If health really is the front and centre issue people say it is in this election then it follows that the party that comes up with the best set of policies stands to gain a lot of extra votes. Over the next few weeks, therefore, all the main groupings will be publishing detailed plans that aim to remedy the many troubles of the health service.
On Monday it was Fianna Fáil's turn to unveil its proposals to deal with this "full-blown crisis", as health spokesman Stephen Donnelly described it under the glare of the TV lights at the party's election headquarters in central Dublin.
His pitch was strong on diagnosis, arguably less so on cure. You could fill “the equivalent of Croke Park, Thomond Park and Páirc Uí Chaoimh combined” with the patients added to waiting lists during Simon Harris’s tenure as Minister for Health, he said, while the number of children with long waits had increased 20-fold.
He said the only way to fix these problem was through a new government, especially one with a “credible plan”. But was the plan he then proceeded to outline credible?
First there were the promises – among them 5,000 extra doctors and nurses, 2,600 beds, 5 million more homecare hours, as well as reduced waiting times for hospital appointments and procedures. These are big numbers, but over the five-year span of a government, and given a rising and ageing population, they are not necessarily extravagant.
But all of this expansion needs serious money. The HSE, for example, estimates it costs a cool €1 million to provide and staff each new hospital bed.
Mr Donnelly threw out another big number to explain how the party would fund this expansion. Some €2 billion of the extra money expected to be available to the next government would be allocated to health.
Overspent
This is equivalent to about €400 million a year in "over-and-above" money for the health service over the five-year period. That isn't a huge amount of cash when you consider the HSE has overspent by almost €1 billion over the past two years. There is, therefore, a question as to whether Fianna Fáil is allocating enough money to fund its many proposals.
It could give itself more scope by proposing reforms capable of saving money. Observers both within and outside the system have remarked on the considerable duplication of services in some parts of the health service. At the very least there is room for reorganising services so different centres can specialise in what they do best and produce better results. After all wasn’t Mr Donnelly a management consultant in a previous life?
With an election in the offing this was not a road Mr Donnelly was prepared to travel. Aside from thinning out the layers of HSE management and reforms arising from the realignment of regional health structures, there was no area of the €17 billion-a-year health service he felt could do with a cost-saving reform.
And although Fianna Fáil supports Sláintecare and its central plank is the disentangling of public and private medicine, Mr Donnelly parried questions about when this would happen.
He was also less than explicit about whether he would support the Government’s offer of €250,000 a year to consultants who sign up for public-only contracts, instead preferring to highlight the high cost and disruption such a change could cause.
Private medicine
Pending the theoretical removal of private medicine from the public system, a la Sláintecare, the party will actually be spending more than ever on private medicine. This is because it wants to double the funding of the National Treatment Purchase Fund (NTPF), which outsources at least half of its public waiting-list patients to private consultants. Mr Donnelly says the NTPF intervention is an emergency one, but it has been going on so long now it doesn't feel that way.
In summary the Fianna Fáil prescription for health sounds like: enough funding to meet growing demand (unless the state of the public finances changes); a “hasten slowly” attitude to reform; and promises of better, more efficient and less dysfunctional management.
