Additional hospital beds and three new elective hospitals – Sláintecare

A single tier public health system within a decade, 2,600 additional hospital beds, and three new elective hospitals have been promised as part of the official implementation strategy for the Sláintecare plan. Maureen Browne reports.

The 82 page implementation strategy was launched in August, by Health Minister, Mr. Simon Harris, 15 months following the publication of the Sláintecare report by the Oireachtas Committee on the Future of Healthcare.

Launching the implementation strategy the Minister said the strategy provided the framework within which a system-wide reform programme would be advanced. He said there would be six-month reports on the progress of the changes.

The Implementation Strategy lays out 106 actions to be taken over the next ten years. These include:

  • A new GP contract which will result in universal free GP care by 2028, which will give general practice a greater role in chronic disease management.
  • A new HSE Board and the reconfiguration of the HSE to improve accountability and support integrated care.
  • A new Model of Healthcare through the development of a new Citizen Care Masterplan for the health service and new models of care that are population-health centred.
  • Launching a programme of public engagement on Health Outcomes and a nationwide series of events in 2019/2020 to promote health and well-being.
  • Enhance Community Care, including the expansion of community-based diagnostics facilities, a new community nursing service and a continued programme of investment in primary care centres.
  • Continued investment in community mental health services.
  • Introducing a new statutory scheme for homecare services.
  • Reviewing the eligibility framework to develop a roadmap to achieve universal entitlement.
  • Choosing locations and commencing the planning process for new elective hospitals in Cork, Dublin and Galway.
  • Tackling long waiting times for acute hospitals by continued investment in the NTPF and the development of an integrated waiting list management system.
  • Developing a national clinical strategy and hospital group strategic plans to guide organisation of hospital services.
  • Rolling out eHealth systems and infrastructure.
    The Minister said dedicated implementation structures were being established to support the reform programme.

The new Sláintecare Programme Office is being led by Ms Laura Magahy and a Sláintecare Advisory Council is being put in place, chaired by Dr Tom Keane.

“In recognition of the central role of the Programme Office, the Executive Director of the Sláintecare Programme Office will be tasked with refining the Implementation Strategy into a more detailed Action Plan within three months of taking office. This will include a review of the actions and associated timeframes, the development of detailed milestones and timelines for year one and the assignment of responsibility for each action,” the Minister said.

Dr Tom Keane, Chairperson of the Sláintecare Advisory Council said, “Similar to other countries, the Irish health system needs to radically change if it is to properly meet the health needs of the population. Strong leadership, clear governance and effective engagement of stakeholders across the health sector will be essential to successful reform, as will a long-term vision for health policy that remains constant from government to government – that is what Sláintecare represents.”

There was disappointment in many places that when he launched the implementation strategy the Minister gave no figure either for the overall cost of implementing the ten year plan or costings for the individual 106 actions.
Initially the cost of implementing Sláintecare was stated to be in the region of an additional €2.8bn over a ten year period.

However, a number of organisations have warned that this is an underestimate of the costs involved.
The Health Insurance Authority (HIA) has said there was little doubt that Sláintecare would require a substantial increase in current Government spending on healthcare, and that this would almost certainly lead to a rise in taxation.

The regulator said there was little doubt that additional spending of at least €1 billion per annum and probably considerably more than that would be required in the public hospital system to achieve the Sláintecare target waiting time of a maximum of 12 weeks for elective treatment in public hospitals.

It said that the Government would also have to fund the loss to public hospitals of private patient income which is approximately €600 million per annum at current prices.”
The HIA said the plan to remove private healthcare from public hospitals could also threaten the viability of some private hospitals.

The VHI said the 192,433 people holding its cheaper “non-advanced plans” had access to private treatment in public hospitals as their primary benefit. However, it said under the Sláintecare proposals to separate private healthcare from public hospitals, these products would no longer operate.

The VHI would seek to upgrade people covered by these cheaper plans to more expensive private hospital plans, which could be expected to cost their members about €300 per annum more. The VHI said that undoubtedly a large number of members with the cheaper plans would be unable to afford this price increase and would cancel their policies. These members would then have to rely exclusively on public hospitals.

The Irish Hospital Consultants Association has warned that the actual cost of implementing the Sláintecare proposals would actually be nearly €20bn in the first decade, with the cost increasing to €28bn plus inflation in subsequent decades.