The report of the Oireachtas Committee on the Future of Healthcare (Sláintecare) sets out of a transformation blueprint for the Republic's health system. Set up to take political point -scoring out of health, and taking a 10-year view of the nation's health needs, the committee has worked diligently to produce a consensus on the best way forward for our troubled health service.
Initial reactions indicate that no vested interest has fully welcomed the report; this, perhaps counter-intuitively, may be an indicator of Sláintecare’s value and potential success. For too long, debate on the health system has been dominated by special interest groups.
The committee’s recognition that funding will be essential for major structural change is welcome. It was the lack of such investment that condemned previous attempts at health service reform to failure. Whether a fund of €3 billion over six years is sufficient to expand acute hospital capacity and meet other critical needs remains to be seen but by specifying an amount, the committee has laid down an important marker for future ministers for health and finance.
But the report disappoints in its proposals for the Health Service Executive. That "the HSE in future will act as a more strategic 'national centre' carrying out national level functions" suggests it will simply reproduce work already carried out by the Department of Health. The HSE is an "elephant in the room" in our dysfunctional health system and the lack of detail about how to deconstruct the monolith is a weakness in the report.
Sláintecare contains a number of proposals that will be key to success or failure. It sets out an urgent need to reorient the health system so that the majority of care takes place in primary and social care settings. A laudable and modern approach to health service delivery, its implementation faces considerable challenges: reversing the current difficulties in recruiting and retaining staff to allow for sectoral expansion; and persuading a population used to accessing most of their care in acute hospitals that an even better standard of chronic illness care will be available in the community.
Although the disentanglement of public and private healthcare and the phased elimination of private care from public hospitals will be welcomed by some, it faces hurdles. Replacing private income currently received by public hospitals from private patients will be critical, as will careful workforce planning. And care must be taken not to completely separate public and private hospitals to the detriment of patients in both.
The real test of Sláintecare will be whether it contributes to the end of unacceptable waiting times, reverses inadequate home care services and creates truly equitable access to our health system.