Opinion: all questions around health should be to do with the funding and implementation of the Sláintecare plan

Health is consistently one of the main issues in general election campaigns in Ireland, and this campaign is no different in that regard. But what is different this time around is that there aren’t as many differences between the parties’ health policies, as we now have an agreed cross-party 10-year plan for the future of the Irish healthcare system.

The Sláintecare plan was launched in 2017 with the aim of creating a single-tier public health system, where access is based on need rather than ability to pay. Critical to the plan will be additional funding going hand-in-hand with reforms to the existing system. 

The plan envisages a reorientation of the health system to focus more on primary care rather than hospital care. At hospital level, one of the most important recommendations of the plan is to remove private practice from public hospitals. At primary care level, it recommends the roll-out of free-at-the-point-of-use GP care to all, along with more diagnostic facilities in primary care settings.

From RTÉ Radio 1's This Week, Tony O'Brien, former Director General of the HSE and columnist with the Sunday Business Post, on how voters can assess election health proposals

As detailed in 2018's Health Service Capacity Review, the plan will require significant capacity improvements right across the health service, including thousands of extra hospital beds, a 20% increase in consultant numbers and a 48% increase in the primary care workforce. A Sláintecare Implementation Office has been established to oversee the reforms.

So if there is broad agreement about the plan, what should you be asking your election candidates in relation to health?

Are you or your party committed to funding the plan?

The Sláintecare plan involves increasing health spending to the point where we will be spending €2.8bn per annum more than we were at the start of the plan at the end of the 10-year timeframe. This is over and above the natural increases in spending needed to cater for our growing and ageing population and medical inflation. A transition fund of €3bn over the first six years of the plan was also proposed, to move towards universal healthcare and deal with some system legacy issues.

From RTÉ Radio 1's Morning Ireland, Laura Magahy, executive director of Sláintecare, discusses healthcare reforms, including the setting up of regional health bodies

Based on the figures in the plan, we should therefore have seen roughly a €1.4bn increase in funding last year (2019) and we should be seeing roughly €1bn per year extra going towards health over the lifetime of the next government. But the extra funding so far for health has not met these expectations, so from a funding point of view, we are already falling behind. Will your candidate support the additional funding needed to pay for the improved services?

Where will the money come from?

This is related to the first question about commitment to funding the Sláintecare plan and will be key to ensuring its success. The proposal in the plan is to fund it via general taxation and some ring-fenced taxes, levies or charges. However, on the up-side, the plan envisages that the additional €2.8bn per annum of public money will be partially offset by nearly €1.5bn per annum less in direct household expenditure on health, arising from reduced or removed charges for services and lower demand for private health insurance.

But given that we also have a housing crisis and funding shortages in a number of other areas of public expenditure, how will your local candidate ensure that the funding from general taxation is adequate for the needs of the plan? What ring-fenced taxes, levies or charges do they propose to bolster the general taxation funding? And if they or their parties are proposing tax cuts as part of their manifestos, how is this consistent with proper funding for health and other services?

What will your candidate do to ensure that the Irish health service is an attractive environment for people to work in?

What will the candidate and their party do about capacity?

One of the biggest challenges in implementing Sláintecare will be increasing the capacity of the Irish health system, which is already struggling to meet demand, before we account for our growing and ageing population. Recruitment and retention of staff, which is already an issue across the sector, will therefore become even more important, particularly in the context of the specific capacity increases called for in the Health Service Capacity Review. We are also competing in a global marketplace for talented health workers, with shortages of staff predicted internationally. 

However, it is not solely about money. Issues are regularly raised about working conditions within the system.  What will your candidate do (in terms of financial and non-financial incentives) to ensure that the Irish health service is an attractive environment for people to work in?

The other capacity issue relates to capital investment across the sector. The National Development Plan allocates €10.9bn to health up to 2027. This money is to pay for new hospitals, primary care centres, mental health facilities, and replacement and refurbishment of community facilities. Yet, as we have seen in recent years, the cost of the National Children's Hospital has ballooned and is likely to end up close to €2bn. What will your candidate do to ensure that the money allocated for all of these other health-related capital projects will be sufficient?

From RTÉ Radio 1's Morning Ireland, UCC health economist and Brainstorm contributor Brian Turner on the past, present and future of Sláintecare

How will Sláintecare be phased in?

The plan contained a very detailed timetable of reforms, with associated costs. However, the outgoing government brought forward some measures and has not implemented others that were due to be in place in Year 1 of the plan. Will your local candidate stick to the Sláintecare timetable? If not, what would they propose to bring forward/push back and why?

The views expressed here are those of the author and do not represent or reflect the views of RTÉ