Beveridge was no socialist. He thought taking the burden of healthcare and pension costs away from corporations and individuals and giving them to the government would increase the competitiveness of British industry while producing healthier, wealthier, more motivated and more productive workers keen to buy British goods. And he was right.
In June 2016, the Dáil established the Committee on the Future of Healthcare, with Róisín Shortall in the chair. Its stated goals were to achieve cross-party, political agreement on the future direction of the health service and to devise a ten-year plan for reform. The extent of challenges facing the health service and the need to set out a vision for long-term change, was reflected in the Committee’s Terms of Reference, which included recognition of:
- The severe pressures on the Irish health service, the unacceptable waiting times that arise for public patients, and the poor outcomes relative to cost
- The need for consensus at political level on the health service funding model based on population health needs
- The need to establish a universal single-tier service where patients are treated on the basis of health need rather than on ability to pay
- To maintain health and well-being and build a better health service, we need to examine some of the operating assumptions on which health policy and health services are based
- The best health outcomes and value for money can be achieved by re-orientating the model of care towards primary and community care where the majority of people’s health needs can be met locally and
- The Oireachtas intention to develop and adopt a 10-year plan for our health services, based on political consensus, that can deliver these changes (oireachtas.ie here).
In May 2017, the Committee presented the Sláintecare Report to the Government, who shelved it.
The National Budget isn’t St Brigid’s Cloak
For decades now successive Ministers for Finance have attempted to divide the national cake by cutting ever thinner slices and spreading them over an ever-increasing set of demands. But the national budget isn’t St Brigid’s cloak.[i]
Nobody likes paying taxes, particularly when they disappear into that big black hole where the national cake is stored. We need a more progressive approach to funding vital resources. Most of us, I believe, would be happier if we knew how and where any increased tax would be spent and could see the value in improved services. We could, for instance, borrow an idea from Attlee’s 1945 Labour Government and introduce a form of National Insurance Stamp to fund a world-class Health Service. A ring-fenced contribution to be spent on clear, decisive action to implement Sláintecare and deal with the disastrous situation in Irish healthcare would be a vote winner.
Obviously, there will be no actual stamp. And, equally obviously, the contribution will be progressive and income related.
Hospitals will be allowed to charge extra for ‘hotel’ expenses—private rooms, private chefs, hairdressers, manicurists, whatever—but not for medical treatments.
The health service would continue to receive at least the same percentage of the national tax take as was allocated on day-one-minus-one of Sláintecare’s implementation. The state would continue to cover the costs of infrastructure and equipment, building and maintenance, and to act as paymaster and quartermaster, buying and distributing medication and other supplies. No change there—except, of course, that we would no longer build hospitals at taxpayer expense to be handed over to private interests.
And, because none of the allocated spend on healthcare would be siphoned off by private hospitals, we could afford to hire the extra staff needed and pay them the wages they deserve.
The national insurance contribution could be managed and distributed by a repurposed and improved VHI to be paid to the hospitals on a per treatment basis—the national insurance money would follow the patient. Those payments would go directly to the hospital as a discretionary budget, and would pay, for instance, for a primary-care unit that would potentially save lives[ii] by leaving the Accident and Emergency department to deal with emergent cases—heart attacks, strokes, car crashes, and so on. Both the primary care unit and the A&E would then be income producing, as would many facilities that are currently considered to be a drain on resources.
Wards currently closed because there is no money available to run them would reopen once they were income producing rather than resource draining. Procedures delayed because of staff shortages would be treated in a timely fashion. Waiting lists would be an attractive source of further income and not a Damoclean sword threatening to destroy the entire health service.
How many people would object to paying a National Insurance Contribution if it meant that neither they nor any of their loved ones would join the estimated 350 patients who die needlessly each year in our hospitals as a result of A&E overcrowding (irishhealth.com)?
How many would object if it meant that neither they nor their loved ones would join the one million people languishing on waiting lists, becoming inevitably sicker while waiting to see a consultant who will place them on a waiting list for treatment?
Who would object to being able to access all medical care without delay and without charge?
Healthcare can no longer be an expensive privilege in the private tier and a catch-as-catch-can system of firefighting in the public tier, where patients present at ever later stages of their illness costing both lives and resources that could have been saved with timely access. Top-quality healthcare has to be available to all citizens equally and without delay. Healthcare is a basic common good, not an optional extra for the rich.
[i] Legend has it that Brigid asked the King of Leinster for land on which to build her monastery. He refused. She asked again, this time only requesting as much land as her cloak would cover. He agreed. Brigid told her four helpers to take a corner each of the cloak and walk in different directions; as they did so, the cloak began to grow and spread to cover sufficient land on which to build her monastery.
[ii] Fergal Hickey, President of the Irish Association for Emergency Medicine (IAEM), has estimated that as many as 350 excess patients die each year in our hospitals as a result of A&E overcrowding. (irishhealth.com).