Irish Health Care: A Fundamental Reform Proposition

Current Affairs Editor Hassan Baker interviews Róisín Shortall TD on the health service reform proposed by her party, The Social Democrats.

The long waiting periods, and not enough beds or trollies are all the rage when it comes to any discussion regarding the Department of Health. The Social Democrats are proposing a reformation of the health service in Ireland, emphasising on the move from a two-tier system into a single-tier system. Motley met with TD Róisín Shortall to discuss such a reformation.

A universal single tier health care service is the standard in every other European country. “

Roisin-ShortallThe current Irish health care service is governed by the Health Care Act 2004, and is described as a two-tier system as it includes both a public and a private provision of health care. TD Shortall expressed her criticisms towards the two-tier system: “You’ve got about 40% of the population who have a medical card, by in large they’re left waiting for services. We know there’s about half a million people on waiting lists for hospital services at the moment. On the other side, you’ve got nearly half of the population who rely on very expensive private health insurance, the premiums go up every year, and the kind of cover that they get for that isn’t very good. It’ll cover them if they have to go to hospital, but if they need to see a consultant or a GP, there’s no cover for that. So it’s a very unsatisfactory system, and it doesn’t serve either side particularly well.”

The Proposed Reform:

She explained that “The Social Democrats are very much of the view that we need a fundamental reform on our health service, and that we need to move towards a single tier health service, that’s universally available, and that’s free at the point of use.” Free to the point of entry meaning that under this reform, visits to a GP, a public health nurse, a physiotherapist etc. would all be free. She went on to assure that precautions will be taken place to make sure that such service won’t be abused.

“Apart from what makes more sense from a public policy point of view and a cost point of view, decent health services should be a fundamental right for people.”

One of the big actions that this proposed health system is aiming to undertake is the shift in focus from hospitals to primary care services. So rather than having crowded hospitals, an efficient use of GP’s and other primary care providers would be used to promote preventative heath measure for chronic illnesses. Chronic illnesses include diabetes, asthma mental illnesses etc. In 2014, it was reported that eighty six per cent of deaths and 77% of disease burden were caused by chronic diseases.

“We need to fundamentally reform our health system in terms of how we deliver health care, because we’re far too dependent on hospitals. We’re too hospital-centric at the moment. Generally speaking we want to try to encourage much more health promotion and preventative medicine. But when issues arise, when you develop a health condition, you should be able to have that dealt with at an early stage locally, by your GP or your public health nurse.“

Another reason given to switch away from a hospital-centric system is the current congestion in hospitals: “So very often, people either can’t get to see a physiotherapist locally or they can’t afford to go to the doctor. So they leave their condition until it gets worse and inevitably, a lot of people end up having to go to hospital when their condition is worse and where the treatment is less successful than if it happens at an early stage and it’s much more expensive. It doesn’t make sense to have so much concentration on our hospitals.”

Currently GP’s locate where they want, and that has meant that certain areas may not get the same level of healthcare that they need, because not enough GP’s are locating in these areas. ”Unfortunately in areas that need healthcare the most, they’re the areas that are least likely to have it at the moment. At no level, either HSE or the Department of Health level, is the responsibility taken for insuring primary care services are available… The areas where there is the greatest health need are the lowest socio economic areas of predominantly low income, and there’s a very close correlation between poor health and low socio economic background. It’s called the social determinants of health.”

“We believe that as a country we can do much better in relation to health care provision.”

TD Shortall expressed criticism towards the HSE in regards to the uneven dispersion of health care services: “I was a minister in the department of health for a short period from 2011 to 2012 and at that point I was able to secure €20 million for employing additional primary care staff. That €20 million would have allowed 300 additional staff. We did a lot of work to identify where those staff are most needed and we planned out how we were going to allocate them. Unfortunately, the then Minister for Health pulled the plug on the budget so we weren’t able to go ahead with that. I think it’s really important that we know where staff are employed. That’s a very basic thing. But the HSE doesn’t know where their staff are employed and they can’t tell you what the ratio is of population to staff are in different areas.”

In regards to how an even dispersion can be implemented, TD Shortall explained that she had commissioned a study into this for the allocation of the 300 additional staff. The study involved querying health offices for lists of staff and then comparing that to the population in that area. Certain factors were weighted in the study, such as older people, and socio economic disadvantage. “There was a hugely wide variation in ratios of staff. So there’s no rational resource allocation approach within the HSE, and that’s a key thing as far as I’m concerned.”

water_medicine_hiresTD Shortall expressed a concern towards over usage or unnecessary prescription of pharmaceuticals, especially in regards to mental health: “GP’s very often prescribe medication for somebody, when there are better strategies, but those services are not available. I’m thinking particularly in relation to mental health services. A GP very often, because he/she is under pressure they will give a prescription for benzodiazepines when a person is stressed. Instead of that, it would be much better if there was access to a counselling service. So in some ways I would say, we need to de-medicalise our health service and bring it down to the lowest level in terms of supports that people need.”

The proposed reform seems to be very much data oriented, and as stressed in The Social Democrats’ manifesto, an emphasis on transparency through public data would be characteristic of such a policy change. It would be a very large shift from our current system, which seems to always be under scrutiny and criticised on either tier.