I BELIEVE even when times are tough, this Government can make a difference to people’s lives. Nowhere is that more true than in the Department of Health, which touches everyone’s life at some point.
Minister for Health Leo Varadkar
I’ve spent the last few weeks meeting staff in the Department, in agencies and in the wider health service to find out what they do, and to get their thoughts.
It’s been rewarding and enlightening. I still have a lot to learn and many more meetings to come, but perhaps I can offer some initial thoughts on my priorities for the next 18 months.
Health tends to make the news when something goes wrong, but 99pc of the time things go right. There are lots of good things going on in Health right now: new primary care centres, hospital facilities and hospices, thorough inspections of nursing and care homes, well-run general practices, clinical programmes which are setting and raising standards, and new screening programmes – to mention just a few.
We should talk about the good things a little more while never losing sight of our mission to correct what remains wrong.
The most immediate challenge is negotiating a realistic and adequate budget for health for 2015. Since the change of government, spending on health has been flat. The big budget cuts were actually made by the previous government of Fianna Fail, Greens and Independents.
But a flat budget in health does not leave any space to care for a growing or ageing population and little space to fund new treatments and services.
Nevertheless, there are lots of good things to come. We have agreed to start with Universal GP Care which means access to your GP for no fee or a nominal fee. This is the first step to Universal Health Care, something which has been the norm in other western countries for generations, but not in Ireland. Our health service is in transition from one which mainly treats sick people in hospitals, to one which mainly keeps people well in their communities.
The first groups to benefit will be children under six and seniors over 70. These age groups need to attend their GP most frequently. We’ll then move on to primary and secondary school children, and then other adults. There will be bumps in the road and we need to be prepared to make changes as we go along. Maybe it might take a bit longer than originally planned, but it’s going to happen.
Universal Primary Care should also include the management of chronic diseases in the community and things like minor surgery and dental and optical services.
Importantly, everyone will be registered with a GP for the first time and will have a unique health ID number. This personal number will apply right across the health service, with benefits for both patients and service providers.
At hospital level, we should concentrate on getting the new Hospital Groups up and running and implementing the ‘money follows the patient’ model of funding. The HSE should remain in place at least until all of this has bedded down.
We can do more to reduce the price of medicines for patients and taxpayers. The HSE has done a great job in reducing the price of some medicines, like Lipitor. But it’s only a start and we should do a lot more to reduce prices and mark-ups.
The next 18 months will be especially exciting for building projects as we lay the concrete foundations for our new health service. These include dozens of new primary care centres and the start of construction work on the new Children’s Hospital, the National Maternity Hospital and the new Central Mental Hospital. We’ve been talking about these projects for too long. It will be great to see the cranes moving in.
Nevertheless, even with all the good things going on, morale among health service staff is pretty low. It’s not just about pay cuts: there is a sense that things can never improve, there is reform fatigue, and a feeling that management, government and media don’t believe they can do anything right. We’re losing doctors, nurses, managers and other health professionals overseas and to the private sector.
Yet the people who work in our health service are phenomenal. With fewer staff and reduced budgets they have produced better outcomes and held our services together. I know I cannot personally reverse the pay cuts. That will be discussed in the run-up to the expiry of the Haddington Road Agreement. But perhaps there are some things I can do to raise morale and restore confidence and trust. It’s important that we make careers and jobs in the health service attractive again.
Thinking long-term, we also need to get a handle on our health as a nation. Many diseases can be avoided or ameliorated with a healthier lifestyle or improved diet, like diabetes, hypertension, or chronic heart and lung diseases. Yet the opposite is happening, and they are having a serious impact on the health budget. That’s why I will be setting aside a lot of time to promote the Healthy Ireland initiative, and I hope to bring forward a new Public Health Bill dealing with alcohol and other matters next year.
Universal GP Care and Primary Care are the first two parts of the Government’s plan for Universal Health Care – the third part is Universal Health Insurance. Personally, I think we need to get Universal GP and Primary Care right and show people that it works before trying to bring Universal Health Insurance into the hospital system. That’s why I think the original timetable to have Universal Health Insurance in place by 2019 is too ambitious.
At the same time, people are giving up private health insurance or downgrading to a cheaper plan. In some cases, tough but necessary budgetary decisions have worsened this trend. I want to work with the insurers to stem the tide and increase coverage. Some changes are already under way, such as discounts for families. Discounts for students and younger people will come next.
I know the next 18 months are not going to be easy, and I don’t think for a second that I can solve all of the problems in our health service, but I do think I can steady the ship. Working alongside Kathleen Lynch, the Minister for Primary and Social Care, and with the support of my Government colleagues, Department officials, HSE leaders, health service staff, and health sector organisations, I think we can make a real difference.
And by focusing on a small number of priorities, I think we can make some real improvements too.
