For many people, the problems in the health service are well-known and the various solutions have been rehearsed ad nauseum.

With the General Election manifestos now published, it's time to have a look at some of what is being promised for health, for the next five years.

Health is a vast subject - and one of the top issues for the public - and there is no shortage of reform promises from politicians.

The backdrop to this is the recent record figure of hospital overcrowding, with 760 patients waiting on one day earlier this month. There have been upsetting pictures of elderly patients waiting on trolleys in emergency departments and 750,000 people are on some kind of waiting list for hospital care, or to be seen at an outpatient clinic.

Sláintecare consensus

To try to remedy this the main political parties have broadly bought into the Sláintecare 10 year reform plan; although there are some differences on emphasis, or phasing.

But it has essentially meant that there are no fundamental differences in health policies - which makes this election a bit different.

Whoever forms the next government, they will be closely judged on delivering on Sláintecare.

Because Sláintecare is agreed as the grand plan, in this election campaign health manifestos differ less on the big things.

Sláintecare is costed at about €5.8 billion.

The way this is broken down is:

  • A once-off transition fund of capital investment of €3 billion over the first six years, for big areas such as renovation and bed capacity, ehealth, primary care, GPs and consultants.
  • On top of that the extra day-to-day funding of around €2.8 billion, a lot of it front-loaded before tapering off towards the latter years.

Sláintecare was published in May 2017 and concern has been expressed that it is already behind in terms of implementation.

Most political parties are promising to deal with the big issues of hospital capacity - more beds and frontline staff; in particular extra consultants and nurses and midwives.

The choreography of appointing extra staff and beds is important - there is little point in having lots more higher-paid consultants if they can not get access to beds and vital theatre time, and instead have to wait around.

Building up community services with extra staff, GPs and home care are also featured heavily.

Overall, political parties are promising extra day-to-day health spending commitments over the term of the next government, varying from €2-€5 billion.

Day-to-day spending promises for five years

  • Fine Gael - €5 billion
  • Fianna Fáil  - €2 billion
  • Sinn Féin - €4.5 billion
  • Labour -  €5 billion

It's worth bearing these spending level in mind, when matching plans against Sláintecare.

How the parties plan to spend in health

We see that Fine Gael is promising an extra €5 billion for health.

It says it will appoint 5,000 more nurses and midwives and a net extra 1,000 hospital consultants, under a public-only contract.

Fianna Fáil says it will spend a "prudent"  extra €2 billion on health for new and expanded services, by the end of the next five years.

There's a big difference between Fianna Fáil's extra €2 billion and the promised spend of others at €5 billion. Why?

Fianna Fáil insists that its spending plans are in no way a like-for-like comparator with Fine Gael, claiming the Fine Gael spend includes money on demographics that already pre-committed in the fiscal space.

It claims other parties are promising amounts of money that do not exist, for things that can not be delivered.

It's a political charge that the party will have to explain as we move closer to 8th February.

Fianna Fáil is committing to appoint 4,000 more nurses and midwives, 800 more each year, given the recent annual recruitment rate of 500.

It says it will appoint 1,000 more consultants and end pay inequality for specialists appointed after 2012.

It is also emphasising the need to boost investment for general practitioners.

People can confuse primary care with general practice - primary care is a much bigger issue beyond GPs, and includes primary care services, other community staff as well medical cards and drugs budgets.

Just before the General Election was called, it was agreed that talks would begin between hospital consultants and the State on a new public-only contract. That's a key element of Sláintecare to free up hospitals to do more public work.

History shows that these talks can take months, or years even to conclude, but perhaps this time it will be different.

Health is a very labour-intensive area, with most of the funding going on wages.

While plans to appoint more staff will be broadly welcomed, where all these professionals come from is an important question, given the well-publicised recruitment and retention issues.

Overall, during the term of the last Government, HSE staffing increased by 8,868 to 119,126 by the end of last year.

The number of extra consultants appointed was 328 and there were 2,008 more nurses, according to Department of Health figures.

HSE management/administration numbers increased the most - up 2,042.

Many structural reforms have been tried over the years, amidst some criticism that the health service is built too much around staff needs and work practices, rather than the patient's needs.

To build up capacity, most parties are in agreement with the 2018 Bed Capacity Report and putting in place 2,600 more beds.

Beds are costly because each new bed opened needs to be serviced by extra staff and also increases the workload on the diagnostic and overall services too.

Fianna Fáil is promising a four hour waiting target for patients in emergency departments; ambitious considering the current experiences of people.

How soon that might realistically be delivered is a big question - even the NHS in Britain is finding such a target for patients to be seen, admitted, discharged or transferred as very challenging.

The CervicalCheck controversy dominated much of the health issues during the last Government term.

All parties are behind the Dr Gabriel Scally and RCOG report recommendations.

Sinn Féin has pledged to carry out all CervicalCheck screening in Ireland if in government, at a cost of €16m.

However, no definitive timeline on when this would happen is given.

The outsourcing of testing to the US has been a major issue, despite Dr Scally's report stating that the laboratories visited are meeting the regulatory requirements in their country.

Rebuilding full screening capacity here would take many years and the system is also due to move to a new and better screening method - primary HPV testing - from late February.

Sinn Féin also says it will open up closed beds and fund primary care centres, in particular, provide full staffing for those that do not have a GP, speech and language therapists, occupational therapists and psychologists.

Overall, the Sinn Féin proposals would see an extra €4.5 billion for health in day-to-day spending over the next five years.

It is committing to 1,500 extra hospital beds, 2,500 nurses and midwives and 1,000 more consultants.

While hospital services attract a lot of attention, primary and community care is also very important in terms of keeping patients out of hospitals.

Fine Gael is committing to appointing over 3,800 more primary care staff and other parties have similar plans.

The Labour Party is promising to fully implement Sláintecare and to invest €5 billion over the next five years.

It says it will put in place 2,600 extra beds, 4,000 nurses and midwives, 1,000 consultants, as well as increasing GP training places by 300.

The party also says it would do a comparative spending analysis on acute and non-acute spending in the various regions.

This is to establish if some hospitals are being underfunded compared with others. The party points to the regularly overcrowded University Hospital Limerick compared with Beaumont in Dublin, as an example.

All the parties are on the same hymnbook as regards the need for 1,000 extra consultants, although the Sinn Féin figure also includes the appointment of non-consultant hospital doctors.

In terms of extra nurses and midwives, there are some variations:

Extra nurses and midwives

  • Fine Gael - 5,000
  • Fianna Fáil - 4,000
  • Sinn Féin - 2,500
  • Labour - 4,000

Extra hospital beds promised

  • Fine Gael - 2,600
  • Fianna Fáil - 2,600
  • Sinn Féin - 1,500
  • Labour - 2,600

With Róisín Shortall having chaired the Sláintecare report it's no surprise that the Social Democrats are fully behind the document; seeking to build an Irish NHS, with a single tier system, based on need and not the ability to pay.

The party have also committed to making mental health a priority, increasing the current 6% spend of the health budget on it, to 10%.

It also supports free GP care, which under Sláintecare would be phased in based on means over five years.

Fine Gael, Fianna Fáil and Labour are promising free GP care for under 18s over the term of the government.

Sinn Féin is promising to introduce free GP care for all within five years at the SlainteCare cost of €455m.

Fianna Fáil is promising to double investment in the National Treatment Purchase Fund to €200m.

This has been criticised as going counter to Sláintecare and a continuation of funding private hospitals and delaying reforms.

The Green Party supports the Sláintecare plan and has committed to adequately funding healthcare reform through that framework.

It has promised to invest in GP services to ease pressure on hospital waiting lists.

It wants an urgent review of the Fair Deal Nursing Home support scheme. The Green Party has also emphasised the need for an urgent review and increase in resources in therapy service areas that affect many people with disabilities.

It wants the prescription of cannabis-based medicines permitted through pharmacies.

In its manifesto, People Before Profit want to end the two-tier system, establish a National Health Service free at the point of use, increase frontline staff and cut waiting lists.

It plans to abolish the HSE and replace it with democratically-elected community councils.

The party has promised to guarantee access to healthcare in 18 weeks.


On disability, Fine Gael has promised to develop a plan to coordinate implementation of the UN Convention on the Rights of Persons with Disabilities (CRPD) and to fund disability projects in the community.

Fianna Fáil says it will ensure that home support is adaptable and responsive especially for conditions such as dementia.

It is also going to introduce a top-up payment for people with disabilities of €10 for those in receipt of various benefits and allowances.

Sinn Féin has committed to make rights real for people with disabilities and giving the Taoiseach and his department responsibility for the delivery of equality for people with disabilities.

Labour is promising to develop individualised budgeting for care services to give recipients more autonomy and choice.

It also says it will increase investment in services that help prevent blindness or loss of hearing.

Promises, promises

The capacity problems with the health system will take time to fix.

The reality is that overcrowding and delays in accessing treatment will continue for some time, even with various promised reforms and investment.

The public will rightly also wonder - if all the proposals being tabled now are the answers, why have they not been implemented before now?

But all election manifestos come with health warnings of their own. They contain promises and, as we all know in life, not all promises are kept.