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Back to the future of healthcare for Oireachtas

10 Aug 2016

Dara Gantly looks at the important work ahead for the new Oireachtas Special Committee on the Future of Healthcare

To be honest, I didn’t fully understand all the kerfuffle surrounding Back to the Future Day last October 21, 2015 — the day in the 1989 Back to the Future sequel when Marty McFly travelled to a future filled with hover skateboards, holographic cinemas, flying cars and self-tying runner boots. Even the official Health Canada website got in on the act, publishing a recall notice on a DMC-12 car with a “defect in the flux capacitor [that] could lead to inability to travel through time”.

Perhaps the celebration was partly because we had all got here! Remember, the Berlin Wall was still standing when this Hollywood blockbuster was first released.

Certainly the summer release of the interim report of the Special Committee on the Future of Healthcare last week (August 4) was no blockbuster, running as it does to just 13 pages — the first five of which are taken up by a title page, contents page, committee listing and Chairperson’s foreword, with the concluding two pages a terms of reference appendix. So little flesh on the bone. However, what immediately struck me was the fact that not only are just four of the 14 members Fine Gael TDs, but the vast majority are not members of the current minority Government, and six of the 14 are women. And the Committee Chair is one Róisín Shortall TD. I’m tempted to put the full members in my own appendix at the end of this piece — not, I assure you, to pad out my work.

“We have before us a unique opportunity for cross-party consensus in developing a coherent and meaningful healthcare strategy, which can be implemented over the next 10 years,” commented Deputy Shortall last week. “As a Committee we look forward to continuing our work, engaging with the relevant stakeholders and grasping this opportunity. We also look forward to debating this Interim Report in the Dáil chamber at the earliest possible opportunity.”

Most readers will recall the events surrounding Deputy Shortall’s resignation as junior minister for health in September 2012, over the “lack of support for the reforms in the programme for government and the values which underpin it”. At the time, she said the public had a right to expect decisions on health infrastructure and staffing would be made in the public interest based on health need and not driven by other concerns.

These ‘other concerns’ ultimately culminated in the decision by the then Minister for Health Dr James Reilly to add 15 locations, including two in his own constituency, to a list of 20 sites for proposed primary care centres, without, in Deputy Shortall’s opinion, adequately explaining the rationale behind the move. To be fair to Senator Reilly, he detailed in the Dáil the three-part criteria for prioritising the locations (a “logistical logarithmic progression”) and insisted that the widening process was “transparent” and a “good move” for the health system. But his Minister of State for Primary Care was gone, and it was a bitter blow.

Of course, we also found out last week that only one out of 36 promised primary care centres promised by the last government four years ago has actually opened its doors — in Kells, Co Meath — with the other 35 PCCs at various stages of construction, design or with no progress whatsoever. And what about those two in North Dublin? Construction of the Balbriggan PCC is under way and it is expected to be completed early next year, while it is reported that the site selected in Swords has been sold and a new advertisement is thus required for the project.

Deputy Shortall’s appointment to serve as Chair (the 14 members voted to elect her) must be some vindication, in her eyes, of the stand she took. As well as leaving Government in 2012, she also resigned the Parliamentary Labour Party whip and started down the path of the ultimate formation of the Social Democrats. This certainly was one of the first major blows for the FG/Labour coalition, and perhaps set the tone, or ‘mood music’ to use the journalistic parlance, for everything that was to come.

But back to the Future of Healthcare: what’s in this new interim report? Not a lot, except for an outline of the Committee’s proposed goals, work schedule and approach — much of which is already detailed in its terms of reference.

Roisin Shortall

We did learn that the Committee has held a number of briefing sessions with relevant stakeholders, including health policy experts from Trinity College, representatives of the HSE and Department of Health, researchers from the ESRI, and Dr Eddie Molloy, management consultant. It held its first public session on July 20 (with the Health Reform Alliance), and further public sessions are to be held on a weekly basis from September until November.

We again already knew that the Committee is required to present a final report to the Dáil by January 23, 2017, whereupon the Committee shall stand dissolved — a “very short time frame” that has already been flagged by members. So in order to ensure that its work is tightly focused, the Committee has identified key issues and work streams that it believes are necessary to address. And based on the work streams a list of potential witnesses is being developed. So you might get that call.

The work streams include: future vision and strategic challenges; funding model; primary care; integrated care; chronic disease management; access to care; quality and safety; resource allocation; organisational reform; workforce planning; stakeholder consultation; and finally implementation and monitoring. Phew, that’s some list!

Is all this really doable? To recap, the objective of the Committee is to achieve cross-party consensus on a 10-year vision for the health service with an emphasis on quality of patient care, supported by strong managerial and organisational accountability. But it also wants to draw up an implementation plan, setting out achievable targets with appropriate milestones and resources needed for implementation; establish what healthcare entitlements should be covered under an agreed definition of ‘universal’ healthcare; outline the steps required over time to implement universal healthcare, including an appropriate funding model; develop a model of integrated healthcare with an emphasis on primary and community care; and analyse future healthcare needs and assess the resource implications of demographic trends and health deprivation data.

In other walks of life this could be construed as workplace bullying — i.e. giving you impossible jobs that can’t be done in the given time or with the resources provided. Alternatively, it could mean that the Committee may just have time to gather enough evidence from previous reports on the health service (there’s certainly no shortage!) and repackage them as our new 10-year strategy — which, this time, has cross-party support.

Yet who has been in power for the most of the past decade and a half shaping health policy and the multitude of health reform plans? Fine Gael, Labour, Fianna Fáil and the PDs. It will thus be interesting to see how the more left-leaning members of the Committee will shape the final report — or whether we will see a few minority reports emerge next January.

Whatever happens, you have the opportunity to shape this ‘Future Healthcare by sending in a submission giving your views on a long-term health care strategy for Ireland. Just email by August 26. There are piles of health service reform roadmaps just gathering dust in Hawkins House, which could easily be used by Committee members to shape this new 10-year strategy. And with the time frame they have been given, they may have no other option than to dust them off — which is not necessarily a bad thing.

As for Marty McFly and Doc Brown, they didn’t need roadmaps where they were going!

Dara Gantly

Click here to view the full article which appeared in Irish Medical Times: Opinion