Our ailing health service needs more of a miracle than a ‘vision’

The minister for health, Simon Harris, published a strategy document — a 10-year plan to reform the health service — last week. 

Our ailing health service needs more of a miracle than a ‘vision’

He described it as a “vision”. I think it’s fair to say that if the minister had a launch saying he intended to land on the moon before his 35th birthday (three years away) the public would have responded with more credulity.

The feeling on the ground is that our ailing health service needs more by way of miracle than vision.

Fine Gael has finally pinned its colours to the mast with the Sláintecare plan, after a number of years where no one had a clue where the government party actually stood on the future of the health services.

However it was interesting to note that such a transformative plan, with potential to affect every one of us during our lifetimes, was attended by only one Cabinet member and that was Harris.

We’ve heard much mention of how, back in 2011, Fine Gael set its mind at solving our jobs crisis and could now bring that approach to health.

Despite it being an appalling recession all shoulders were put to the wheel back then and we now have unemployment below 6% for the first time in a decade.

Cast your mind back to November 2011 when the then government published its big action plan with the promise of creating 100,000 jobs by 2015.

The launch was spearheaded by then Taoiseach Enda Kenny. Alongside him at the launch held in the Government Press Centre was then tánaiste and Labour leader Eamon Gilmore and alongside him then minister for jobs, enterprise and innovation Richard Bruton.

That one had all the bells and whistles. A more recent example would be the massive hoopla surrounding the launch of the National Development Plan earlier this year where the Cabinet enjoyed a publicity-fuelled group hug in Sligo.

This latest one though; not so much. It has a slight air of nobody’s child.

Described as a blueprint for the future of the health service, the product of cross-party agreement by way of an Oireachtas committee, what we have here is the hope and expectation that the Government will lead and fund its implementation.

That Sláintecare plan was published in May 2017 outlining a 10-year-plan to “fix” our health

service. It was published by the cross-party Oireachtas committee, which did very good work, chaired by Social Democrats co-leader Róisín Shortall.

But it would take 13 months before Laura Magahy was appointed as the executive director of Sláintecare, and Dr Tom Keane as chairman of the Sláintecare Advisory Council.

Then last week we finally had the implementation plan published after much speculation about rows between the departments of health and public expenditure over funding.

Then, in a further knock, on the day that Simon Harris was due to lay out the “vision” for the future of healthcare in Ireland, Fianna Fáil, armed with its calculator, cleverly planted a bigger health story in the media.

Rather than reports about much needed reform, instead the headlines were dominated by Fianna Fáil slamming the fact we have almost one million Irish people on waiting lists for hospital appointments.

We have ever lowering expectations of our health service.

There is a cynicism and exhaustion that has allowed the Government to launch this strategy with 106 actions, and not actually allocate a budget to it.

It certainly is good news that we have a plan but collective Government muscle must be put in behind it. It’s interesting to note how, in recent weeks, a real media “squeeze” has been put on Minister Harris about how bad things are in hospitals and on waiting lists.

But so dire is the crisis that no one individual will solve it.

Looking at the bigger picture it’s well worth looking back at the appearance of Dr Tom Keane before a hearing of that Oireachtas Committee on the Future of Healthcare which produced the initial Sláintecare report.

He was there to talk about our national cancer strategy, which he successfully introduced against the odds — given that it involved closing some cancer services, in order to improve the service.

For anyone even with a passing interest Dr Keane’s views are worth reading in full, not least his thoughts on how crucial political leadership is to such a reform process.

Then health minister Mary Harney had recruited Dr Keane from Canada and he said her

support and that of the then government was invaluable.

They did ask to be “kept in the loop”, but at no point was he ever pushed in any particular direction. “If anything they always reassured me to stay the course and to keep going”.

He reminded the Committee members of how taoiseach Bertie Ahern and subsequent taoiseach Brian Cowen had come under pressure to “yield” on the issue of cancer services in the North-West from their own Fianna Fáil TDs.

“I received phone calls from both of those individuals telling me to go ahead and that they would deal with the political issues. The political support was incredibly important. I did have autonomy”.

This is the sort of pressure that can be expected to occur on multiple occasions in an overall health service plan with proposals recommending the shutting down of particular A&E units or amalgamating certain services in certain hospitals, or changing work practices.

Another interesting aside is that Dr Keane said he had come from the outside (Canada), owed no one any favours, and had refused all social invitations from physicians “golf games and all the usual stuff” so he could be seen to be totally impartial “and not doing business in the normal way that things are done in Ireland”.

He believed that a cynicism had built up within our healthcare system. It was a relief though to hear someone with his knowledge of the Irish health system say he did not believe our problems are too big to fix.

But he pointed out that a much needed dialogue was necessary to educate the public about what must happen over the next few years. That would have to make clear that if we want a health care system like the Scandinavian countries, we will have to pay for it.

For all the lack of general Government momentum around Sláintecare it is most heartening to know there was the wisdom to get someone with Tom Keane’s record on board once again for this vital Sláintecare project.

It is too soon to tell how Laura Magahy will fare in her new role. As I mentioned earlier Dr Keane had far more to say including the need not just for the public, but for the doctors and the nurses and the managers and the non-medical staff to all row in behind this.

But all of this is a mammoth task and must be led from the top politically.

That means the next significant launch should be led by the Taoiseach, with plenty of cabinet muscle, including the Finance Minister Paschal Donohoe, in behind him.

At the same time the weight of some actual figures in terms of money needs to be committed. Then we might have ourselves a plan.

If he’d said he intended to land on the moon before his 35th birthday the public would have responded with more credulity

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