A myriad of items on the Minister’s in-tray 

The Health Minister will be kept busy with many existing issues and doubtless some new challenges arising

Recent months have seen the formation of a new Government and the appointment of a new Minister for Health. But what are the issues that she will have to deal with and what does the Programme for Government tell us about the priorities for health?

Minister Jennifer Carroll MacNeill is still settling into her new role – if anyone can settle as Minister for Health – and I wish her well in her endeavours. Like any new occupant of that role, she will have a busy in-tray, with many existing issues needing to be tackled and doubtless some new, and perhaps unforeseen, issues cropping up as time passes – an early example of this was the recent publication of the HIQA report into children’s spinal surgeries at Temple Street.

Among the existing, or ongoing, issues facing the Minister is the move to the new health regions, which is continuing apace. The integration of different levels of care (primary, secondary, and tertiary) will, if successful, yield benefits for patients and healthcare staff alike.

However, it is not clear how some budgetary decisions will be made. For example, while funding at health region level will be demand-led – based on population adjusted for some need indicators – how will this tie in with the supply-side funding that is necessary in certain cases? After all,  some services are not delivered in all regions, so patients from one region may need to be treated in another.

Another issue that the Minister has inherited is the National Children’s Hospital (NCH), which will (hopefully!) open on her watch. The final cost of this is likely to be known only after it has opened and any remaining mediation – or litigation – around cost escalation has been resolved.

A recent, and very informative, report from the Parliamentary Budget Office examined the costs of hospital build projects in Ireland versus international comparators. It found that the cost of the NCH (per bed or per square metre, based on current cost estimates) will be above average, but not the highest among children’s hospitals.

The report also estimated that the capital cost of building a new hospital only represents around 5-10 per cent of the lifetime operational costs of such buildings.  While that may provide some solace, it is still worth noting that the cost overrun on the NCH is greater than the estimated cost of many of the other individual hospital build projects that the Minister will be overseeing, such as the National Maternity Hospital or either of the two elective hospitals (in Cork and Galway) that were costed in the report.

Waiting lists will also be an issue with which the Minister will be grappling. While progress has been made in some areas, overall numbers, and the number of those waiting long periods of time, remain too high. One potential positive in this regard, however, is the number of consultants that have signed up to the public-only consultant contract (POCC). While newly appointed consultants have no option but to take this contract, the numbers transferring from older contracts to the POCC have been significant, and the latest estimates are that over 60 per cent of public hospital consultants are now on public-only contracts.

The commitments contained in the Programme for Government will also keep the new Minister busy, with some being quite ambitious, while others will have a positive effect on population health as well as service delivery.

The promise of additional hospital bed capacity is welcome, although it is unclear how many of the beds will be new and how many refurbished, and therefore what the net addition will be.  The construction of the National Maternity Hospital and four new elective-only hospitals (the two in Cork and Galway mentioned earlier, along with two in Dublin – an increase of one from the Sláintecare report) will be challenging, given capacity constraints in the construction sector and the cost of such large capital projects.

The increased roll-out of injury units should help to take pressure off hospital emergency departments, which would be welcome.  Extending GP visit cards to children aged under 12 will further progress a Sláintecare aim, but may cause further increases in waiting times for GP services if additional GP capacity does not match the increased demand.  A new statutory home care scheme will also be a worthwhile initiative, though its design is, as yet, uncertain.

The Programme for Government also contains wider health-related measures, some of which come under other departmental votes, but which will assist in improving population health. These include public health measures, which will help to shift the emphasis from care to prevention and initiatives like expansion of the hot school meals programme, which will help to address the social determinants of health.

With all of these issues, and more besides, the Minister certainly won’t be idle in the coming years.