A universal health plan

Labour Health Spokesperson, Jan O’Sullivan, T.D. urges health managers at all levels in the service to be as creative and as collegiate as possible in changing the way things are done to save money rather than cutting services.

As I begin to write about my vision for the Health Services in 2011, the economic future of our country is in grave doubt as the IMF and the ECB move in to take stock of how Ireland can be rescued from the parasitic tentacles of a failed banking sector that threatens to take us all down with it.

Jan O’Sullivan
Jan O’Sullivan

We don’t yet know where this will lead. We don’t know what will be in the forthcoming budget but we do know that a substantial portion of the pain needed to reach the 2014 fiscal target will be front-loaded; the Government plans to make severe cuts in public spending in 2011.

It is going to be a very tough year for the health services.  Minister Harney has already indicated that there will be budgetary cuts of between €600 million and €1 billion imposed on top of the severe cuts of last year. If, as suggested, the adjustment this year is in the order of the €6 billion being suggested and if, as appears to be Government policy, this will be done by way of cutting public spending rather than taxation, then inevitably the big-budget Departments, including Health and Children, will take the brunt of the pain.

Labour’s approach would be different.  We do concur with the target of reaching a three per cent fiscal balance by 2014.  However, we believe that taking €6 billion out this year will be too deflationary and do too much damage to public services. Furthermore, we have already said that we would make the adjustment for 2011 through 50 per cent on expenditure cuts and 50 per cent through taxation measures.

The current early retirement/voluntary redundancy scheme will be incredibly difficult to implement because there was no preparation for it and it is not targeted to particular grades or levels of management and administration

So, if Labour were in Government to draw up the next budget, there would have to be cuts in health spending, but they would be much less severe that those likely to be imposed by the incumbents. I believe that the Government’s approach will inevitably damage front-line services, do irreparable damage to the progress that has been made in building capacity and will make it extremely difficult to implement policy changes.  However, that is the challenge that will face health managers next year and will, most likely, also face me and my colleagues because we are likely to be in Government before the end of the year.

Flexibility

The Voluntary Redundancy/Early Retirement Schemes and the Croke Park Deal have the potential to bring about the stream-lining, efficiency and flexibility of work-practices that are needed. Labour has long been calling for a targeted voluntary redundancy/retirement scheme and we spelled our approach out in detail in a document ‘Reform of the HSE’ which I published, on behalf of the Party in 2008. However, the current scheme will be incredibly difficult to implement because there was no preparation for it, it is not targeted to particular grades or levels of management and administration and there is no power to refuse the scheme to key people within the organisation. My fear would be that there will be so much re-organisation, negotiation and settling in to new roles going on that cutting all budgets across the board will be seen as the only feasible way to reach targets.

This would be a tragic waste of opportunity and I would urge managers at all levels in the service to be as creative and as collegiate as possible in changing the way things are done to save money rather than cutting services.  What I mean by being ‘collegiate’ is engaging with all who work in the particular service, doctors, nurses, allied professionals and other staff to achieve savings and co-operation in how things are done.  We are in a space we have never been in before and there is no place for putting up the defences around one’s own particular patch.  We need a sense of common purpose in every hospital, every primary and community care team, every network.

This needs leadership at all levels and it will not be easy but there are already many good examples within the Irish public health service of real teamwork that results in good patient care, a good working environment and financial efficiency.

The sooner we move to paying hospitals on the basis of what they do the better

If Labour is elected to Government sometime in 2011, we will begin the phased implementation of our Universal Health Plan.  Some of the elements of reform needed to achieve our aims are stated policy already and must be advanced in 2011, irrespective of who is in Government.  These include: Developing the capacity and use of primary, community and continuing care which is much more cost-effective and socially preferable to acute hospital admittance; the introduction of a Unique Patient Identifier, which is long overdue; a unified IT and financial co-ordination system, the need for which was spelled out so clearly when the new CEO of the HSE, Cathal Magee, appeared before the Public Accounts Committee and strengthening the governance of each unit of service delivery and empowering people with specific responsibility to make decisions within their budgetary allocation.

We cannot close more public hospital beds.  In August this year, 1,044 beds were closed in public hospitals and our bed occupancy rate is the highest in the EU; waiting lists are up and Emergency Departments are at breaking point.  The sooner we move to paying hospitals on the basis of what they do the better but, in the meantime, they have to function and reconfiguration should not be used as a smokescreen for service reduction.

I wish all readers a Happy New Year…..it will certainly be challenging!