Healthcare is a right

A summary of Sinn Féin’s new all-Ireland policy document on healthcare.

Sinn Féin Core Policy Proposals

A new universal public health system for Ireland that provides care to all free at the point of delivery, on the basis of need alone, and funded from general fair and progressive taxation.

Fundamental re-orientation of the health system to adopt a central focus on prevention, health promotion and primary care (including mental health care), and on ultimately eliminating the underlying social and structural causes of ill-health and premature death, such as poverty and inequality.

Immediate establishment of a Health Funding Commission to report within a reasonable timeframe on the projected costs of the transition to an all-Ireland system of universal provision, taking into account all spending on health services under the current systems, including state funding and spending on private insurance, and make recommendations on how the state can best harness these resources in the interests of more equitable and efficient delivery.

Healthcare is a right

Enshrine the right to health and the right to healthcare in a future all-Ireland Charter of Rights and a future United Irish Constitution, and seek in the meantime to amend the current 1937 Irish Constitution to include these rights.

Enshrine the right to healthcare in legislation, and make this a fully enforceable right in Irish Courts.

Establish a Health Ombudsman to provide an administrative remedy short of the courts, in the interests of speedier and less expensive resolution of disputes and redress regarding violations of the right to healthcare.

Introduce equality-proofing and human rights-proofing to all health policy, law and practice, and introduce public health-proofing of other areas of law and policy.

Pursue other aspects of our economic and social programme, as increased social and economic equality will have a positive impact on health outcomes.

Interim Policy Proposals - 26 Counties

Invest all health funding in the public system, immediately end tax breaks for private hospitals and the land gift scheme, phase out public subsidisation of and ultimately replace the private system within an agreed timetable.

Medical cards for all under-18s (as a transitional measure towards a fully-universal public access service).

Rollout of the promised Primary Care Centres throughout the state on an accelerated timetable.

A timetabled and fully resourced strategy to deliver the additional 3,000 hospital beds required.

Halting the over-centralisation of hospital facilities and reversal of cutbacks in services at local hospitals.

A plan for enhanced provision of essential public nursing home beds, community care facilities and home care.

Ensuring working conditions, promotion prospects and remuneration sufficient to maintain trained staff in the health services, halting the exodus from the public system and from the country.

All new hospital consultant posts to be public-only.

Interim proposals - Six Counties

Increased health funding from the British Government in fulfillment of their obligation to the people of Ireland in a period of conflict resolution and political transition.

Restoration of local democratic accountability through the Assembly and All-Ireland Ministerial Council, including ministerial responsibility for health and social services.

Investment in structural and management reorganisation and full implementation of the previously agreed health strategy Investing for Health.

All-Ireland co-operation and progressive integration of health services, to maximise health resources on the island as a whole.

Resistance to privatisation of healthcare.

A Single, All-Ireland Strategic Health Executive

Sinn Féin proposes the establishment of an All-Ireland Strategic Health Executive that will progressively subsume the Health Service Executive in the 26 Counties and the Strategic Health Authority in the 6 Counties (proposed under the recent Review of Public Administration).

The All-Ireland Strategic Health Executive will have overall responsibility for ensuring national level coordination of the delivery of health services on the island. Its remit will cover primary/community care (including pharmacy and dental services) and hospital services.

To ensure public accountability, the Board of the Strategic Health Executive will include not only service management but also directly elected political, service user, and advocacy representation, and staff representation elected by health service workers.

Community Health Partnerships for Accountable, Effective Delivery

Sinn Féin proposes the establishment of Community Health Partnerships (CHPs) that will be accountable for the delivery of all healthcare within their geographically defined areas.

Community Health Partnerships will be managed by a unique cooperative of local public representatives, service users, advocates, health professionals and systems experts. Reflecting at local level the governance structures of the All-Ireland Strategic Health Executive, they will be democratically accountable to the local communities they serve and act as a standing mechanism for community participation in healthcare decision-making.

Community Health Partnerships will be responsible for the strategic planning and oversight of all community-based services and local hospital services. For the first time, local health needs will be at the centre of planning and delivering local health services.

A New Emphasis on Primary Care

Introduce comprehensive community-based primary health and social care services for all, free at the point of delivery, including General Practitioner and dental services and abolish all prescription charges.

Configure primary care services on an all-Ireland basis.

Develop a network of modern and accessible Primary Care Treatment Centres

Establish a network of properly-resourced Primary Care Teams to oversee the delivery of primary care services in Community Health Partnership areas. These groups will be multi-disciplinary and multi-agency in nature.

Appoint salaried GPs to work in the Primary Care Teams and negotiate to phase-in salaried contracts for all other GPs.

Prioritise prevention and early intervention.

Make advanced screening services (i.e., national breast and cervical cancer screening) available locally, promptly and widely - based on risk criteria rather than age alone - to ensure early detection of cancers and other illnesses.

Equality in Hospital Care

Introduce a comprehensive hospital care system that is free at the point of use.

Configure hospital services on an all-Ireland basis.

Institute a national plan for the provision and resourcing of hospital care, including clear access targets.

Configure all hospitals to ensure that emergency services are available as locally as possible. For the vast majority of the population, these services should be located less than 45 minutes travel time away. No one should be more than one hour’s travel time from an A&E Unit, when the three critical access factors are taken into account: hospital location, road conditions and ambulance provision.

Transfer the management of local hospital services to the Community Health Partnerships.

Extend Rural Community Rapid Responder schemes nationwide.

Invest significantly in the ambulance service, including upgrading of the existing fleet and introducing an air ambulance fleet.

A New Emphasis on Mental Health Care

Interim Proposals

Build on the groundwork laid in the 6 and 26 Counties including:

- Full implementation of the 26 Counties’ Mental Health Act 2001.

- Full implementation of the 26 Counties’ Department of Health and Children Mental Health Expert Group’s recommendations as set out in A Vision for Change (2006).

Introduce a spending programme to remediate decades of under-funding, followed by ringfencing at least 12% of the health budget for mental health services, as recommended by the WHO.

Establish an All-Ireland Mental Health Commission, to promote and implement the best standards of care within the mental health services and to fund research on an all-Ireland basis.

Sinn Féin Policy Proposals

Legislation to introduce statutory rights to equality and self-determination for people with mental ill-health, to ensure empowerment of people with mental health needs, and guarantee a right to participation in decisions affecting them and to advocacy if necessary.

Legislation to introduce a statutory right to timely access to appropriate mental health services.

Reconfigure primary, secondary and children’s/adolescent mental health care services to manage a shift away from secondary services over the next 5-10 years, such that the vast majority of mental health care is provided by Primary Mental Health Care Teams (providing a 24 hour service).

Establish a network of step-down services and other comprehensive community supports for those making a transition out of secondary care facilities.

Establish a network of fully-resourced Child and Adolescent Mental Health Services throughout Ireland, coterminous with the Primary Mental Health Care Teams.

Suicide Prevention

Make suicide prevention an area of co-operation under the all-Ireland Ministerial Council to give the issue the strategic co-ordination it requires.

A fully resourced, comprehensive All-Ireland Suicide Prevention Strategy

Invest in further clinical and community-based research on suicide prevention.

Develop national mental health awareness and anti-stigma campaigns to help tackle the issue of suicide (the See Me Campaign in Scotland provides a positive example).

Include ‘parasuicides’, people at risk of suicide, families bereaved by suicide, and families of people at risk of suicide in policy-making on this issue.

Full-Spectrum Drug and Alcohol Treatment Services

Dedicate adequate funding to significantly expand the availability of drug and alcohol treatment, and to eliminate waiting lists for treatment.

Expand the spectrum of services available so that all drug and alcohol users who want to avail of treatment and other services can do so, and have these meet their needs - whether they want to establish a drug-free life or plan to continue to use these substances for the time being and want to do so more safely.

Ensure drug and alcohol users also have access to the other counselling and medical services they need, without discrimination. Denial of such access can lead to unnecessary illness and even preventable death.

Urgent Appeal