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At a press conference in Government Buildings in Dublin yesterday evening, Minister for Health Simon Harris conceded that the introduction of a €25 million “primary care fund” was not going to deliver a brand-new, fit-for-purpose, modern GP contract, but, he surmised, it was a start. The overall health budget for 2018 is almost €15.3 billion.
The €25 million fund was a “signal of intent”, underlined the Wicklow TD, who on several occasions cited Minister for Finance, Public Expenditure and Reform Paschal Donohoe’s reference in his Budget Day speech about wanting a multi-annual process in respect of a new GP contract. This was “on the record of the Dáil” on Budget Day, no less, and if that did not send a serious message to GP organisations, Minister Harris was not sure what else could. Previously, the under-sixes deal on free GP care was not a Budget Day announcement, pointed out the Minister, who said he was not going to ‘play his hand’ in relation to monies available for a process under negotiation.
The additional €646 million in current expenditure, with over €200 million earmarked for “new developments”, was emphasised by Minister Harris during the press conference. He acknowledged, however, that some of the extra €646 million would have a pay component, although did not specify the amount. He pointed out that better pay will be a factor in recruitment and retention.
Minister Harris said he was also in discussion with Minister Donohoe around the finalisation of the 2017 outturn but that both Ministers “are very clear” this would not have an adverse impact in relation to delivery of services for this year or 2018.
Indeed, it appeared the only dampener on Minister Harris’s mood was the NAGP’s post-budget threat of possible industrial action. Responding to a question on the matter, the Minister’s usually affable persona took on a more prickly edge.
“The Competition Authority might have a view in relation to collective action by people who are contractors. But on a much more serious note, I certainly hope it wouldn’t come to that,” stated Minister Harris.
The Minister wanted people to remember that he had made sure the NAGP had a formal consultation role in relation to the delivery of a new contract. He said on a day when he considered that there was positive news in the health budget announcement, it was “prudent not to be knee-jerk”. He said issuing statements before seeing all of the detail and engaging with the Department and HSE was “not the way I do my business”.
“I know the IMO are working very hard in this regard [GP contract], I want to thank them for that; the NAGP have a significant number of views and issues they want to see advance and I want to thank them for that and let us work our way through it.”
In 2018, said Minister Harris, he “will want to see movement from GPs as much as they will want to see movement from me”. While his priority was extending free GP care to more children, he said he recognised that a key area for GPs was chronic disease management.
He said the primary care fund can be built on year-on-year.
“I am very ambitious, as I know GPs are on more we can do in primary care and I am pleased that they too recognise it is not all about GPs, it has to be about practice nurses, it has to be about community intervention, it has to be about OTs…so we have a fund here, and I think the prudent thing for people to do when you are in the middle of negotiation, whichever party you are, is to keep negotiating, keep talking…”
More generally, Minister Harris said the Government was already following through on Sláintecare through moves such as reduction on prescription charges and increased funding in areas like homecare. He said Sláintecare and health reform are on the agenda for a Cabinet ‘away day’ this Friday. He will be submitting an implementation plan to Government before the end of 2017, he said.
On hospital care, Minister Harris said little on bed capacity, reverting to his standard response in relation to awaiting the Health Service Capacity Review, which is due to conclude this year.
A “new access programme” for 2017/2018 includes €75 million to reduce waiting lists; €37 million extra for home care packages and transitional care beds; and €20 million for extra capacity and support for hospitals in 2018.
There is also an additional €471 million for capital over the period 2018 to 2021, with €39 million for capital in 2018. With some major capital projects agreed – or acknowledged as highly necessary – this will be considered by many as a drop in the ocean. Minister Harris almost admitted as such, referring to “huge capital needs in health” and outlining that the HSE is currently conducting a “profiling exercise” in this regard.
Meanwhile, the mental health budget has risen to over €885 million, from €711 million in 2012. The allocation for disability services will rise to over €1.763 billion in 2018, compared to the €1.688 billion allocated in the National Service Plan 2017.