Republican News · Thursday 30 November 2001

£10 billion health blunder

BY ROBBIE MacGABHANN

The government's health strategy fails to recognise that ideally there should not be a market for healthcare. There should be one public free system

Four and half years into government and Fianna Fáil with their Progressive Democrat tail wagging, this week brought the state's media together to tell us that yes, there is a crisis in our healthcare system. It was a bit like an updated version of the emperor's new clothes. Bertie Ahern has suddenly admitted that his previous claims about our health service were fundamentally wrong and that yes, waiting lists are too long, yes, primary care treatment is deficient, and yes equipment and buildings are out of date.

QUALITY AND FAIRNESS?

So what's the next step for our dynamic coalition duo now that they finally have faced up to the problem? Quality and Fairness - A Health System For You is the solution. It promises us:

3,000 extra hospital beds over the next 10 years,

A decrease in treatment waiting list times,

A New National Hospital's Agency,

A New National Primary Care Task Force,

A Treatment Purchase Fund.

The coalition policy document also promised us the same old flawed two-tier healthcare system. The signs were all there in the detail of the new strategy.

For example, though there was a lot of hype about the proposed £10 billion in extra spending over the next ten years, Minister Mícheál Martin was not sure how much money they had to spend next year and the much-vaunted £10 billion over the next decade in extra spending is not guaranteed.

Yes, there will be 3,000 new beds, which in reality is only putting back into the system what Fianna Fáil took out in the late 1980s and Fine Gael and Labour in their sojourn in government in the 1990s forgot to put back in.

But the Irish Hospital Consultants Association believes there is a need for 5,000 new beds. With so much effort and analysis put into our healthcare system by the government, how can there be such a discrepancy between what they think is necessary, and what one of the major players in the health service think is needed?

FF FLAWS

However, this only touches on what is one of the fundamental flaws of the Fianna Fáil/Progressive Democrat health strategy. If there really were "quality and fairness" in our health service, why would we need to have a private sector health service? Surely it would become meaningless in the new era of an equal health service for all?

The reality is that the coalition plan is just tinkering with the system and at times bad tinkering. For example, a Treatment Purchase Fund is to be set up to buy bed space in private hospitals and pay for medical procedures from these hospitals as a means to cut public hospital waiting list times.

This week, VHI chief executive Vincent Sheridan voiced concerns that private hospitals might not to be able to provide treatment for the most common procedures on current waiting lists. Again, surely with so much effort put into this health policy, the coalition government must have known that the VHI had problems with their master plan and this is only one of them?

VESTED INTERESTS

One possible explanation is that the coalition government had to plot a middle ground through all the vested interests in the health sector when formulating their plan. This might explain why Minister Martin chose to ignore the findings of a report by Deloitte and Touche, which criticised the existing health board system where competing political interests on health boards were seen to have a negative impact on the value for money service of the boards.

The one vested interest ignored throughout the new policy, though, is the cocooned position of the private health system within the public. Bad enough that the state is already subsidising half the costs of private patients using public hospital facilities and that through the Treatment Purchase Fund it is to give more money to the private system. The Deloitte and Touche report also found that though the VHI have 20% of the beds in public hospitals, they only contribute 11% of the costs of running these hospitals.

Bertie Ahern told us that he wants "nothing less than a world class service for every patient". Well, he or Mícheál Martin have yet to explain how their proposals will bring this about if your income is still the key determinant of how quickly, how comfortably and how well you are treated in the health service.

NO MARKET

The real flaw in the Quality and Fairness strategy is this, it fails to recognise that ideally there should not be a market for healthcare. There should be one public free system, the best possible one with the greatest possible input from those it claims to service. The ten-year strategy should be one that seeks to transform the current failed system into the one-tier service that really is world class for everybody, regardless of how much they earn or where they live.

Until the coalition cabinet face up to this reality, all their hype about world class health will be just another twist in the emperor's new clothes story.