Slaintecare – just don’t hold your breath

County View

County View
John Healy

Slaintecare was unveiled with bells and whistles last week. The radical plan to transform our health system and deliver the utopia of free health care for all has finally been launched. The end is in sight for our two tier system, for the contradiction of private beds in public hospitals, for the privately insured being able to jump the waiting list over their less privileged brethren. And all with a new HSE board to boot.
And, for the first time, the new health plan has managed to achieve political consensus, with cross party support for the ten year rollout of Slaintecare. No longer will it matter which party is in power, or which Minister for Health holds office, Slaintecare is untouchable.
Its objectives are now set in stone, its funding guaranteed, its implementation targets clearly identified. With a one off transitional fund of € 3 billion., and an additional equal amount needed by year ten, Slaintecare comes with a hefty price tag but, the Minister assures us, it will not mean increased taxation.
Good luck with that, as they say.  The new healthcare strategy is akin to demolishing your home and deciding to rebuild it to a more modern standard and design. And if it is going to take ten years, finding somewhere to live in the interim is the least of your worries. Because the more you build the new edifice on old ground, the more you discover all the additional changes which have to be made to your original plan.
With Slaintecare, the central theme of closing down of private beds in public hospitals seems like a straightforward idea. But then, thanks to the skewed combination of health insurance and hospital costs, you discover that private beds had been contributing a disproportionate amount to the running costs of public hospitals. Private patient income accounts for €600 million per annum of the running costs of public hospitals (and if you have ever seen sight of the treatment bill for a VHI patient in a HSE hospital, you will understand why). So the first thing the government will have to do is to fund the loss of income for public hospitals.
And then there are the senior medical consultants who derive a large part of their income from treating private patients in public hospitals. Up to 2500 consultants have contracts which allow them to carry out limited private practice in public hospitals, an arrangement which allows the system to recruit and retain specialists who otherwise would be lured away to jurisdictions where salaries are multiples of what they are here. They too will have to be compensated for the losses unless the whole system is to collapse.
Slaintecare envisages less people being treated in hospital and much more reliance on services in the community. There will be free GP care, €800m. will be spent on putting new diagnostic equipment into the community, primary care will be a key part of the new reforms. But this in turn will depend on replenishing the declining pool of GPs across the country, and reversing the income cuts which have seen so many rural communities deprived of GP services.
And finally there is the knock-on effect of Slaintecare on the health insurance sector. Less and less people will bother with health insurance since the primary benefit – private treatment in public hospitals – will no longer exist. Those who do choose to remain in health insurance will be forced to move to more expensive plans.
The tangled web which is the Irish healthcare system is made up of many strands. It is doubtful whether Slaintecare has fully thought through what the effect will be of unravelling that system.