One in a lifetime chance to transform healthcare must not be wasted
Posted on: 19 September 2017
Speaking last Thursday to the Fine Gael think-in, Leo Varadkar strongly endorsed Sláintecare – the final report of the Oireachtas Committee on the Future of Healthcare – which was published in May.
The Taoiseach said he ‘very much supports the principles of the that report, that of universal healthcare, separating public and private practice in our hospitals, providing much more healthcare in the community, reducing out-of-pocket expenses and charges for patients, [having] greater decision making at regional and local level and a real focus on public health’.
Never before has there been a ten year plan for health reform in Ireland. Not since the Tallaght strategy has political consensus been achieved on such an important public policy issue. Sláintecare is more significant than the 1987 economic agreement between a minority Fianna Fail government and Fine Gael as it has support from across the political spectrum. All parties except Solidarity signed up to Sláintecare, who agree with its aim but felt it did not go far enough.
Sláintecare can be viewed as the first, tangible example of what ‘new politics’ was meant to do – empowering politicians from across the political spectrum to make policy and legislate.
‘New politics’ emerged in the aftermath of last year’s general election, when no party had an overall majority. Fine Gael made the grand gesture of offering Fianna Fail a national government which they refused. Fine Gael then spent 70 days negotiating a Programme for Government with Independents as well as agreeing a Confidence and Supply Agreement with Fianna Fail.
The Programme for Government specified how ‘the new political landscape in Ireland presents a historic opportunity to radically reform Irish politics – to fundamentally change the relationship between Government and the Oireachtas, and with it the relationship between the Irish people and their parliament’.
Political scientists, David Farrell and Jane Suiter have categorised Irish democracy as ‘Westminster style majoritarianism’, similar to the UK and France whereby whoever is in government can determine the policy with little attention paid to the opposition views. They assess ‘new politics’ as potentially creating a more equal balance of power between the government and the whole Oireachtas, as is the case in other European countries such as Denmark.
Political analyst Noel Whelan has detailed how new politics has stymied government with the enactment of just 24 Bills in the first year of this government. Opposition politicians use ‘new politics’ as a derogatory term, citing it as the lowest common denominator of Fine Gael, Fianna Fail and the mongrel group of Independents which supports Government.
The ‘new politics’ of Sláintecare is evident in the motion that led to the establishment of the Oireachtas Committee on the Future of Healthcare which was drafted by Social Democrat TD, Roisin Shortall, during the 70 days it took to form a government. Shortall got 89 TDs to sign it. Conveniently, there was a commitment to an all-party committee to develop a ten year plan for health in the Programme for Government, published the day after the Shortall motion.
Simon Harris, just weeks after his appointment as health minister, instead of opposing the Shortall motion, published an amended version setting up the Committee. The modus operandi of the Committee – constantly seeking to achieve consensus – and the publication of the final report are all signals of effective ‘new politics’.
Internationally, political consensus and cross-party support has been identified as central to bringing about major health system reform, which is usually stymied by political short termism and opposed by vested interests.
Sláintecare recommended the establishment of an Implementation Office by July 2017 in the Department of An Taoiseach. In Leo Varadkar’s first speech as Taoiseach on 14 June, he mandated health minister Simon Harris to set up the Implementation Office (in the Department of Health) and at the last cabinet meeting in July, the health minister was given approval for appointing a lead to run the Implementation Office. Last Thursday, Varadkar said Harris would publish a road map on implementation by year-end.
Given the history of failed reform in the Irish health services, moving swiftly on Sláintecare is central to its credibility. Also critical is who is appointed to head up and staff the Implementation Office. Budget 2018 will be a good indicator if there really is political consensus on adequately resourcing Sláintecare and the change needed to bring it about.
The report details the increased investment in health that is required to implement Sláintecare over a ten-year period. There were political noises that Sláintecare is not affordable, when in fact continuing to fund the broken system that we have is prohibitive. We cannot afford not to implement Sláintecare.
Apart from Brexit, the biggest policy challenges facing government are fixing the perennial crises in health and housing. Both require long-term, slow, hard systemic change for which political consensus is essential.
The Taoiseach, the health minister, politicians of all parties and none have this once in a generation opportunity to bring about a functioning, high quality, universal, affordable health and social care system through Sláintecare. It is in the interest of everyone in Ireland that they grasp it.