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‘The way we deliver our health service must change’

By Mindo - 11th Sep 2019

In advance of the IHCA’s AGM, the Minister for Health Simon Harris writes about Sláintecare, the de Buitléir report, and the implications for consultants 

I am pleased to be invited to write this article at a pivotal time for the development of our health services and for consultants who play a central role in the provision and management of care within the health system.

In the past year, significant progress has been made in putting in place the framework that will enable us to deliver Sláintecare successfully.

We have put in place the pillars for reform. We have announced our new regional health areas, the first major structural reform of our health service in 15 years.

Once established, these regional bodies will plan, fund, manage, and deliver integrated care for people in their region. Bodies will be responsible for planning and delivering care at a local level, based on the needs of the people living in their region.

We recently announced the recipients of the Sláintecare integration fund, awarding those who support the delivery of community healthcare in their local community.

Significant advances have been made in implementing the trauma strategy, including the recent appointment of a National Clinical Lead for Trauma Services, the implementation of the bypass protocols for Naas General Hospital for patients with orthopaedic trauma and major trauma injuries and the commencement of the formal process for the designation of the major trauma centre for the central network and trauma units for Dublin.


Despite what you read, Sláintecare is alive and delivering. We are delivering a universal health service that offers the right care, in the right place, at the right time, with a priority-focus on developing primary and community services.

In order to do that, we will need to increase capacity. Since 2017, an additional 267 beds have been opened. A further 75 beds opened in 2019 as part of the 2018/2019 winter plan. We now have a plan to deliver 480 beds between now and 2021.

We will also need, as Sláintecare recognises, increased acute capacity and an expanded workforce, including additional consultants.

De Buitléir report

I recently published the Report of the Independent Review Group established to examine private activity in public hospitals. Mr Donal de Buitléir and his group conducted a comprehensive examination of this very complex matter. Ireland is unusual in that those with private health insurance or who can pay out-of-pocket are able to access services in public hospitals quicker than those who do not have private health insurance or who cannot afford to pay.

One of the fundamental principles of the All-Party Oireachtas Committee on the Future of Healthcare report is that we would disentangle public and private healthcare financing in acute hospitals and remove the ability of private insurance to fund private care in public hospitals. I realise that achieving this objective will be very challenging and is of concern to you.

However, it is my view that this is the only way we can build a health service that is fair for everybody, where everybody is treated equally based on their clinical need and not on their ability to pay.

The report outlines the changes that would be needed to ensure the policy shift starts reasonably quickly. While it will take some years to fully remove private activity, progress can be made on an incremental and progressive basis.

This will avoid any sudden shock to the system and implementing the recommendations over the course of Sláintecare makes it more affordable and ensures it happens while we also improve our overall health service.

As already noted, we are committed to developing additional capacity in our acute hospitals, to improving our care models and enhancing access to diagnostics. These, and other reforms that the Sláintecare programme office are working on and will be delivered over the coming years, are absolute necessities to ensuring the development and modernisation of our acute hospital system to address current capacity challenges and increase integration between the hospital sector and community-based care in the future.

I am acutely aware that the recommendations of the review group have obvious implications for consultants working in our health service and for those we hope to recruit over the coming years. I also know that the way we deliver our health service must change. The role of our acute hospitals will fundamentally change as more care is delivered differently and we now have an opportunity to make sure that our health service moves in a direction that is fit for the demands of the 21st Century.

When the report was launched, I committed to consulting with key stakeholders to examine the implications in more detail. The Government hasn’t yet made decisions on the report’s recommendations, and the actions we take in response to the recommendations will have to be taken within the context of the wider system improvements planned in Sláintecare and the Public Service Stability Agreement.

Given how long-standing and extensive private practice in the public system is, it is fair to say that the proposal to remove private activity from public hospitals is one of the fundamental reforms envisaged in Sláintecare.

I want to ensure that consultants see that they can have a positive future career here, including those who have taken up posts abroad in recent years. In recent months you have been highlighting the need to increase capacity to support service delivery and to address waiting lists, the challenges in filling consultant posts and, related to this, the need to resolve the pay differential between established and ‘new entrant’ consultants. I acknowledge that recruitment and retention of consultants is a significant challenge for our health services at present.

Given the importance of consultants to the future delivery of Sláintecare, it is vital we work together to address areas of concern.

Yes, this will mean examining the issues of pay, but it will also look at reform in line with our goals under Sláintecare. I am sure that working together we can ensure a better health service for the Irish population.

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