Expert gives verdict on Fine Gael, Fianna Fáil and Sinn Féin health manifestos

Health is one of the key issues discussed on doorsteps around the country.

Hospital overcrowding, lengthy appointment waiting times and a lack of community care have all been highlighted as problems any new government must tackle.

An expert in health services at University College Cork has cast his eye over manifestos put forward by some of the main parties on how to solve issues facing the health sector. Professor John Browne is the Director of the National Health Services Research Institute in Ireland and is a health services researcher with a professional background in health outcome measurement.

After examining the health manifestos set out by Fine Gael, Fianna Fáil and Sinn Féin, Professor Browne said that there is actually a huge overlap between the parties in relation to many of their proposals.

“There are very small areas of difference, mostly relating to the timing and implementation of their health plans,” he said.

Professor Browne explained that, almost understandably, the three parties appear to be focusing on the ‘now’ problems, such as the trolley crisis and waiting times, rather than larger structural problems, like prevention measures and wider HSE reform.

Common themes:

One recurrent pledge is for treatment based on need not income.

“Fine Gael and Sinn Féin are more explicit about measures to deal with this, and more explicit about the moral aspect of discriminating by income. Fianna Fáil more cautious, but still acknowledges the problem.”

The three parties also agree on the need to expand acute hospital capacity.

“All three parties are on board with the need to add 2,600 beds in coming years, per capacity review, and 1,000 new consultants,” said Professor Browne. “Fianna Fáil and Sinn Féin also mention nurses.

“All three parties acknowledge the need for flow measures that will deal with delayed discharges, such as community beds, and homecare packages with an additional one million hours per year mentioned."

In terms of free GP access for all, Professor Browne said: “Fianna Fáil is more obviously cautious about the roadmap to this, citing the need for negotiation and agreement with GPs.”

He also highlighted a common focus on underserved groups. “Mental health, disability, maternity, dental, addiction services are acknowledged to a greater or lesser degree by all,” he added.

All three mentioned a focus on moving resources and decision-making power away from the centre and to the regions.

“Funding models, staffing based on local population need, which should benefit the Midwest and South especially. There is also admirable attention to detail on costings – they have all done their homework."

Common weaknesses:

With common themes across the manifestos, comes common weaknesses.

Professor Browne highlighted a lack of sufficient attention to “big picture prevention” as an issue for all three.

Instead of focusing on preventative measures such as diet, healthier modes of transport and so on, the manifestos are all very ‘downstream’ in that they aim to deal with illness once it has arisen, rather than preventing it.

He also criticised the lack of a focus on waste and overstaffing in some sectors of health.

“All three parties don’t do enough to acknowledge that we aren’t getting enough ‘bang for our buck’ in health spend compared to the NHS for example. Are the services we subcontract to voluntary providers good value for money?” he asked.

Specific weaknesses:

As well as common weaknesses, Professor Browne said some of the manifestos contained weak points specific to that party’s vision for health in Ireland.

“The ambition or vision aspect of the Fianna Fáil manifesto is weak,” he said. “I don’t get the sense that they have a strong commitment to Sláintecare, and they don’t mention getting private practice out of public hospitals. There is a feel of ‘pour more money into the same hospital system’ about some of their proposals."

“Fine Gael seem to have an excessive faith in agencies, reports, task forces to get the job done - perhaps understandable seeing as these were mostly their invention.

“The track record is not so great, for example, the national trauma strategy seems to be in permanent limbo. I’d like to have seen more acknowledgement of areas where they have failed and what they are going to do about it,” said Professor Browne.

“Sinn Féin’s section on mental health is very brief compared to Fianna Fáil and Fine Gael. Then, Fianna Fáil has some surprising sloppiness with typos, and bullet points in the cancer section with no text. Overall, it did not feel as slick, where the slickest by far was Fine Gael.”

Specific strengths:

Professor Browne also highlighted a number of specific strengths that he found in the health manifestos.

“The ambition and vision aspect of the Sinn Féin manifesto is very strong - a vision of an NHS for Ireland that we can all be proud of,” he said, adding that Sinn Féin also places a strong emphasis on equality, as did Fine Gael.

Looking at specific strengths in Fine Gael’s manifesto, he highlighted the party’s apparent commitment to Sláintecare implementation.

“They have nailed their colours to the mast and they should be applauded for this,” he said. “The last thing we need is to tear this plan up and start again, again.”

He pointed to very “detailed and coherent sections on disability and mental health” in Fianna Fáil’s manifesto as its main strength.

He saved special praise for Sinn Féin’s attention to detail in their own manifesto.

“As an academic, I was impressed by the wonkishness of the Sinn Féin manifesto,” he said. “It wasn’t the populist document I was expecting - they spent a lot of time constructing cogent arguments before detailing the actions they want to take. They seem more technocratic than I expected,. You get the feeling that the team who wrote the document is experienced and have been thoughtful.”