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This general election will be crucial in determining the future of our health system
With the announcement that the general election will take place on 8 February, I was reminded of when, a few months ago, I debated with a good friend who works in politics. He chided me that my advocacy was wasted because research shows that people don’t vote on health or housing but on what Government will give them the most money in their own pockets.
I think that is true of our past. What is missing from the narrative of the boom years is that many of us voted based on promises of tax cuts. In a democracy, we get the Government we vote for. So we, as voters, must also accept responsibility for our part in setting the mandate for elected officials.
If we are serious about tackling homelessness and health, not only should we not expect a tax cut, we should expect a tax increase on high earners. I believe many of us would support this IF — and it is a big ‘if’ — we saw that translated into a society where no child is born into homelessness or grows up homeless and where every person has timely access to primary and secondary care.
Sitting in the audience at the Claire Byrne Live healthcare debate with my IHCA colleagues and friends Laura, Donal and Martin, we watched aghast as politician after politician used Sláintecare as the ‘get out of jail card’ for every tough question on what their healthcare priorities were.
We have cross-party agreement politically that Sláintecare is the vision for healthcare provision. What we haven’t heard is what they intend to do for patients who need access now, both in primary or secondary care, as we transition to this new system. Stephen Donnelly attempted to address this during the debate and got pilloried. It was quite extraordinary to watch. As a clinician, this is my key question: What is your plan now, for access this year, to prevent another trolley all-time high when we get the next capacity surge?
This is where it gets tough. This is where we have to ask the hard questions. I have written before on the concerns that a poorly-funded Sláintecare could actually worsen health inequality and lead to a widening of the two-tier system where the public health system becomes akin to the Veterans Health Administration in the US and our private sector thrives. If there was a general expectation that Sláintecare will be funded to the level needed for successful implementation, we should expect that most people would not consider their private health insurance necessary because access and quality in the public system would be excellent. The increasing investment of shrewd businessman Larry Goodman in private hospitals is a loud gong that alerts me that we are not the only ones who think that there is a boom expected in private healthcare in Ireland. That worries me greatly. We need to get this right.
All of us need a thriving public health system. Public hospitals are where complex and the vast majority of emergency care takes place. General practice is the bedrock of enduring doctor-patient relationships. It’s worrying that at the exact time we have the lowest consultant numbers in the EU and the longest waiting lists, we also see general practice in crisis, with many practices closed to new patients, and this includes the entire county of Monaghan, many villages where GPs are retiring and not being replaced, with 700 GPs due to retire in the next five years. Any policy that is forced on staff without shared vision and collaboration is doomed to fail.
I cannot speak for GPs, but consultants are sidelined and scapegoated, held responsible for system failures but excluded from shaping policy. For 18 months we have tried repeatedly to meet with the team leading Sláintecare. We are still waiting. Eminent GP Dr William Behan has outlined serious issues with Sláintecare costings: GP workload underestimated by 40 per cent. If we have learned anything this past five years, it’s that the public tolerate poorly inaccurate estimates of costs when it comes to the public purse. There is an opportunity cost to getting this wrong and money wasted in health is money not spent tackling housing, transport, education and the challenge of our time: Climate change.
There is a saying in Safety II: “Work as imagined versus work as done.” Without being condescending, politicians engage in “work as imagined”, but clinicians and patients experience “work as done”.
My hope for the next Government is that GPs and consultants will have a Minister for Health who negotiates new contracts instead of announcing them on TV or social media. It is Government’s role to set policy but it is our role as clinicians and patient advocates to guide them to successful implementation so that it works for patients. A system that works for patients is a system that works for doctors. By definition, it is one where doctors and all health professionals flourish, are treated with respect and are given the tools to innovate, lead and provide timely, excellent care for patients.
I dearly hope that in five years we will be on the Wharton MBA as a model for how fast healthcare access can improve and that the biggest issue for the HSE will be coping with capacity surges related due to healthcare tourism because our access, standard of care and patient experience are so excellent. That sounds like a fantasy. But I believe it is achievable.
I hope you all vote. I also hope that as canvassers call to our doors, we all send a clear message that the mandate for Government is to fix homelessness and address capacity in the public health system so that everyone has timely access to care. We are our values.