In the powerful BBC drama Together Sharon Horgan’s character, whose elderly mother, a nursing home resident, dies from coronavirus, says she doesn’t want things to go back to the way they were before the pandemic. Nor should we.
For our health service, there is an opportunity to build something different – like Aneurin Bevan did as the UK’s minister for health when he launched the National Health Service (NHS) in 1948 in the aftermath of the war. Hopefully soon, we will be in the aftermath of this war, although there may be battles and skirmishes to be fought for years to come.
In our hospitals, if you have Covid-19 it doesn't matter if you are a public or a private patient; you get treated the same way and there are no private ventilators
To explain the new NHS, Bevan sent a leaflet to every household in post-Blitz Britain, saying “Everyone – rich or poor, man, woman, or child, can be part of it. There are no charges . . . There are no insurance qualifications . . . But it is not a charity. You are paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness”. Essentially, this is what Sláintecare is.
In May 2017, a cross-party parliamentary committee published the Sláintecare report, detailing plans to establish a universal, single-tier health service in which patients are treated solely on health need. For the first time ever, we had a political consensus in relation to health reform. Up until the arrival of Covid-19, progress on Sláintecare was slow. The virus, however, has given us a taste of what Sláintecare would be like.
You can’t buy a vaccine with your debit or credit card or skip the queue or get one in a fancier booth if you have private healthcare insurance. In a vaccination centre, everyone goes in through the same entrance and leaves by the same exit. In our hospitals, if you have Covid-19 it doesn’t matter if you are a public or a private patient; you get treated the same way and there are no private ventilators. These parts of the healthcare field are level and access is based on need.
But not all parts are – or were – level. There once was a steep uphill slope where the nursing homes are, and there are more and more big potholes where the non-Covid-19 services are. On top of this there are bomb craters scattered everywhere from the cyberattack.
But we should take courage and not despair. We have learned important things about ourselves in Covid-19: our ability to change quickly when pushed, our ingenuity at solving almost insurmountable problems, our commitment to put the interest of our patients above every other consideration (including risking our own health and lives), our willingness to put on the green jersey for Ireland. We also saw at first hand the benefits of equity and the tragic consequences of inequity.
Before Covid-19, the wheels of change moved slowly in our health service despite a plethora of glossy policy documents and colourful Gantt charts. Covid-19 changed everything.
Almost overnight, inertia was replaced by agility and momentum; words were transformed into actions; red tape was slashed; good ideas were valued; tight purse strings were loosened; institutional pyramids were flattened; job descriptions changed; surgeons became physicians; soldiers became vaccinators; backroom staff went on the front line; extra staff were recruited.
Where once you might have spent years developing business cases to refurbish a ward or add on a few extra clinic rooms, suddenly pods were dropped like manna from the skies, existing structures were remodelled, new spaces found, equipment procured. A field hospital was built and when we didn’t need it, it was converted in double quick time into a mass vaccination centre and surplus equipment was sent to India.
Implementing Sláintecare will need money, willingness to change, ingenuity and leadership. In Covid-19, we have shown we have the last three in spades
Around the country, all sorts of centres sprung up – for contact tracing, testing, vaccinations. Laboratories processed samples on an industrial scale. Guidelines were implemented, and revised ones were retweeted within days as new evidence emerged.
More patients got test results and advice over the phone than ever before, and we wasted far less time travelling to meetings because of Zoom, Webex and Microsoft Teams. After work you could catch your breath, have a coffee and get the latest Covid-19 update in the company of a thousand colleagues on a webinar.
Our world changed quickly and we changed to keep pace with it.
With more and more people vaccinated, and admissions to hospitals and ICUs continuing to drop, we are now starting to ramp up the non-Covid-19 services, while keeping a close eye on the emergence and spread of variants of concern.
As discussions about Sláintecare resume, I seldom, however, hear it described in glowing terms by my medical colleagues. Most say “it’s unaffordable”, “there isn’t capacity in the public system”, “public hospitals will lose the private income they depend on to operate”, “the new consultants’ contract will result in doctors leaving the country and put off some thinking of studying medicine”.
Having said that, no one says “we need to continue the old way of treating patients differently based on their ability to pay”. This is not what you are taught in medical school. You’ll never read this in a treatment guideline. You’d never say this to a patient as bluntly as this. Deep down everyone knows this is not the way things should be in a health service run by the State. However, if we do not grasp the opportunity to change, we will end up stuck in the same rut for years to come.
Implementing Sláintecare will need money, willingness to change, ingenuity and leadership. In Covid-19, we have shown we have the last three in spades. As for money, Bevan was right: universal healthcare is not charity; we will have to pay for it, mainly through taxation or the equivalent. Despite the economic costs of the virus, this is an investment we must make. More than ever, we know our health is our wealth. Like Sharon Horgan says, things can’t go back to the way they were.