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Pace of Sláintecare implementation questioned

By David Lynch - 20th Feb 2023


Concerns over the rate of progress with the Sláintecare reform agenda were raised at the National Health Summit in Dublin.

IHCA President Prof Robert Landers told attendees the health strategy “hasn’t yet delivered”.

He said the reform programme has not provided the promised increase in the number of hospital beds or consultant posts.

“We are all these years in the Sláintecare programme now and we are not really seeing it in the hospitals,” Prof Landers said.

He was asked during a questions and answers session whether the new consultant contract would deliver on a core aim of Sláintecare, which is removing private healthcare from public hospitals.

Prof Landers said: “It will play some role.”

“But when you look at the activity in our public hospitals at the moment, only about 4 per cent of the activity… is for private elective care,” he added.

“So, it’s going to take that out, but it is not going to deliver a huge increase in capacity that we need.”

Speaking during the same panel session, Dr Sara Burke (PhD), Director of the Centre for Health Policy and Management, Trinity College Dublin, said “the removal of private practice [from public hospitals] was never about increasing huge amounts of capacity in the system”.

“It was about providing equitable, universal access so everybody got care on the basis of need not the ability to pay. But it is just one cog in a very complicated machine and many more of those cogs need to move at the same time. So a big one that needs to move is this investment in the community… it is beginning to happen, but we need to do much more.”

Dr Burke said her overall assessment of Sláintecare was that implementation is occurring, albeit at a slow pace.

“I think if you look at all the policies and even the HSE service plans, Sláintecare is driving the policy intent. So it is there at a policy level. But I think at an implementation level, it has been slow.”

Dr Burke said that the Covid-19 pandemic contributed to implementation delays.

However, she added the pandemic also “accelerated aspects of Sláintecare”.

“We have seen a bigger investment in the health system, an investment at the level that was laid out in the original report. We have seen a significant increase in workforce despite the challenges.”

Dr Burke said that “clarity” was required on the governance of the Sláintecare programme. She said it was important to know “who is ultimately responsible for providing that reform”.

Mr Robert Watt, Secretary General at the Department of Health, was also part of the panel discussion. He said “as ever, in our system, the person who is ultimately responsible for delivering healthcare reform is Minister [for Health Stephen] Donnelly”.

According to Mr Watt, there had been some “fantastic change” taking place under Sláintecare.

“Most people in this room would also agree with that because that is their experience. But of course, we could do more and that is the challenge…. So the challenge for us is that we have this plan and we are committed to this plan.”

He also said change “can be difficult” for an organisation of the HSE’s size.

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