Labour’s manifesto covers health in a section labeled ‘Standing Up for Families & Communities’ which gives a clear idea of the context. The health section is called ‘A New National Community Health Service’. The idea is to have a single tier system with free access to care from GP to hospital. There will be a Minister with specific responsibility for this work. Like Renua, they suggest setting up a National Health Forum to ‘ develop a shared approach and understanding on the future challenges’ for our health services, which seems a good idea.
They plan to recruit 5,500 more staff, and lower the current charges for prescriptions, both the GMS and on the drug prescribing scheme. Free GP care will come in over five years, along with community based chronic disease programs, to be delivered by GP’s, nurses, and others. No mention is made of the governance of these programs. This would require 1,428 more GP’s. I’ve no idea where this eerily specific number comes from, but this is in addition to the 5,500 other staff they plan to recruit.
They will improve access to dental health services, and bring in the National Maternity Strategy. Both of these seem very good ideas. For mental health, they want to focus on early intervention, especially for young people. They will provide access to counseling services, and better treatment for those with so-called ‘dual diagnosis’ – drug or alcohol addiction, and a serious mental illness, a much neglected group of patients.
For hospitals, they plan 1500 extra beds, to improve access, and reduce A/E wait times and waiting lists. They will also move to activity based funding – Money Follows the Patient, and and a new, much tougher system of financial and managerial accountability.
They support a sugar tax, and tighter controls on food marketing, with much better food labeling. They will bring in mother and baby clinics, to do what is left unspecified, and increase support for physical activity in children.
Almost no details of costs are given, apart from a total of €2.975 billion. This isn’t broken down in any way, but may well be in roughly the right ballpark. There is no real discussion of health management, or ways of improving health care delivery.
These polices are well focused. I am fairly sure that only a very large increase in activity and resources in general practice, primary care and community care, can untie the knots in our health services. However, there is a lack of serious thought about what these services might look like, how much they might cost, and who would provide the necessary clinical governance for them. My own view, for what it is worth, is that this can only be done by GP’s, but in any event, someone has to do it. I doubt we can afford a large increase in both hospital resources and general practice resources. They do not consider widening the roles of practice nurses either, but there is compelling evidence that, working with GP’s, these professionals can provide expanded good quality care for many people with long-term chronic disease.