a new funding paradigm encompassing the acute and primary care health sectors. And there is no doubt that integrated care will require significant changes in work practices.

Questions remain: Will taxpayers be prepared to view trolley crises and waiting lists with the same distaste as water charges? Will consultants be content to lose fees for consultations more frequently managed in the community, and will they routinely deliver care outside hospital settings? Will GPs be prepared to devolve more care to a wider healthcare team, including community pharmacists, practice nurses, advanced nurse practitioners and physician associates? The impression at the recent Primary Care Partnership Conference in Dublin was that many healthcare professionals are prepared to buy-in; to construct teams rather than, as it was put, ‘empires’. But only once trust is established.

The report of the Oireachtas Committee will present yet another opportunity to strongly orientate towards integrated care, with a shift of emphasis towards the community. And with the tsunami of chronic diseases and health challenges posed by an ageing population, this requirement is a pressing one.

But the most critical buy-in will be political. It will require major investment on many fronts, including transitional funding and implementation of a national electronic healthcare record, which will be so crucial for integrated care. There are also some startling capacity deficits in the acute hospital sector, it must be remembered. Successful reform will hinge on a huge level of co-operation and support between political parties, but most of all from those tenuously holding the reins of power.

In 2007, in an infamously iconic election poster, Enda Kenny pledged to “end the scandal of patients on trolleys”. The can has been kicked down the road far enough. People have suffered long enough.